Private health insurance

Requirements for private health insurance

Who can switch to PKV?

A PKV tariff only replaces statutory health insurance if your insurance status allows this. As an employed person, you usually need a regular annual salary above the compulsory insurance limit. Different access rules apply to self-employed people, civil servants and students.

Private health insurance: costs

What do you pay yourself?

There is no fixed standard price. Age at entry, health assessment, scope of benefits, and deductible levels determine the premium. A low-cost student plan does not guarantee that the subsequent adult plan will also be similarly priced.

In addition to the health insurance contribution, there is compulsory private nursing care insurance and, if applicable, daily sickness benefit. Also plan contributions for family members. You should only deduct a possible contribution refund once the requirements and amount have been determined.

Your employer contributes to the premium.

For employees eligible for subsidies, the employer generally pays a maximum of half of the eligible health insurance contribution, limited by the statutory maximum subsidy. Separate rules apply to compulsory long-term care insurance. You bear the deductible yourself; it is not an insurance contribution.

A high deductible requires a reserve.

You might be healthy one year and face multiple bills the next. Always budget for the full agreed deductible. Check if it applies per year, per person, or for specific services, and whether preventive care is excluded. As an employee, a lower contribution may not save you the full difference, as your employer’s contribution could also decrease.

GKV or PKV: What changes in everyday life?

Both systems can offer suitable protection. A PKV tariff with weak services is not made any better by the word “private”. Conversely, a good tariff can contain services that the statutory health insurance does not cover to the same extent.

You usually receive the bill.

The cost reimbursement principle generally applies in the PKV. You will receive an invoice and submit it to the insurer. It reimburses what has to be paid according to your tariff. Direct billing is also possible for some hospital services; clarify this with the clinic and insurer beforehand.

Health check and application

Organize your documents before switching.

The health questions are not a memory test. Request patient records or billing summaries in advance and verify them against the questions. The exact wording and timeframe matter. Omitting known issues, diagnoses, or treatments could void your policy.

In the case of pre-existing illnesses, a professionally accompanied risk inquiry can be useful before making a formal application. Clarify which data goes to whom and whether the request can be made anonymously. Depending on the findings and tariff, the insurer can request a surcharge or exclusion or reject the application.

1. Clarify insurance status. Have your eligibility, existing contract, and possible start date checked.
2. Compare tariffs with the same needs. Include deductible, compulsory nursing care insurance and daily sickness benefit.
3. Await acceptance and conditions. A calculation result is not yet a binding acceptance of admission.
4. Ensure continuous coverage Only terminate existing protection once the new coverage has been bindingly and completely clarified.

PKV in old age and when contributions increase

The premium must remain affordable on your pension.

Aging provisions are intended to help finance the higher medical costs in old age. They do not guarantee a consistent premium. With typical long‑term adult plans, the premium is not recalculated solely based on your age on each birthday. Under legal conditions, adjustments can result from changes in benefit expenditure in the insured collective.

A lower pension does not automatically make private health insurance (PKV) cheaper. Therefore, budget based on the income you are likely to have later. Also clarify any possible subsidy from the statutory pension insurance and the conditions for additional contribution relief tariffs. Their premiums should already be included in your budget today.

First check a tariff change with your own insurer.

Under Section 204 VVG, you can request a switch to other tariffs from your insurer with equivalent coverage. Acquired rights and age-related reserves are credited. For higher or more comprehensive benefits, the insurer may impose additional conditions. Compare the differences in writing, especially regarding deductibles and reimbursement limits.

Switching to another insurer is different: it may require a new medical assessment, and ageing reserves are not fully transferable at will. A lower figure in the new offer is therefore not enough reason to switch.