Private Health Insurance
Private Health Insurance System (Private Krankenversicherung - PKV)
Instead of opting for statutory health insurance, you can choose private health insurance (PKV) under certain circumstances. If you are employed and want to take out private insurance, you must inform your employer so that they do not automatically enroll you in a statutory health insurance scheme.
You can generally opt for private health insurance if any of the following apply:
- You earn more than the applicable annual income threshold
- You are self-employed or run your own business
- You are a civil servant
What Does Private Health Insurance Cover?
Private health insurance generally offers comprehensive coverage and access to a wide range of healthcare services, depending on your chosen plan. This can include:
- Doctor visits and specialist appointments
- Health check-ups
- Hospital treatments
- Dental care
- Prescriptions and medications
You can usually customize your insurance plan by choosing additional benefits and coverage options.
Contribution Calculation
Unlike statutory health insurance, PKV contributions are generally not directly based on your income. The cost of your policy depends on factors such as:
- Your age
- Your health and pre-existing conditions
- Your chosen insurance plan
- Your occupation
- Your deductible
- The level of coverage and benefits
Some insurers may require a medical questionnaire or health assessment before accepting your application.
Optional Additional Benefits
Depending on your insurance plan, you may be able to add benefits such as:
- Additional dental treatments
- Professional teeth cleaning
- Private or semi-private hospital rooms
- Treatment by specialists
- Sick pay
- Child sick pay
- Direct access to specialists
- Alternative medicine
- Reduced deductible
- Other premium coverage options
Deductible (Voluntary Self-Contribution)
You can choose a deductible (Selbstbehalt), meaning the amount of eligible medical expenses you pay yourself before the insurance begins to reimburse costs.
A higher deductible generally means lower monthly premiums, while a lower deductible usually means higher premiums.
Family Insurance
One of the major differences between PKV and statutory health insurance (GKV) is family coverage:
- GKV can cover eligible family members without separate contributions under family insurance.
- PKV generally requires a separate policy and premium for each family member.
This is an important factor to consider when comparing PKV and GKV, especially for families.
Changing Your Provider
Changing private health insurance providers can be more complicated than changing statutory health insurance providers.
Before switching:
- Check the notice period in your current insurance contract.
- Check whether your new insurer requires a health assessment.
- Compare the benefits and exclusions of the new policy.
- Consider whether switching could affect your accumulated ageing reserves (Alterungsrückstellungen).
Do not cancel your existing policy until you have confirmed that your new health insurance coverage is in place.
Tax Benefits
Contributions to private health insurance may be partially tax-deductible as part of your annual income tax return.
The exact amount that can be deducted depends on the type of coverage and applicable tax rules.
Sick Pay
If you are employed and become ill:
- Your employer generally continues paying your salary for up to 6 weeks, subject to the statutory requirements.
- After this period, income replacement may be available through your private insurance if your policy includes Krankentagegeld (daily sickness allowance).
The amount and starting date of sickness payments depend on the policy you choose.
Maternity Pay
If you are employed and privately insured, you may be entitled to maternity benefits during the statutory maternity protection period.
The exact payment arrangements depend on your employment status, health insurance situation, and applicable statutory rules.
Long-Term Care Insurance
Anyone with private health insurance must also have private long-term care insurance (private Pflegepflichtversicherung).
It can provide benefits for:
- Assistance with daily activities
- Nursing care
- Home care
- Care services depending on the recognised level of care
Long-term care insurance is separate from your private health insurance premium and is subject to its own contribution rules.
Risks Compared to Statutory Health Insurance (GKV)
Difficulty Returning to GKV
Returning from PKV to GKV is only possible under certain circumstances.
For example, an employee may become subject to statutory insurance again if their circumstances change and they are no longer eligible for private insurance.
Self-employed people generally face additional restrictions when trying to return to GKV.
Age Limit
After the age of 55, returning to statutory health insurance can become particularly difficult if certain conditions are met.
Financial Risks
PKV premiums are generally not directly linked to your income and can increase over time due to factors such as healthcare costs and tariff adjustments.
By contrast, GKV contributions are primarily based on income, subject to contribution ceilings and other statutory rules.
Family Costs
Unlike GKV family insurance, PKV generally requires separate premiums for spouses and children who are privately insured.
No Guarantee of Return
Choosing PKV is an important long-term decision. A later change in employment, income, family circumstances, or age does not necessarily mean that you will be able to return to GKV.
Carefully compare the long-term costs, family situation, coverage, and conditions for returning to GKV before choosing private health insurance.
We have listed the most common private health insurance providers — just click on the link and go directly to the provider!