What is private health insurance?

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9 mil­li­on

Num­ber of full coverage insu­rees [1]

The origins of pri­va­te health insuran­ce (PKV) can be traced back to the soci­al secu­ri­ty laws of Otto von Bis­marck at the end of the 19th cen­tu­ry. By pro­vi­ding health insuran­ce only for employ­ed citi­zen, the­re were many peop­le who did not have access to public health care: civil ser­vants, self-employ­ed, free­lan­cers, craft­s­men, etc.

First “mutu­al insuran­ce com­pa­nies” moved into this gap and over time, the sup­ply (and demand) of pri­va­te health insuran­ce and pri­va­te medi­cal care grew.

PKV is dis­tin­guis­hed bet­ween full coverage insuran­ce and sup­ple­men­ta­ry coverage insuran­ce. That means that you can sub­sti­tu­te the PVK for the public health insuran­ce (GKV) or sup­ple­ment your GKV.

Who is actual­ly allo­wed to sub­sti­tu­te the PKV for GKV is, ana­lo­gous­ly to the GKV, regu­la­ted very stric­t­ly.

Mean­while, the PKV is an estab­lished indus­try and in addi­ti­on to near­ly 9 mil­li­on peop­le having full coverage, the­re are about 25 mil­li­on pri­va­te sup­ple­men­ta­ry insuran­ces in Ger­ma­ny, pro­vi­ded by near­ly 50 orga­ni­sa­ti­ons [1].

What are the benefits of private health insurance?

Each pri­va­te insu­rer must offer a basic plan, which is com­pa­ra­ble in its bene­fits to tho­se of the GKV. In addi­ti­on, the­re are basic bene­fits that must be cove­r­ed and are pre­scri­bed by law.

Apart from that, the­re is the so-cal­led “plan free­dom”. This means that pri­va­te insu­rers have a free choice in what they offer, what pro­ce­du­res they cover and which they do not cover.

The exact com­po­si­ti­on of bene­fits one recei­ves depends on the cho­sen plan. The­re­fo­re, it is extre­me­ly important to read the fine print and know what to look for.

Unli­ke the GKV, the PKV makes use of the “reim­bur­se­ment princip­le”. That means that you must first pay for the pro­ce­du­res yours­elf, sub­mit the bill to your pri­va­te health insuran­ce com­pa­ny and then get reim­bur­sed accord­ing to your plan.

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39,01€ bil­li­on

Total PKV pre­mi­ums paid in 2017 [2]

Who should have private health insurance?

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5%

Average annu­al pri­ce increa­se of a PKV plan [3]

This ques­ti­on but must always be ans­we­red indi­vi­dual­ly and by con­si­de­ring a mul­ti­tu­de of aspec­ts.

First, you must actual­ly be eli­gi­ble for pri­va­te full coverage. Sim­pli­fied speaking, the­se groups are eli­gi­ble: civil ser­vants, jud­ges, etc .; self-employ­ed and free­lan­cers as well as employees ear­ning more than 60,000 € per year befo­re taxes.

Unli­ke the GKV, inco­me does not play a role in the cal­cu­la­ti­on of your pre­mi­um. More or less only your health sta­tus, the cho­sen bene­fits and your age are important. The sicker and older, the more expen­si­ve.

A switch back to the GKV is also regu­la­ted by law and is some­what dif­fi­cult by design. That was done to pre­vent young and healt­hy peop­le from initi­al­ly going into the PKV and swit­ching back once they are old and/or sick.

To put it in very simp­le terms, a PKV means access to very good medi­cal care, short wai­ting times and a more indi­vi­du­al com­pi­la­ti­on of the cove­r­ed pro­ce­du­res.

On the other hand, a PKV can be expen­si­ve, you liter­al­ly only get what you pay for and the pre­mi­ums increa­se with age, no mat­ter your inco­me.

Questions? We have answers.

Under­stan­ding the pri­va­te health insuran­ce mar­ket and what is best for you.

We will get back to you wit­hin 24 hours — wit­hout any com­mit­ment from you and in your pre­fer­red way.