Private health insurance

Private health insurance

Private health insurance usually covers additional benefits and procedures that are not or not entirely covered by the public health insurance. Waiting times are shorter but the entry barriers and the prices can be high. Moreover, the law clearly dictates who gets in and who does not.

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Private health insurance

What is it?

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?

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.

Who is it for?

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.

Private health insurance

Did you know?

39,01€ billion

Total PKV premiums paid in 2017 [2]

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