PKV Health Check for Expats: How the Gesundheitsprüfung Works

What is the PKV Gesundheitsprüfung?

The Gesundheitsprüfung (health check) is the step where a private health insurer reviews your medical history before deciding whether to insure you, and on what terms. It is a written questionnaire, the Gesundheitsfragebogen, completed as part of the application. There is no physical examination, no blood test, and no doctor's appointment arranged by the insurer.

This is the structural difference from GKV. The statutory system takes every eligible member regardless of health, because contributions are set by income, not risk. PKV is priced on age and health, so it has to ask. Your answers become a legally binding part of the contract.

It helps to see the health check for what it is. It is not a test you pass or fail. It is a pricing exercise: the insurer is working out what your cover should cost, and in the large majority of cases the answer is a workable one.

What does the health questionnaire ask?

Every insurer writes its own form, and they differ more than people expect: in how many questions there are, in the wording, and in how far back each one reaches. What follows is the shape most forms share, not a standard set. Only the questions your insurer actually asks in writing create a duty to disclose,[1] so the form in front of you is the one that counts. Typical lookback periods:

• Illnesses, chronic conditions, and complaints, including ones that have since healed: usually the last 3 years.
• Outpatient treatments, operations, and check-ups: usually 3 years, with some insurers extending to 5.
• Inpatient hospital stays, surgery, and rehabilitation: usually the last 5 years.
• Psychological and psychotherapeutic treatment, including counselling: 5 years as standard, but 10 years at many insurers.
• Questions with no time limit at all, typically a cancer diagnosis, an HIV infection or a history of dependency. Not every insurer asks these without a limit, and some ask other categories open-endedly instead. Check the form rather than assuming.
• Current data: height, weight, eyesight, and any recognised disability.

Three rules are worth knowing. Conditions that have fully healed still count if they fall inside the lookback window. Something you left out can be added in writing at any time while the contract has not yet been concluded, and if the insurer asks further questions before it accepts, those have to be answered too.[1] There is no three-day window and no cut-off before acceptance, so send a correction as soon as you notice, however late it feels. And the insurer may not make cover conditional on a genetic test.

The most practical starting point is your GP's file. You have the right to request it free of charge,[2] and doing so before you apply removes most of the guesswork. It is a starting point rather than the measure: what you have to declare is what you know and were asked about,[1] wherever it is written down. Specialist visits your GP never saw, hospital records and treatment abroad count the same way.

What can the insurer decide?

An insurer can respond to your application in one of four ways. The most common, when your history is straightforward, is acceptance at the normal premium, with no addition and no exclusion.

If you have a condition that carries a calculable extra risk, such as well-controlled high blood pressure or an allergy, the insurer may apply a Risikozuschlag (risk surcharge), typically 10 to 50 % on top of the premium for that tariff. As an alternative, it may offer a Leistungsausschluss (benefit exclusion): one named condition or body part is left out of cover, and everything else is insured normally. A treated knee, for example, might be excluded while the rest of the policy is unaffected.

The fourth outcome is rejection, which insurers reserve for a narrow set of severe or high-cost cases. Insurers can also combine a surcharge with an exclusion, and you are always free to decline or negotiate any offer they make.

How are pre-existing conditions handled?

The reassuring reality is that most pre-existing conditions are manageable. A surcharge or a targeted exclusion is the normal result for routine medical history, and the insurer still provides full cover for everything else.

Take a realistic example. Someone with treated hay fever and a knee arthroscopy four years ago will, at most insurers, see either a modest surcharge or an exclusion limited to the knee. The hay fever alone is often priced in at no extra cost. This is ordinary underwriting, not a barrier.

There is one area that genuinely behaves differently. Recent psychotherapy, particularly when combined with medication such as antidepressants, is the most common reason an application is declined rather than surcharged. It is worth knowing this early, because it shapes the timing and the choice of insurer rather than ruling PKV out. Most other diagnoses are negotiable.

Even in a difficult case there is usually still a route. The Basistarif[3] must accept applicants from a defined group, with no surcharge and no exclusion, and its premium is capped at the GKV maximum contribution. The group is set by law: people already privately insured or free to leave the public system, and residents who are not compulsorily insured in it.[3] Someone who is compulsorily insured in the public system is not in it. And an insurer may still refuse where it previously withdrew from or challenged a contract of yours over a deliberate non-disclosure.[3] It is a strong backstop, not an unconditional one.

What is the Risikovoranfrage, and why does it matter?

The Risikovoranfrage (anonymous risk inquiry) is the single most useful step in the whole process, and the one most people skip.

Before any formal application, a broker sends an anonymous inquiry to the underwriting teams of several insurers at once, usually three to five. It contains your year of birth (not your full date of birth), your profession, your tariff preference, and your full diagnoses for the last 5 to 10 years. It does not contain your name, your date of birth, or your address.

Each insurer replies with the offer it would make: normal acceptance, acceptance with a surcharge of X, acceptance with an exclusion of Y, or a rejection. The reply is not legally binding, and the formal application is assessed again, but in practice the answers are consistent.

Because the inquiry is anonymous, a negative answer has no consequences whatsoever. Nothing is recorded, no rejection sits on a file, and you are free to apply to whichever insurer gave the best terms. A common worry among expats is that a refused application follows you around. It does not: PKV is not part of the cross-insurer HIS database, and HIS does not store medical data in any case. The anonymous pre-check exists precisely so you can test the market before a single document carries your name.

What happens if you get the disclosure wrong?

German insurance law treats the disclosure duty, the vorvertragliche Anzeigepflicht, seriously. You have to answer the questions truthfully and completely, measured against what an average applicant without medical training would understand.

If you leave something out, the consequences scale with fault.[1] Simple negligence gives the insurer only a limited cancellation right. Gross negligence allows it to withdraw from the contract, or to adjust the terms retroactively if it would still have insured you on different conditions. Deliberate concealment allows withdrawal outright, and a deliberate deception lets the insurer void the contract from the start.[4] The insurer's rights generally lapse 5 years after the contract begins, extended to 10 years in deliberate cases.

One protection is worth knowing about because it is rarely mentioned. Even where the insurer withdraws from the contract, it still has to pay for a claim if the undisclosed fact had nothing to do with it, neither with the claim arising nor with the size of the payment.[5] A forgotten knee operation does not cost you cover for an unrelated illness. The exception is deliberate deception, where that protection falls away.

This is not a reason to be nervous. It is a reason to be thorough, and thoroughness is easy to arrange: request your GP file, run the anonymous pre-check, and disclose everything in the questionnaire. The one move that genuinely creates risk is leaving a diagnosis out in the hope it slips through. It is also unnecessary, because a surcharge or an exclusion is almost always a better outcome than a contract that can be unwound years later.

How should you approach the health check?

A four-step sequence removes almost all of the uncertainty: request your medical file from your GP[2] (free, gives the recorded history that defines what to declare), have a broker run an anonymous Risikovoranfrage across several insurers, compare the resulting offers, then file the formal application only with the best-fit insurer. Each step in detail:

1. Request your medical file from your GP.[2] It is free, and the recorded history of the last 5 to 10 years is the best starting point. Add anything it does not contain: specialist treatment, hospital stays, and records from abroad.
2. Have a broker run an anonymous Risikovoranfrage across several insurers, so you see the real offers before anything carries your name.
3. Compare the results. An experienced broker knows which insurers are lenient on which conditions, because the same diagnosis can be priced very differently from one insurer to the next.
4. File the formal application only with the insurer that offered the best terms, and disclose everything in the questionnaire.

Two practical points. Waiting periods, the 3-month general and 8-month special periods,[6] are largely waived when you switch seamlessly from German GKV, because your previous cover is credited in full. And a clean application can move quickly, sometimes within days, once the pre-check has done its work.

If you would like the anonymous pre-check run for your situation, across the insurers most likely to accept your history on good terms, book a consultation. The health check rewards preparation, and the preparation is straightforward once you know the steps.

What do expats specifically need to know?

Two factors matter more for expats than for domestic applicants: medical history from your home country still counts (anything diagnosed within the lookback window is disclosable wherever it was treated, and home-country records should be requested before applying), and foreign diagnoses can be harder for German underwriters to price, which makes the anonymous Risikovoranfrage especially valuable for expat profiles. Detail below:

First, medical history from your home country still counts. If a diagnosis falls inside the lookback window and you knew about it, it is disclosable, wherever it was treated. If your records are held abroad, it is worth requesting them before you apply, the same way you would request a German GP file.

Second, a foreign diagnosis can be harder to predict. A German underwriter reads an unfamiliar treatment history more cautiously than a domestic one, which is exactly why the anonymous Risikovoranfrage is so valuable for expats: it converts an unknown into a concrete set of offers before you commit. Some insurers also expect a minimum period of German residence or documented local income from very recent arrivals, and this varies by insurer, so the choice of where to apply matters.

For an expat, the health check is not the obstacle it can appear to be at first. It is a process with clear steps, a built-in anonymous safety net, and, in the large majority of cases, a workable result at the end.