Your PKV Premium Just Went Up: What You Can Actually Do

Why your premium went up

A premium increase in PKV is not arbitrary, and it has nothing to do with your individual claims. The mechanic is set in law and predictable.

Every PKV tariff is priced on assumptions about how often the cohort sees doctors, how much each treatment costs, and how long people live. When the real-world experience drifts too far from those assumptions, § 203 VVG lets the insurer recalculate.

The thresholds are codified in § 155 Abs. 3 VAG: actual claim costs across the cohort have to come in more than 10 % above plan, or mortality has to be more than 5 % off, before the insurer is allowed to adjust at all. Some insurers contractually set tighter thresholds (5 %/3 %).

Even when a threshold is crossed, the recalculation is not unilateral. An independent Treuhänder (an external actuarial trustee, similar in role to an auditor) reviews the maths under § 203 Abs. 2 VVG and has to approve before any adjustment takes effect. The Treuhänder checks the numbers, not the wider question of whether the increase feels fair.

The result is a single percentage applied to every contract in the affected tariff cohort. Your individual claim history is not part of the calculation. Filing a claim does not raise your own premium; the trigger is collective, never personal.

Several drivers have stacked up in recent years:

Treatment costs have grown faster than originally assumed. This is the biggest single factor.

People are living longer, so the payout periods PKV is funding extend.

Interest rates dropped in the years after 2010, which means insurers' reserves earn less, and the part of every premium that flows into those reserves has to grow.

Older tariff cohorts have built up substantial Altersrückstellungen, which get revisited as the cohort ages.

Two routes, equal weight

The notice opens two routes you can choose between. Neither is a default best answer. The deciding factor is how disciplined your current insurer has been on long-term premium adjustments, weighed against what fresh underwriting at a different insurer would deliver given your current age and health.

Most insureds end up with one of these two routes. A small set of cases sits at break-even where either works; in that situation the call usually goes to whichever delivers the simpler long-term contract.

Option 1: Tarifwechsel within your insurer (§ 204 VVG)

§ 204 VVG gives every PKV-insured the statutory right to switch to a different tariff within the same insurer. The mechanic is precise.

Equivalent or lesser benefits → no new health check. If the new tariff has the same or fewer benefits than your current one, the insurer cannot require fresh underwriting. Existing risk surcharges (Risikozuschläge) from the original health check carry forward proportionally to whatever scope they were originally placed on.

Better benefits → health check only on the additional scope. If the new tariff includes benefits your current one does not (a richer dental tier, for example, or higher reimbursement on alternative medicine), the insurer can underwrite the difference. They cannot re-underwrite what you already had.

Altersrückstellungen carry over in full. Your accumulated ageing reserves stay attached to the contract. This is the structural advantage of an in-house Tarifwechsel that the external route cannot match.

Insurers must provide an overview of available alternative tariffs on request. In practice, the in-house options the insurer surfaces in the letter are not always the strongest in the catalogue. A structured Tarifoptimierungs-Beratung (Tarifwechsel review) compares the full available tariff set and identifies the ones that genuinely improve the price-benefit ratio for your specific entry age and health profile, including older tariffs that the insurer is not pushing but is required to make available.

Beyond the tariff itself, two structural levers can make a measurable difference without a switch. An adjusted Selbstbeteiligung (deductible) lowers the monthly premium directly and works for clients with stable claims experience. A Beitragsentlastungstarif (premium-relief rider) builds in a fixed-euro reduction for retirement and is independent of tariff choice. Restructuring optional riders (for example, switching a separate Krankentagegeld from a high-benefit/low-waiting-period setup to one matched to your actual income-protection need) can free up real money without changing the core cover.

This route fits when the current insurer has a solid long-term track record on premium stability, the existing tariff line has internal alternatives worth moving to, and the value of preserved Altersrückstellungen plus locked-in entry-age pricing outweighs what a fresh underwriting elsewhere would deliver.

Option 2: Anbieterwechsel (changing PKV insurer)

The second route is moving to a different PKV insurer entirely. The cancellation runs through the § 205 VVG Sonderkündigungsrecht (the 2-month right of cancellation that the premium notice itself opens), and the § 146 VAG Übertragungswert carries the Basistarif-equivalent portion of your accumulated reserves to the new insurer.

How the reserve transfer works. Under § 12 Abs. 1 Nr. 5 VAG and § 146 VAG, the Übertragungswert is calculated by the outgoing insurer and confirmed in writing. It corresponds to the share of your Altersrückstellungen that the Basistarif scope of cover would have funded. Anything you have built up beyond that scope stays with the old insurer.

This is a normal feature of how inter-insurer mobility is handled in the PKV system, not a penalty. The trade-off is direct: you give up a portion of accumulated reserves for the prospect of long-term premium stability at a different insurer. When the current insurer's record on premium discipline has been weak across multiple adjustment cycles, that trade-off can be substantially in your favour over a 20- or 30-year horizon.

The new insurer will underwrite you fresh. This is the gating factor on whether the route is open to you at all. A profile that was unproblematic at age 30 may now face surcharges or exclusions at 50, depending on what has happened to your medical history in between. An anonymous Risikovoranfrage (a market-wide risk pre-check) is the standard way to clarify what acceptance, surcharge, and exclusion responses you would actually receive without putting your name on file at any insurer.

This route fits when the current insurer's premium adjustments have been frequent or sharp across multiple years and the comparison with more disciplined insurers shows a meaningfully better long-term trajectory, your health profile still permits clean acceptance at a different insurer (or acceptance with manageable surcharges), and the long-term math favours stability over preserved reserves on a multi-decade horizon.

The 2-month deadline (§ 205 VVG Sonderkündigungsrecht)

The premium notice opens a 2-month window under § 205 Abs. 4 VVG during which you can cancel the contract, even when an ordinary contract term would otherwise apply. This is the timing constraint for the Anbieterwechsel route. Two technical points matter.

The window starts on the date you receive the premium adjustment notice, not on the effective date of the increase. Mark the date the letter arrives; the deadline is calculated from there.

The cancellation only takes effect with proof of a seamless follow-on health insurance contract in place. § 193 Abs. 3 VVG enforces continuous health insurance cover for every German resident; § 205 VVG implements this on the cancellation side. In practice the new contract has to be signed and confirmed before the cancellation date, with cover starting no later than the day after the old cover ends. Without that proof the cancellation is simply ineffective; your existing contract and premium obligation continue. The system is self-protecting against accidental cover gaps.

One technicality often missed. A Krankentagegeld-only premium increase does not trigger Sonderkündigung of the Vollversicherung. They sit in separate AVB (insurance terms). A Zahnzusatz (supplementary dental) increase at the same insurer typically does, because the shared general conditions apply across both contracts. Read the letter for which contract the adjustment refers to before assuming the right of cancellation applies.

If the chosen route is Tarifwechsel within the same insurer, no Sonderkündigung is needed and the deadline does not constrain you.

What you should not do

Do not cancel without a follow-on contract in hand. A cancellation without proof of seamless cover is simply ineffective for the Vollversicherung. You stay in your existing contract, and if you stop paying, you trigger the Mahnkaskade (statutory dunning cascade) under § 193 Abs. 6 VVG: written reminders, a 1-month deadline, and ultimately demotion to the Notlagentarif (emergency-only tariff under § 153 VAG). Notlagentarif covers only acute care, pain treatment, pregnancy, and child preventive care. Avoid this path; it is the worst possible outcome of any premium-increase reaction.

Do not take comparison-portal "switch saves €200 a month" claims at face value. Online aggregators routinely benchmark headline premiums without surfacing what is actually being compared: the long-term premium-stability track record of the new insurer, the transferred reserves, the underwriting result you would actually receive, and benefit differences that look small in a feature list but matter in real medical situations. A genuine comparison runs the math at that level of detail, with the new insurer's adjustment history specifically in view.

Do not do nothing. If the contract is left to drift, the next adjustment cycle compounds on top of the current one. Both routes (Tarifwechsel and Anbieterwechsel) are designed to be used, and the contract structurally rewards the people who actively manage it.

What an independent broker actually does in this conversation

The § 6 Abs. 1 Nr. 2 Versicherungsvermittlerverordnung (VermV) requires a Versicherungsmakler to advise on existing contracts, not just place new ones. When a client brings a premium adjustment notice in for review, the structured workflow:

Verify the legal basis of the adjustment. Was the auslösender Faktor (triggering threshold under § 155 Abs. 3 VAG) actually met? Was the Treuhänder approval documented? An adjustment is not contestable on the basis that it is high; it is contestable when the procedural requirements were not met.

Run a premium-stability analysis on the current insurer. How frequent and how large have the adjustments been across the relevant tariff lines over the past 10 to 20 years? How does that compare with the more disciplined insurers in the market for a profile like yours? This is the comparison that decides which of the two routes fits.

Run a § 204 VVG Tarifwechsel review against the insurer's full catalogue, not just the in-house options the letter surfaces. Identify the tariffs that match or improve current scope at lower cost, plus structural levers (Selbstbeteiligung, Beitragsentlastungstarif, optional riders).

If Anbieterwechsel is the answer, run a Risikovoranfrage before any application. The anonymous market check returns acceptance, surcharge, and exclusion responses without putting your name on file. This avoids a permanent Ablehnung-Vermerk if the new market does not take you cleanly.

Time the Sonderkündigungs-window if Anbieterwechsel is the call. The 2-month deadline is non-negotiable; the new contract has to be signed and confirmed before the cancellation date.

For TheGoodBroker clients, this is the work: take a premium adjustment notice, run the full premium-stability analysis plus § 204 review, lay both routes out with the underlying numbers transparent, and act on whichever one improves your math. Book a consultation for a structured review of your specific letter.

What to do when the letter arrives

A practical sequence the day a premium adjustment notice lands.

Read the letter carefully. Note the new gross monthly premium, the effective date, and the Sonderkündigungsrecht deadline (typically 2 months from receipt). Mark the deadline in your calendar with a one-week buffer for paperwork.

Request the insurer's § 204 VVG Tarifwechsel options. Insurers must provide a list of available alternative tariffs and the relevant comparisons on request. This is the document that tells you what is even available before deciding anything.

Get an independent premium-stability analysis. A Versicherungsmakler compares the current insurer's premium-discipline track record against the rest of the market for your profile, and compares the in-house Tarifwechsel options against what would actually fit you across both routes.

Decide on a route, jointly. If Tarifwechsel within the insurer wins on the numbers, no Sonderkündigung is needed. If Anbieterwechsel wins, the new contract has to be in place before the cancellation date.

Document the Übertragungswert (in case of Anbieterwechsel). The transfer value is calculated by the outgoing insurer and confirmed in writing. Keep that document; it is the formal record of what reserves have transferred and what stayed with the old insurer.

The single biggest mistake on a premium increase is treating the letter as a verdict on PKV. It is not. It is the standard mechanic of a regulated long-term contract, and you have two regulated levers to respond with. Pulling the right one depends on a comparison that the insurer is not required to run for you.

If you would like the worked numbers for your specific situation, book a consultation; we will run the premium-stability analysis, the § 204 VVG review, and a Risikovoranfrage if Anbieterwechsel is on the table, then make sure the timing works on whichever route you choose.