PKV Glossary

Rejection / Decline

When a PKV insurer declines your application due to health risks. Being rejected by one company does not prevent you from applying to others.

Initial Commission

A one-time commission paid to the insurance broker or agent when a new policy is signed. Included in your premium — you don't pay it separately.

Unemployment Benefit I

Income-related unemployment benefit for those who have contributed to unemployment insurance. Recipients are generally required to join GKV unless they apply for exemption within 3 months.

Unemployment Benefit II / Citizen's Income

Means-tested basic income support (formerly Hartz IV). PKV members receiving Bürgergeld face a difficult situation: the job center pays only a limited contribution toward private health insurance premiums.

Outpatient Treatment

Medical care without an overnight hospital stay — GP visits, specialist consultations, diagnostics, and minor procedures.

Home Care

Professional nursing care provided in the patient's own home by qualified nursing staff.

Employee

To access PKV as an employee, your gross annual salary must exceed the JAEG (€77,400 in 2026) for at least one full calendar year.

Residence Registration

Registering your address at the local Bürgeramt — one of the first admin steps after arriving in Germany. Proof of health insurance is often required.

Acceptance

The insurer's decision to accept your PKV application. May come with conditions like risk surcharges or benefit exclusions.

A1 Certificate

EU certificate proving a posted worker remains covered by their home country's social security, preventing double contributions.

Medical Inquiry

When your insurer contacts your doctor to verify information on your application or during claims review.

Doctor's Invoice

In PKV, you receive the bill directly from the physician, pay it, then submit it to your insurer for reimbursement.

Medication / Pharmaceuticals

PKV typically reimburses all prescribed medication without co-payments. In GKV, you pay €5–€10 per prescription.

Residence Permit / Visa

Your legal right to live in Germany. Health insurance is usually a prerequisite for obtaining or renewing a residence permit.

International Health Insurance

Coverage for medical costs abroad, typically for short-term trips. Essential because GKV provides very limited coverage outside Europe.

Federal Financial Supervisory Authority

Germany's financial regulator overseeing banks, insurance companies, and financial services firms. Approves PKV tariffs and monitors insurer solvency.

Care Needs Assessment

Formal in-person assessment by the Medizinischer Dienst to determine your Pflegegrad (care level).

Government Healthcare Subsidy (Civil Servants)

Partial government reimbursement of medical costs for civil servants — typically 50% for the employee, 70% for spouses, 80% for children.

Premium / Contribution

The monthly amount you pay for health insurance. In GKV it's income-based; in PKV it's based on health, age at entry, and chosen tariff.

Premium Reduction Tariff

A supplementary tariff you pay into during working years to lower your main PKV premium in retirement.

Premium Waiver

Partial or full premium exemption during certain situations like parental leave.

Contribution Rate

The percentage of gross income for GKV premiums. General rate: 14.6% plus Zusatzbeitrag (avg. 2.9% in 2026), split equally between employer and employee.

Premium Deferral

Temporary arrangement when you cannot pay PKV premiums. Prolonged non-payment triggers the Notlagentarif.

Consultation Documentation

Legally mandated written record of the advice given during an insurance consultation.

Trailing Commission

Recurring commission paid to a broker for as long as your policy remains active.

Portfolio Transfer

Administrative transfer of an existing policy from one broker to another. Does not affect coverage or premiums.

Custodianship Directive

Document nominating a legal guardian if one becomes necessary.

Gender-Differentiated Tariffs

Pre-2012 PKV tariffs with separate premiums for men and women. Closed to new business.

EU Blue Card

Residence permit for highly qualified non-EU workers. Often enables immediate PKV access.

Dental Bonus Booklet

GKV record of annual dental check-ups. 5–10 years of documented visits increase the dental prosthetics subsidy by 20–30%.

Gross Income

Total salary before taxes and deductions. The relevant figure for JAEG and BBG comparisons.

Gross Policy (Commission-Inclusive)

Standard insurance policy with brokerage commission included in the premium.

Citizens' Relief Act (2010)

Law that made the basic health/care insurance portion fully tax-deductible.

Chief Physician Treatment

Treatment by the senior/head doctor during a hospital stay — a hallmark PKV benefit.

Chronic Illness

A long-term medical condition affecting PKV underwriting and GKV co-payment caps.

Brokerage Commission

Compensation a broker receives from the insurer. The client pays nothing extra.

Data Protection (GDPR)

Strict rules on how your medical and personal data is stored, processed, and shared.

Digital Health Applications

Certified health apps that can be prescribed by doctors and covered by insurance.

Direct Billing

When the insurer pays the hospital directly, bypassing the usual reimbursement model.

Double Taxation Agreement

Bilateral tax treaties affecting how insurance contributions are taxed across countries.

Out-of-Pocket Share

Portion of nursing home costs not covered by care insurance. Can be €2,000–€3,000+/month.

Single Room (Hospital)

Private hospital room during inpatient stays — a premium PKV benefit.

Electronic Health Card

Chip card every GKV member receives. PKV members use their Versicherungsschein instead.

Electronic Patient Record

Germany's national digital health record system. PKV participation is voluntary.

Parental Allowance

Government-paid benefit during parental leave — 65–100% of net income, capped.

Parental Leave

PKV premiums continue during parental leave but the employer subsidy stops.

Salary Conversion / Salary Sacrifice

Converting gross salary into benefits (e.g., pension). Can affect JAEG calculations.

Posted Worker / Secondment

Temporary assignment abroad where the worker may remain insured in their home country (up to 24 months).

Reimbursement

The amount your PKV insurer pays back after you submit a medical invoice.

Reimbursement Rate

Percentage of a bill your insurer covers — 100% in premium tariffs, sometimes 80% in budget tariffs.

Initial Disclosure

Legally required information a broker must provide at first contact.

EU Regulation 883/2004

EU regulation coordinating social security systems across member states.

European Health Insurance Card

Card giving GKV members access to necessary healthcare in EU/EEA countries.

Expatriate / Expat

Foreign national living in Germany. Insurance rules depend on visa, employment, and origin country.

Specialist (Doctor)

Doctor with specialized training. PKV members can see specialists directly without a GP referral.

Fixed Subsidy (GKV Dental)

GKV pays a fixed amount toward dental prosthetics regardless of chosen treatment.

Free Choice of Doctor

Right to see any licensed physician without a referral. Standard in PKV.

Free Choice of Hospital

Right to be treated at any hospital, including private clinics.

Maternity / Childbirth

Coverage for prenatal care, delivery, postnatal care, and midwife services.

Generic Drugs

Non-branded medications after patent expiry. GKV promotes generics; PKV covers both.

Marginal Employment / Mini-Job

Employment up to €538/month. Not a path to PKV eligibility.

Health Declaration

Formal written statement about your medical history used during the PKV application.

Health Fund (GKV)

Central fund pooling all GKV contributions for redistribution to Krankenkassen.

Health Questions

Questionnaire on PKV applications covering 3–10 years of medical history.

Cross-Border Commuter

Someone living in one country but working in another. Special EU insurance coordination applies.

Full Dormancy Option

Preserves re-entry rights AND continues building ageing provisions during dormancy.

Group Insurance

Employer-negotiated PKV contracts with potentially simplified health checks.

General Practitioner (GP)

Family doctor handling primary care and referrals. In PKV, you can bypass the GP and go directly to a specialist.

GP Gatekeeper Model

Optional GKV model where you always see your GP first, in return for reduced co-payments.

Therapeutic Treatments & Medical Aids

Combined category for physiotherapy, speech therapy, medical devices, etc.

Dental Treatment & Cost Plan

Formal plan required before major dental work. Your insurer confirms coverage in advance.

Therapeutic Treatments

Physiotherapy, massage, occupational therapy, speech therapy, podiatry.

Alternative / Naturopathic Practitioner

Licensed non-physician. Often covered by PKV; rarely by GKV.

Medical Aids / Devices

Wheelchairs, hearing aids, prosthetics, orthopedic shoes, etc.

GKV Maximum Premium

Highest possible monthly GKV premium. Also caps the employer subsidy for PKV members.

Maximum Fee Rate (3.5×)

Absolute maximum multiplier doctors can charge under the GOÄ fee schedule.

Hospice

Residential end-of-life care facility.

Individual Health Services (Self-Pay)

Services not covered by GKV, offered as self-pay. Many are standard in PKV.

Chamber of Commerce Registration

Mandatory registration for licensed insurance brokers.

Vaccination / Immunisation

Both systems cover STIKO-recommended vaccines; PKV often adds travel vaccines.

Premium Calculation Ordinance

Regulation dictating how PKV premiums must be mathematically calculated.

Funded / Capitalised System

PKV's financing model: each generation saves for its own future healthcare costs.

Association of Statutory Health Insurance Physicians

Regional body coordinating between GKV-contracted doctors and health funds.

Switching Health Funds (GKV)

Changing from one Krankenkasse to another. Simple, no health check, 12-month binding.

GKV Accreditation (Doctor)

A doctor's license to treat GKV patients.

Orthodontics

Braces, aligners, jaw correction. Coverage varies widely between PKV tariffs.

Basic Dormancy Option

Preserves re-entry rights only, without building ageing provisions during dormancy.

Combined Care Benefits

Mix of professional care services and cash benefits, proportionally adjusted.

Obligation to Contract

GKV must accept everyone. PKV has no such obligation (except for Basistarif).

Cost Estimate / Pre-Approval

Treatment plan with cost breakdown submitted to your insurer before expensive procedures.

Health Insurance Fund (Public)

A statutory health insurer (e.g., TK, AOK, Barmer). ~100 exist in Germany.

Medical Transport / Ambulance

Ambulance services and medically necessary transport.

Health Insurance Obligation

Since 2009, every German resident must have health insurance.

Spa Treatment / Rehabilitation

Structured medical rehabilitation, inpatient or outpatient.

Cancellation Notice Period

Standard: 3 months to the end of the insurance year.

Short-Term Care

Temporary nursing facility stay, up to 8 weeks/year.

Claims Processing

Your insurer reviewing and reimbursing submitted medical bills.

Benefit Exclusion

Specific conditions or treatments excluded from your PKV coverage.

Benefit Catalog

Full list of treatments covered by your specific tariff.

Continued Salary Payment (Sick Leave)

Employers must pay full salary for up to 6 weeks during illness.

Income Tax / Wage Tax

Tax deducted from salary. PKV premiums reduce taxable income via Sonderausgabenabzug.

Broker Mandate

Document authorising a broker to act on your behalf with insurers.

Medical Necessity

The standard insurers use to determine whether a treatment is covered.

Medical Advisory Service

Independent body assessing Pflegegrad classifications.

Multi-Bed Room / Ward

Hospital ward with 3+ beds. Standard in GKV.

Minimum Contribution (GKV)

Lowest possible GKV premium for voluntarily insured members with low income.

Morbidity-Based Risk Equalisation

Mechanism redistributing GKV funds based on members' health risk profiles.

Maternity Protection

Mandated leave: 6 weeks before birth, 8 weeks after. Full pay continues.

Proof of Insurance Obligation

You must prove you have health insurance for residence registration, employment, etc.

Net Income / Take-Home Pay

Salary after all deductions. Relevant for real-world GKV vs. PKV cost comparisons.

Net Policy (Commission-Free)

Policy without built-in commission, designed for fee-based advisors.

Emergency Tariff

Bare-minimum coverage for PKV members who stopped paying premiums.

Opening Campaign

Periodic PKV industry campaigns with simplified health checks for certain groups.

PKV Ombudsman

Free independent dispute resolution for PKV policyholder-insurer conflicts.

Option Tariff

Policy guaranteeing future PKV entry without a new health assessment.

Palliative Care

End-of-life care focused on comfort and quality of life.

Advance Healthcare Directive

Legally binding document specifying your medical treatment wishes if incapacitated.

Care Counselling

Free advisory services for navigating the long-term care system.

Care Allowance (Cash Benefit)

Monthly cash payment for people receiving home care from family or informal caregivers.

Nursing Home / Care Home

Residential long-term care facility. Costs typically far exceed insurance coverage.

Professional Care Services

Professional nursing care covered by care insurance.

Care Support Centre

Local advisory centres for all aspects of long-term care.

Care Level (Old System)

Former 3-tier system replaced by Pflegegrad in 2017.

Daily Care Benefit Insurance

Supplementary insurance paying a fixed daily amount per Pflegegrad.

Supplementary Long-Term Care Insurance

Additional coverage on top of mandatory PPV/SPV.

State-Subsidised Care Insurance

Government adds €5/month to your supplementary care premium. No health screening required.

Association of Private Health Insurers

Industry body representing all private health insurers in Germany.

Portability (of Ageing Provisions)

Ability to transfer reserves when switching PKV companies.

Prevention / Preventive Care

Screenings, vaccinations, and lifestyle programmes covered by both systems.

Private Doctor / Practice

Physician treating only privately insured or self-pay patients.

Commission

General term for sales compensation in insurance.

Standard Care (GKV)

Default GKV treatment level. Anything beyond it must be paid privately.

Standard Maximum Fee Rate (2.3×)

Multiplier up to which doctors can charge without written justification.

Travel Health Insurance

Coverage for medical costs during trips abroad.

Residual Cost Insurance

PKV portion covering what Beihilfe doesn't for civil servants.

Risk Assessment (Underwriting)

Insurer's internal evaluation of your PKV application.

Rooming-In

Benefit allowing a parent to stay in hospital with a sick child.

Reserve / Provision

Money set aside by insurers for future obligations.

Suspension of Benefits

Benefits suspended due to prolonged premium non-payment.

Benefits-in-Kind Principle

GKV pays providers directly. You never see an invoice.

Expert / Surveyor

Independent specialist providing opinions in insurance disputes.

Release from Medical Confidentiality

Form allowing the insurer to request your medical records.

Vision Aids (Glasses, Contacts)

GKV covers almost nothing for adults; PKV varies by tariff.

Solidarity Principle

GKV foundation: pay according to income, receive care according to need.

Solvency

Framework ensuring insurers hold enough capital for long-term obligations.

Special Expense Deduction

Tax mechanism for deducting health insurance premiums.

Social Long-Term Care Insurance (Public)

Public care insurance funded through income-based contributions.

Social Security Agreement

Bilateral agreements coordinating coverage between Germany and other countries.

Social Security Contributions

Combined deductions for health, care, pension, and unemployment insurance.

Standard Tariff (Legacy)

Pre-2009 PKV tariff with GKV-equivalent benefits. Closed to new entrants.

Fee Multiplier (GOÄ/GOZ)

Multiplier determining how much a doctor can charge above the base rate.

Standing Committee on Vaccination

Germany's official body issuing vaccination recommendations.

Day and Night Care

Part-time institutional care supplementing home care.

Part-Time Employment

Reduced hours may push salary below JAEG, potentially requiring return to GKV.

Telemedicine

Remote medical consultations via video or phone.

Independent Actuary / Trustee

Legally mandated expert who must approve every PKV premium adjustment.

Surplus Participation

Policyholders share in the insurer's investment returns.

Transfer Value

Portable portion of ageing provisions when switching PKV companies.

Referral

GP referral to a specialist. Not mandatory in PKV.

Pay-As-You-Go System

GKV's financing model: current contributions fund current costs.

Unisex / Gender-Neutral Tariffs

Mandatory for all new PKV contracts since December 2012.

Insured Person

The individual covered by the policy.

Insurance Supervision Act

Law governing insurer regulation and supervision.

Fee-Based Insurance Advisor

Independent consultant charging the client directly, no commissions.

Insurance Freedom / Exemption

Legal status allowing you to choose PKV over GKV.

Policyholder

Person owning the contract and responsible for premiums.

Compulsory Insurance Threshold

Synonym for JAEG.

Insurance Certificate

Official document confirming your coverage, tariff, and terms.

Insurance Agent

Works for a specific company. Not independent.

Insurance Contract Act

Primary law governing all insurance contracts in Germany.

Intermediary Register

Public database listing all licensed brokers and agents.

Substitute Care / Respite Care

Professional care when the regular caregiver is unavailable (up to 6 weeks/year).

Contract Term / Duration

PKV contracts are typically open-ended with defined notice periods.

Provision Expenses (Tax)

Tax category for qualifying insurance premiums.

Healthcare Power of Attorney

Authorising another person to make medical decisions on your behalf.

Preventive Check-Up

Routine health screenings. PKV often offers broader options than GKV.

Optional Tariffs (GKV)

Special GKV tariff options like premium refunds or deductible models.

Comfort Benefits (Tax Context)

PKV benefits beyond GKV-level care. Limited tax deductibility.

Working Student

Student employed part-time. Insurance depends on hours and income.

Right of Withdrawal

Right to cancel a new insurance contract within 14 days.

Right of Objection

Right to object to insurer decisions such as claim denials.

Dental Treatment

Routine dental care: check-ups, fillings, cleanings.

Dental Prosthetics

Crowns, bridges, implants, dentures. Biggest dental cost category.

Supplementary Dental Insurance

Add-on coverage for enhanced dental beyond GKV.

Additional Contribution (GKV)

Insurer-specific surcharge on top of the 14.6% rate. Average 2.9% in 2026.

Co-Payment (GKV)

Fixed out-of-pocket for prescriptions (€5–€10), hospital (€10/day). Capped at 2% of income.

Second Opinion

Right to seek a second medical opinion before major procedures.

Semi-Private Room (Hospital)

Shared with one other patient. Most common PKV inpatient benefit.

Insurance Intermediary License

Legal basis for insurance broker licensing in Germany.