Beitragsanpassung

Why PKV premiums adjust, and when they are allowed to

A Beitragsanpassung (BAP) is the procedure by which a private health insurer changes the premium on an existing contract. Unlike the GKV, where the legislator can change contribution rates at any time, PKV adjustments are tightly regulated. They are not a matter of the insurer's commercial judgement.

The legal framework:

• § 203 VVG, sets out when and how a premium may be adjusted

• § 155 VAG, defines the actuarial conditions that must be met

• § 203 Abs. 2 VVG, every adjustment needs sign-off from an independent Treuhänder (a certified actuary)

The statutory trigger

An insurer may only adjust a premium when a legally defined trigger is crossed. Under § 155 Abs. 3 VAG, there are two:

• Claims cost deviation over 10 %, actual claims in the tariff exceed the assumed claims by more than 10 % over a rolling three-year observation

• Mortality deviation over 5 %, actual mortality in the tariff deviates from the assumed table by more than 5 %

If neither trigger is crossed, the insurer cannot raise the premium, regardless of what is happening in the rest of the market.

When a trigger is crossed, the insurer recalculates the whole tariff from scratch. The recalculation factors in all assumptions, including the technical interest rate (Rechnungszins), even though that rate on its own is not a trigger.

Why adjustments happen: the five main drivers

1. Rising medical expenses, the single biggest driver in almost every year 2. Demographic shifts, claims are assumed to rise with age, but not always at the pace observed 3. Medical innovation, new treatments, devices, and medications that did not exist at tariff launch 4. Longer life expectancy, more claim years per member 5. Lower interest rates on reserve capital, the Altersrückstellung earns less when rates drop, which reduces the cushion

In 2024, example cost drivers cited by the PKV industry: hospital bed-day costs +37.5 %, orthopedic aids and medical equipment +10.4 %, +8.7 % more hospital treatments.

2025 in numbers

The PKV-Verband's press release in December 2024 reported that in 2025, approximately:

• Two-thirds of the 8.7 million full-insured PKV members received a Beitragsanpassung

• Average adjustment +18 % among those affected

• Average across all members of the affected companies ca. +12 %

Percentages can be misleading. The adjustment is calculated as an absolute euro amount, then applied. A low entry premium (young entry age, older tariff) shows a large percentage effect, even when the euro amount matches a new member's surcharge. Do not treat a large percentage increase as a signal that "your tariff is worse", the absolute figures may be in line with the market.

Your rights when an adjustment arrives

• Sonderkündigungsrecht, the notification triggers a 2-month cancellation window (§ 205 Abs. 4 VVG)

• Tarifwechsel, you can switch to a different tariff inside your current insurer under § 204 VVG, preserving your ageing provisions in full

• Anbieterwechsel, you can switch insurers with a new health assessment and a partial transfer of ageing provisions; usually not the best first move

The Treuhänder review is a real procedural check, not a formality. Irregular adjustments do happen and courts have overturned specific increases in the past, worth a qualified second look if the math seems out of line with the cost drivers cited.