Beitragsanpassung: premium adjustment in German private health insurance

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

For 2024, the PKV-Verband, the association of the private health insurers, reports these increases over the previous year: nursing costs in hospital +17.57 %, hospital services overall more than +10 %, medicines about +10 %, therapies such as physiotherapy, occupational therapy and speech therapy about +9 %, outpatient treatment by doctors more than +8 %.

2026 in numbers

For the adjustments on 1 January 2026, the PKV-Verband reports:

• Around 60 % of privately insured people received a Beitragsanpassung

• About 13 % on average among those affected

These are market figures across all tariffs and ages, not a figure for any single contract. An adjustment is not one percentage applied to everyone: the insurer recalculates each tariff by age at entry, so the same tariff can rise by different percentages at different ages. Your letter states the new monthly premium in euros, and that is the figure to plan with.

Your rights when an adjustment arrives

• Sonderkündigungsrecht, the letter opens a 2-month window to cancel, counted from the day you receive it (§ 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 move to a different insurer instead; you go through a new health check there and take the part of your ageing provisions that matches the Basistarif with you

The Treuhänder checks the calculation, not whether the increase feels fair. An adjustment cannot be challenged because it is high, only when the legal requirements for it were not met.