Private Krankenversicherung (PKV)

What is the PKV?

The Private Krankenversicherung (PKV) is one of two parallel health-insurance systems in Germany. The other is the statutory GKV. Around 11 % of the German population, 8.8 million people, are in the PKV as full-insurance members, with many more carrying a supplementary PKV policy on top of a GKV membership.

The legal framework is spread across multiple statutes:

• VVG (Versicherungsvertragsgesetz), the insurance contract law

• VAG (Versicherungsaufsichtsgesetz), supervision of insurers, including reserve and Basistarif rules

• MB/KK (Musterbedingungen Krankenversicherung), the standard policy terms most PKV contracts build on

• SGB V/XI, where the system intersects with statutory rules (e.g. the JAEG, Pflegeversicherung (long-term-care insurance) mandate)

How it is different from the GKV

The defining contrasts:

• Risk-based, not income-based. Your premium depends on your age at entry, your health at entry, and the tariff you choose. Income does not factor in.

• Funded model. Each generation pre-funds its own future care through the Altersrückstellung (ageing provision). The GKV is pay-as-you-go.

• No free family co-insurance. Every family member needs their own contract. The GKV's Familienversicherung has no PKV equivalent.

• Kostenerstattungsprinzip. You are the contractual partner of the doctor, you pay the invoice, and you submit it to the insurer for reimbursement. The GKV pays providers directly.

• Underwriting applies. A PKV insurer can reject applicants with serious pre-existing conditions; in the GKV, acceptance is automatic.

• Broader benefit set in standard tariffs, chief-physician access, single rooms, generous dental, international cover, wider psychotherapy scope.

Who can access the PKV

Access conditions depend on your status:

• Employees: gross annual salary above the JAEG (€77,400 in 2026) for a full calendar year, then eligible to switch

• Freelancers and self-employed: eligible at any income level, no threshold

• Civil servants (Beamte): eligible from appointment, and PKV combined with Beihilfe is the default path

• Students: eligible with a one-time decision at the start of studies, binding for the whole course

The core trade-off

The PKV promises:

• More direct access to specialists and treatments

• Often lower total cost for high earners, especially single/young profiles

• A funded model with a personal reserve

The PKV demands:

• Exposure to premium adjustments when the tariff's cost assumptions are exceeded

• A harder return path to the GKV: very difficult after age 55

• More paperwork (reimbursement loop, referral discipline)

• No free family co-insurance

• Your current health history is priced in forever; health decline cannot be hidden by an insurer swap

For a healthy 30-year-old professional earning €100,000 with no immediate family plans, the PKV is often financially and qualitatively the better product. For a 45-year-old with a chronic condition, two young children, and a non-working spouse, the GKV usually wins. The correct answer is individual.

Premium growth: the honest picture

A common myth: "PKV premiums rise uncontrollably in old age." The honest picture from the 2005-2025 window:

• PKV full-cover premium growth: ca. +3.1 % per year (WIP-Analyse 2005-2025)

• GKV contribution growth at the contribution ceiling: ca. +3.8 % per year

Both systems face the same underlying cost pressure. Neither is uniquely stable; neither is uniquely out of control. Legal reserves and the § 149 VAG surcharge smooth the PKV growth curve. The GKV growth curve is smoother at the low-income end and steeper at the high-income end.

The 55-year lock

This is the single most important thing for an expat considering the PKV. From age 55 onwards, returning to the GKV becomes practically impossible for most members under § 6 Abs. 3a SGB V, the cumulative conditions (5 years outside statutory cover + at least half that time insurance-free or self-employed) are met by almost every PKV-insured employee of that age.

"I can always go back later" is one of the most expensive sentences said in expat PKV conversations. By the time you want to go back, you often cannot.

The process for joining

The standard workflow, in order:

1. Needs and profile clarification with a broker (ideally one required by law to represent you, not an insurer's agent) 2. Anonymised risk pre-enquiry (Risikovoranfrage) across 3-5 insurers if you have any medical history 3. Formal application to the chosen insurer, with the full Gesundheitsfragebogen (health questionnaire) 4. Acceptance decision, normal, with surcharge, with exclusion, or rejection 5. Signed contract, then, and only then, cancel your GKV with the insurance confirmation 6. Effective date, cover starts from the agreed date, usually the 1st of the following month