Selbstbeteiligung

What is the Selbstbeteiligung?

The Selbstbeteiligung (SB) is your annual out-of-pocket contribution before the PKV reimburses claims. Choose a higher SB, and the premium drops. Choose a lower SB (or zero), and the premium is higher. It is one of the three main levers, along with tariff scope and Krankentagegeld, that shape what you actually pay for PKV cover.

The SB is defined in the tariff's AVB (Allgemeine Versicherungsbedingungen, the general policy terms) and applied per calendar year. If your claims in a year stay below the SB, you pay them yourself and your insurer reimburses nothing. If your claims exceed the SB, the insurer reimburses the excess within the tariff's scope.

The four common models

Market tariffs use one of four SB structures:

• Absolute annual SB, a fixed euro amount applied against all reimbursable claims. Typical steps: €0 / €300 / €600 / €1,200 / €2,500 per year. Rare tariffs allow up to €5,000.

• Percentage SB, e.g. 10-20 % of reimbursable costs, usually with an annual ceiling

• Area-specific SB, separate SB for outpatient, inpatient, and dental. Most common variant: SB applies to outpatient only, with inpatient reimbursed without deductible

• Tiered SB, e.g. €0 in the first year, €300 from year two onwards. Uncommon

The economics: four variables

Whether a higher SB pays off depends on four inputs:

• Premium saving per year, the core comparison figure (typically a few hundred euros per year for a €300 SB vs. €0, with the gap widening with age and tariff scope)

• Expected annual claim frequency, if you typically see doctors 2-3 times per year for small issues, your claims often land inside the SB

• Marginal tax rate, premium reductions reduce your tax-deductible Sonderausgaben while SB payments are largely out-of-pocket (a portion may qualify as außergewöhnliche Belastung above the zumutbare Eigenbelastung); the PKV reimbursement of claims above the SB is itself tax-neutral

• Liquidity tolerance, paying €1,200 out of pocket for a single unexpected year is different from paying €300

The straightforward math: if your typical annual claim total is below the premium saving, a higher SB pays off. If it is above, a lower SB wins.

The Arbeitgeberzuschuss interaction

For employees, the Arbeitgeberzuschuss (employer subsidy) is 50 % of the actual PKV premium, capped at the employer maximum (€613.22 (€584.15 in Sachsen)/month in 2026). A higher SB reduces your premium, which reduces the absolute subsidy, but only up to a point:

• If your premium is well below the cap, the employer still pays 50 % and your net saving from the SB is only half

• If your premium is close to the cap, the employer subsidy stays flat at €613.22 and you capture the full SB effect

In other words, higher earners with tariffs near the employer cap get the most from a higher SB. Younger employees on cheap tariffs see only half the SB benefit after the employer share is accounted for.

The BRE interaction

Many PKV tariffs also offer a Beitragsrückerstattung (BRE), a refund of one to six monthly premiums if you submit no claims in a year. The SB and BRE partly compete: both reward low-claim years.

• With a high SB, you already pay small claims yourself, so not claiming for the BRE does not change your out-of-pocket total

• With a low SB, submitting a small claim loses the BRE: the decision to hold back a bill turns on whether the claim exceeds the net BRE value

Run the combined math before assuming both features stack additively. A tariff with both €1,200 SB and a 3-month BRE is not twice as good as one with just a BRE; in some profiles the SB makes the BRE redundant.

Never a pauschal recommendation

Do not accept a blanket "always choose a €1,200 SB" from a broker or comparison tool. The correct SB is a function of your profile, and the most common mistake is picking a high SB on a tariff where a chronic condition or predictable annual treatment would push claims above the SB every year. In that situation the supposed premium saving is swallowed by the SB before the year ends.