Wartezeit: waiting period in German private health insurance

What is the Wartezeit?

A Wartezeit is an initial period after your PKV contract starts during which certain benefits are not yet payable. If you submit a claim for an affected benefit during the waiting period, the insurer can refuse reimbursement.

The purpose is actuarial. Without waiting periods, someone could sign a PKV contract on 1 March knowing they need expensive treatment on 15 March, and the insurer would take on a premium-free risk. Waiting periods close that window.

The legal framework sits in the standard insurance terms § 3 MB/KK (Musterbedingungen Krankheitskostenversicherung), carried into every mainstream PKV contract.

The two standard periods

General Wartezeit: 3 months

Applies to all benefits not specifically named in the longer list below. In practice: outpatient visits, medication, routine diagnostics, aids and appliances.

Special Wartezeit: 8 months

Applies to a specific list of higher-cost, claim-driven benefits:

• Dental treatment and prosthetics (Zahnbehandlung, Zahnersatz)

• Orthodontics (KFO)

• Childbirth benefits (Entbindung)

• Psychotherapy

Eight months after contract start, these benefits become available under the tariff's normal rules.

No Wartezeit: accidents

Under § 3 Abs. 2 MB/KK, accident-related treatment is not subject to the general waiting period. A broken leg on day 2 of a new contract is covered.

The three waiver routes

There are three ways a waiting period can be credited or waived.

1. Medical certificate (§ 3 Abs. 4 MB/KK)

The insurer can waive the waiting periods by special agreement, if the tariff provides for it, against a medical certificate confirming your current health. Whether a tariff allows this is worth checking before you apply.

For expats arriving without previous German cover this is the route to ask about, but it is not guaranteed: even where the tariff provides for it, the insurer decides whether to grant it in place of missing prior cover. Whether cover from abroad counts as prior insurance is also up to the insurer. For cover from another European country insurers handle it differently, and it can matter whether you are employed or self-employed.

2. Credit for prior insurance (§ 3 Abs. 5 MB/KK)

If you are switching from the GKV or from another full private health insurance without a gap, your uninterrupted time there counts towards the waiting periods. With at least eight months of prior cover, even the longest waiting period is covered.

Conditions:

• PKV application must arrive within 2 months of the prior insurance ending, with the new cover starting straight after it

• Prior insurance must be substitutive (GKV or PKV full cover, not travel insurance or Incoming)

• There is no minimum length: the uninterrupted time counts in full

3. PKV → PKV switch

• Inside your current insurer (Tarifwechsel, § 204 VVG): no new Wartezeit for the cover you already have. For additional benefits in the new tariff the insurer can set one.

• Between insurers (Anbieterwechsel): your time with the previous insurer counts as prior cover, as in route 2, if you apply within two months and the new cover starts straight after the old one.

When the Wartezeit genuinely matters

With these routes, the Wartezeit mainly matters in these cases:

• Longer cover gap (more than 2 months without substitutive insurance before the new application)

• Returning from a long period abroad without an Anwartschaftsversicherung in place

• Children born outside the Kindernachversicherung deadline, the regular Wartezeit then applies (see the Kindernachversicherung entry for the 2-month rule)

• Adding a benefit during the contract (via Nachversicherungsgarantie or an upgrade) where the new benefit has its own waiting period

For all of these, planning ahead, specifically the timing of contract start and the documentation of prior cover, is the way to avoid the problem.

The Kindernachversicherung exception

Newborns registered under the Kindernachversicherung within 2 months of birth are exempt from waiting periods entirely (§ 198 VVG / § 2 Abs. 2 MB/KK). See the Kindernachversicherung entry for the full mechanics.

What "8 months" actually means in practice

An illustration for a new PKV member starting 1 January:

• Immediately covered: outpatient doctor visits due to accidents

• From 1 April (3 months): all standard outpatient care

• From 1 September (8 months): dental, psychotherapy, childbirth

If they received a waiver on application (typical for a seamless GKV → PKV transition), none of the waiting periods apply at all.