Wartezeit

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. 5 MB/KK, accident-related treatment has no waiting period at all. A broken leg on day 2 of a new contract is fully covered.

The three waiver routes

In practice, most PKV members never encounter the Wartezeit because one of three waiver paths applies to them.

1. Medical certificate (§ 3 Abs. 6 MB/KK)

The insurer can waive the waiting period on request, typically against a medical certificate confirming current health status. For most applicants, this happens implicitly: the expanded Gesundheitsfragebogen (health questionnaire) at application already substitutes for the certificate, and the insurer routinely waives waiting periods for accepted applications with clean (or cleanly surcharged) histories.

This is the standard path for expats arriving without previous German cover.

2. Credit for prior insurance (§ 3 Abs. 4 MB/KK)

If you are switching from the GKV or from another substitutive PKV without a gap, your prior insurance time is credited toward the Wartezeit. In practice this means the waiting period is waived entirely.

Conditions:

• PKV application must arrive within 2 months of the prior insurance ending

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

• Market practice: 12-24 months of prior cover is typically treated as fully equivalent

3. PKV → PKV switch

• Inside your current insurer (Tarifwechsel, § 204 VVG): no new Wartezeit applies. Already-served waiting periods transfer.

• Between insurers (Anbieterwechsel): waiting periods are typically credited for equivalent coverage. For upgraded coverage (e.g. adding chief-physician cover that the old tariff did not include), a residual waiting period may apply to the new benefits only.

When the Wartezeit genuinely matters

Given the three waivers, the Wartezeit is rarely an obstacle. Cases where it actually bites:

• 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.