What is included in private health insurance in Germany (2024)

• 11 November, 2024

PKV — Private Krankenversicherung — is a private health insurance in Germany. Private insurance companies themselves determine the number of tariffs and what will be included in them. This allows the insured person to choose the conditions and necessary coverage according to their wishes.

PKV covers:

• Visit to the doctor - treatment by doctors and specialists.
• Inpatient treatment - covers the costs of hospitalisation, including single, double or general ward.
• Outpatient treatment - examinations, tests and procedures.
• Medicines - full coverage of the cost of medicines.
• Prevention – preventive examinations and vaccinations.
• Dental services – treatment, hygiene and dental implantation.
• Ophthalmology – vision testing and correction.
• Additional services - alternative medicine (physiotherapy, homeopathy, massage), auxiliary means.

But there is also a mandatory tariff, which is determined by law. This is the so-called social tariff (Sozialtarife in der privaten Krankenversicherung). It is the same for all insurance companies and is calculated centrally.

The conclusion of an agreement is also mandatory. Flege-flichtverification — insurance that covers the costs of inpatient and outpatient treatment for people who need long-term care due to illness, disability or old age. It includes funding for care at home or in specialized institutions, payments for the purchase of special equipment and home adaptation, the possibility of receiving monetary compensation for relatives providing care at home.

Private health insurance offers its clients guaranteed freedom of choice. Insured persons can independently choose the scope of services and tariff - both when concluding the contract and at any time during the insurance period. Often, companies divide this scope of services into several tariffs, to which additional blocks are also available.

Which private health insurance rate is best for you depends on a variety of factors – such as what services are particularly important to you, whether you are self-employed, whether you want a deductible, etc.

To prevent your health insurance premiums from becoming unaffordable after you retire, there is a rate to reduce them. This means that before you retire, you pay a little more during the entire insurance period. And then the monthly premium is reduced.

The aim of the tariff is to reduce the premium for private health insurance in old age by a fixed amount for life through monthly savings. The tariff works in a similar way to savings plans and can be provided without a health or risk assessment.

The contribution under this rate is paid by the employee and the employer in half (unless the maximum subsidy has been exhausted before that). This contribution is subject to tax deduction. If a divorce is planned in your married life, the amount of savings under this rate is not subject to division. It is also important to note that contributions are paid even after retirement. It may be that in the event of termination of the contract (due to a change of insurance company, due to the death of the insured), contributions are not inherited or transferred to GKV. That is, you will lose these contributions, unless otherwise provided by the insurance company.

The following standard rates are available to insured persons of all insurance companies:

• Base
• Standard
• Extra

The basic tariff is a social tariff in private insurance. It is suitable for people who need and are entitled to social assistance or who cannot be insured in the public insurance system. People who were insured in PKV after 31 December 2008 can switch to it. For people who have been in private insurance for a longer period, the switch to the basic tariff is only available upon reaching the age of 55, retirement or upon having the right to social assistance.

The maximum contribution for the basic rate for an individual is 843,53 euros per month in 2024. The contribution for long-term care insurance is paid additionally. If there is a right to social assistance, the contribution for the basic rate can be reduced by half. If insured persons in need of assistance cannot pay this halved contribution, the social service will pay part of the required contribution or cover it in full.

The standard tariff offers benefits comparable to those of statutory health insurance. It is a comparatively inexpensive alternative to long-term private health insurance. The contributions to the standard tariff for individuals are limited to the maximum contribution to the GKV and are equal to 843,53 euros per month (2024) + the contribution for long-term care insurance is paid additionally. Family members who would otherwise be insured by the GKV can also switch to the standard tariff. Around 53 people are insured under the standard tariff.

All persons who were insured in PKV as of 01.01.2009 can switch to the standard tariff if:

• they had private health insurance for at least 10 years and
• age not less than 65 years or
• at least 55 years of age and total income does not exceed the contribution limit for the GKV (2024: 5175 EUR/month)
• are under 55 years of age and have applied for or received a pension from the statutory pension insurance or have retired in accordance with the civil service rules, and their entire income does not exceed the contribution limit to the GKV (2024: 5175 euros/month)

Insured persons who are experiencing difficulties in paying their private health insurance premiums may agree with their insurer on a possible solution for this period. If the insolvency is temporary, it may be possible to agree with the insurer to defer the premiums. However, the insurer is not obliged to do so.

If the insured person does not pay their premiums for several months, the insurer may take action against the person concerned (sue for debts or initiate enforcement measures such as seizure). This will also be done if the insured persons have switched to another private insurance company or to a public insurance company during the unpaid period. Another option is when the insured person is transferred to an emergency tariff.

The emergency tariff offers a solution in case of temporary insolvency. It is short-term. It is impossible to choose it or switch to it on your own. This tariff is designed in such a way that the contribution is very low. Each private health insurance company sets the amount of payments in this tariff itself. The longer you have paid contributions before, the smaller the amount of payments will be. But penalties will also be charged for late payment.

During this period, insured persons may not pay contributions for "old age" and thus have an excellent chance to settle their debt in the shortest possible time and return to their normal tariff. This happens automatically after the entire debt has been paid off. Medical services are provided in the minimum volume during the emergency tariff. Only treatment for acute illnesses, pregnancy and maternity is reimbursed. For children and adolescents, the costs of medical treatment due to illness or accident, preventive examinations and vaccinations are reimbursed.

• Single, double or regular room.
• The attending physician is the head physician or the doctor on duty.
• Daily hospital allowance (for additional expenses or personal purposes).
• Independent choice of hospital.

• A monthly care allowance that you will be paid in the event of illness.
• Short-term additional payments (for SPA, for example).

• Initial appointment.
• Urgent care.
• Payment for medicines.
• Massage, physiotherapy, alternative medicine.
• Assistive medical equipment (wheelchair, hearing aid, prosthesis).
• Glasses (new, to replace stolen or broken ones, regular replacement even if the previous glasses are intact, contact lenses). Laser correction of visual acuity. Early detection of glaucoma.

• Dentistry.
• Professional cleaning.
• Modern fillings.
• Root canal treatment.
• Dentures (crowns, bridges, implants) have a cost limit per year. In case of an accident, no limit.
• General anesthesia.
• Orthodontist (there may be an age limit).

• Online doctor.
• Recommended vaccinations.
• Preventive examinations (early detection of cancer, prevention of cardiovascular diseases, early detection of high blood pressure, circulatory diseases and metabolic disorders, Doppler ultrasound).

• All over Europe.
• Worldwide (limited duration).
• Medical repatriation.

• Preventive examinations (blood pressure monitoring, weight monitoring, urine tests), laboratory tests (ruling out infections: HIV, hepatitis B, syphilis, rubella), prenatal diagnostics (chromosomal disorders, hereditary diseases, Down syndrome) and visits to the doctor are included in the insurance. The cost of the insurance does not increase.
• After birth, the child receives private health insurance without the need for a medical examination and deductibles if medical risks are discovered.
• 3D ultrasound.
• Childbirth preparation course.
• Natural birth or cesarean section.
• Comfortable postnatal ward and supervision by the head physician.

• Single room.
• The attending physician is the head physician.
• Daily hospital allowance (for additional expenses or personal purposes).
• Short-term additional payments (for SPA, for example).
• Glasses (replacement even if the previous glasses are intact).
• Online doctor.

• Does insurance cover you in countries outside Europe?
• How long can the trip last?
• Is medical repatriation financially secured?

If necessary, we recommend increasing your existing coverage or taking out additional travel medical insurance.

But there is another important point that plays in favor of concluding a Reisenversicherung in addition to your main insurance. As you know, the insurance company pays you a bonus at the end of the year. It can be up to 50% of the annual premiums if the insurance company does not receive any invoices from you during the year.

But when traveling, going abroad, it is difficult to avoid going to the doctor. Because the change of climate, time zones, unfamiliar food and water, other epidemiological conditions, insufficient time for acclimatization increase the risk of failure in the immune system and tourists often seek help (intestinal infections and poisoning, colds, allergies, migraines, eye diseases, insect bites, infectious and viral diseases). In this case, it would be wiser to use an additional option of private insurance - a travel policy. It can cost about 30 euros per year per person. And it will not only protect you on trips, but will also allow you to receive an annual bonus from your insurance company.

Private health insurance includes vaccinations for children and adults according to the national vaccination calendar. However, additional vaccinations for travel abroad may not be included. This depends on your insurance company and the rate at which you are insured. If your contract specifies that preventive vaccinations are also paid for, this means that the insurer will pay for them. If this is not specified for you, but the trip to a country requiring additional vaccinations is carried out in connection with professional activities, then you should clarify this point with your insurance company.

Before your trip, be sure to check the timing and necessity of vaccinations. These may include, for example, vaccinations against meningitis, malaria, yellow fever, etc.

Long-term care insurance (due to illness, injury, old age) is required for all people living in Germany. It does not matter whether you are insured by a public or private company. You will also pay monthly contributions for Pflegepflichtversicherung. Therefore, it is important to know and understand how much you are paying for this insurance.

If you start comparing the amount of monthly contributions, keep in mind that in the payroll of a person insured in state insurance, this line is separate and often overlooked. Therefore, you can only pay attention to the amount of payments for Krankenversicherung. And in private insurance, this payment is already included in the total amount. In the end, it comes out something like this:

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