How are private health insurance rates calculated?

While there are fixed contributions in statutory health insurance, which only differ minimally in the additional contribution of the health insurance funds, private health insurance tariffs are composed of the following criteria, among others

age

profession/ professional group

individual services

health status

deductible

PKV contribution for pensioners - How to reduce costs

It is possible to increase the personal contribution for treatments, medication and the like. This permanently reduces the costs for insurance cover. However, chronically ill people and people who are often ill should reconsider this option - it could become more expensive.

Pro : lower costs with the same services

Cons : Risk of higher costs if you are often ill

The more services the PKV tariff contains, the more expensive it can be. A check is worthwhile. If there are services that you rarely use or that you want to do without, the insurance cover can be cheaper.

Pro : cheaper insurance cover

Cons : Reduced performance cannot be recovered easily

No tariff is set in stone. Insured persons can also change this. There are numerous PKV tariffs that include similar services and are still cheaper.

Pro : cheaper protection with similar performance

Cons : there may be no suitable alternative tariff available

PKV tariffs for financial emergencies

This is a social tariff that must be offered by all private health insurance companies. If you only have a low income, you have the option to choose this tariff – if you have been insured in private health insurance for at least ten years and joined before 2009. More on the standard rate

The tariff is only open to insured persons who entered private health insurance after December 31, 2008. The private health insurance companies must offer this social tariff for low-income insured persons who are considered to be in need of assistance in terms of social law, who are older than 55 years of age or who are drawing an annuity or pension. More about the basic tariff

This tariff cannot be freely chosen by the insured. If the insured suffer from financial bottlenecks and if there are arrears in private health insurance contributions, the insurer can suspend the contract after two reminders. More about the emergency tariff

The private health insurance comparison - why it's worth it

There are over 40 insurance companies (list) that are members of the private health insurance association. Anyone interested in private health insurance is faced with an incredibly large selection of tariffs and tariff options. It is therefore urgently necessary to compare the offers of different providers and their tariff variants. Making a decision independently and without expert advice is almost impossible. A private health insurance comparison, which is accompanied by professionals, is useful for support.

A look at current PKV tests can provide initial clues for your own investigations. Here, providers and their tariffs receive corresponding ratings that can make a rough statement about the quality of a private insurer, individual tariffs or tariff combinations. The personal point of view should, above all, include the desired range of services and the monthly contribution, since these permanently determine the tariff and thus the contribution costs in private health insurance. The following aspects often play a role in the assessment of private health insurance tariffs by experts:

financial strength

balance sheet in the financial market

Post stability

administration costs

amount of the contribution

scope of services

terms of the contract

Ratio of price to performance

Stiftung Warentest

Focus Money

DFSI

Tomorrow morning

Well-known consumer advocates, as well as good private health insurers, emphasize how important it is to compare insurance policies that are taken out for a longer period of time. This applies in particular to private health insurance, since it is intended to accompany the customer for a lifetime. For this reason, an insurance comparison is essential!

"[...] Especially in the case of health insurance, many other criteria also play a relevant role in the selection of a private health insurer and suitable tariffs. These are, for example, the development of premiums, tariff continuity - i.e. how many tariffs the insurer has brought onto the market - as well as its behavior [...] in the benefit regulation."

From the Federation of Insureds brochure "Well insured in private health insurance" from February 2019; retrieved online on September 30, 2019)

Compare: With contribution comparison and tariff comparison in the private insurance

Low contribution or best tariff? The path to private health insurance is influenced by personal wishes and financial possibilities. When comparing private health insurance, the following aspects should be considered:

The risk is measured on the basis of factors such as the age at entry or the individual risk of disability and illness. Some insurers completely exclude certain pre-existing conditions, while others still allow a health check. A risk surcharge is then often levied, the amount of which depends on the disease and the risk of secondary diseases.

There are thousands of tariffs and tariff combinations and the tariff conditions can vary greatly. Some private health insurance providers offer no tariffs at all for certain professional groups, while others only insure civil servants.

For a layman, the tariff jungle is hardly transparent. Professional advice is therefore strongly recommended. However, everyone should prepare well for the consultation and think about the desired services in advance.

Want to know more about PKV

Our readers ask - we answer: The most popular FAQ

In general, the contributions are cheapest when you start at a young age (also in the long term). Formally, there is no upper age limit, but the contributions increase disproportionately with age. It is possible to take out private health insurance after the age of 50, but it hardly makes sense from a financial point of view.

Find out more about getting started with private health insurance for students

The self-employed, civil servants, students (at the beginning of their studies) and freelancers can take out private health insurance without any further requirements. In order to switch to private health insurance, employees must have a gross annual income above the compulsory insurance limit (2020: €62,550.00).

Find out more about the compulsory insurance limit.

The costs for private health insurance (PKV) depend on various factors, including the desired services, age and state of health. There are cheap tariffs for the self-employed, starting at around €300 per month. Employees can get a private health insurance for as little as €200. Due to the aid, civil servants usually only pay up to 150 euros per month. Due to the large number of different tariffs, it is advisable to compare the providers in advance.

More about costs in private health insurance 2019

The contribution assessment limit in statutory health insurance determines the maximum insurance contributions to be paid and is €4,537.50 per month in 2019. In 2020, the value is expected to rise to €4,687.50.

Find out more about the contribution assessment limit her

The contributions for the basic insurance of the private health insurance are deductible as special expenses in the tax return. The insurance company informs the insured person of the amount paid for the basic protection every year. In addition to your own costs, the contributions of family members and long-term care insurance contributions can also be deducted. The information is entered in the “Pension expenses” appendix.

More information on how to deduct private health insurance from taxes

A general answer is not possible here. Private health insurance makes sense for civil servants because they are only entitled to the employer's subsidy in the private system. Employees and the self-employed should weigh up various criteria carefully (Is there a high income in the long term? Are children and family planned? Are special benefits desired?).

Find more answers for employees in private health insurance .

Of course, children can also be included in private health insurance. The contribution is usually significantly lower than for adults, as shown by the contribution calculator on the Internet, because the age at entry and the state of health are decisive factors.

More about private health insurance for children

It is very difficult for pensioners and insured persons over the age of 55 to switch back from private health insurance to statutory health insurance. In principle, this should prevent customers of private health insurance from first enjoying the advantages of private health insurance, only to then be at the expense of the solidarity system in later years. If policyholders still want to withdraw from private health insurance when they are old, the only detour is via family insurance. In this case, the spouse or life partner must be legally insured. In addition, your own income may not exceed 445 euros per month (as of 2019); for mini-jobbers this limit is 450 euros.

Further information on returning to the GKV

If you want to cancel your statutory health insurance to switch to private health insurance, you can always do so at the end of a month. The deadline is 2 months to the end of the month. The start date applies to the first semester of study or when changing employers. Anyone who has not been a member of their health insurance company for 18 months can only change after this period has expired. In the event of a premium increase, this regulation is overridden due to the special right of termination. The statutory health insurance companies are obliged to issue you with written confirmation within 14 days of receipt of the cancellation.

More information on switching to private health insurance

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supplementary health insurance

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Private health insurance requirements - when you can go private

Private health insurance is voluntary insurance. Every employed person can insure themselves privately, provided that the regulations for voluntary health insurance apply to them. These include, for example, civil servants, the self-employed and students. Employees also have the option of taking out private health insurance. However, the total gross income within one year must be above the annual income limit (JAEG), which is recalculated annually and is EUR 62,550.00 in 2020. In 2021, the limit is expected to rise further to an estimated EUR 64,350.00.

The JAEG is not to be confused with the contribution assessment limit , which is important for calculating the health insurance contribution in statutory health insurance.

Requirements & individual advantages according to professional groups

Civil servants can be insured without major requirements and regardless of earnings. In many cases, they are also entitled to assistance from their employer. This covers between 50-80% of the expenses, so that the contribution costs for civil servants are significantly reduced.

Benefits for officials 

Aid entitlement between 50 and 80% for insured persons and their non-working family members

Spouses and children are taken care of by this state subsidy in private health insurance

Civil servants or civil servant candidates only need a so-called residual cost insurance for complete protection

The self -employed and freelancers can choose between statutory and private health insurance. Once you have made the decision to take out private insurance, it is irrevocable. The decision can only be reversed by changing to an employment relationship. The self-employed and freelancers bear the full cost of their health insurance themselves.

Benefits for the self-employed

Your income is not taken into account without exception

If the income increases due to higher income or sales, this is irrelevant for the private health insurance contribution

The self-employed can design their service package individually and thus receive a benefit plus compared to statutory insurance

Employees must be above the compulsory insurance limit with their gross annual income (JAEG) in order to be able to insure themselves with private health insurance. This is 62,550.00 euros/year for 2020; In 2021, it is expected to increase to EUR 64,350.00. If employees exceed this limit, they are free to choose whether they want statutory or private insurance. If you opt for a private health insurance, you should have a permanently stable income above the JAEG.

Benefits for employees

High-earning employees benefit from the income-independent contribution calculation

For example, if you receive bonuses or supplements from your employer, the private health insurance contribution does not increase

The employer contributes half of the monthly costs for private health insurance with the employer subsidy

Students also have the option of taking out private insurance. Within the first 3 months after enrollment, you can apply to a PKV without any major requirements. The private insurance remains in place throughout your studies and cannot be cancelled.

Benefits for students:

You often get very cheap tariffs in private health insurance, because

The younger and healthier the insured person is, the lower the monthly private health insurance premium

TIP for employees and students

If you want to cancel your statutory health insurance to switch to private health insurance, you can always do so at the end of a month. The start date applies to the first semester of study or when changing employers.

Private health insurance: Termination or change

Whether dissatisfaction with the service package or drastic premium increases - there are various reasons for wanting to change private health insurance or even cancel it. Insured persons should be particularly well informed, because a change is not always advantageous. Especially when it comes to retirement provisions, consumers are at a disadvantage and have to reckon with losses. If you still want to cancel your PKV, you should do so in good time to avoid problems with health insurance. In some cases, extraordinary termination is also possible. Policyholders should check in advance whether they meet the necessary conditions.

Privately insured people are generally entitled to a tariff change within their insurance (VVG §204). Switching to a new tariff can be advisable, especially if the contribution increases  or if you are dissatisfied with the previous scope of services. In most cases, costs can be reduced and satisfaction increased. More on the PKV tariff change

If a policyholder is dissatisfied with the services provided by his private insurance company or for other reasons, he is free to look for another provider. Switching to another insurer is only worthwhile in a few cases. The reason for this are the contributions to the old- age provision that the insured person pays monthly with his private health insurance contribution: They ensure that the costs do not increase excessively in old age. The longer the insurance period, the greater the accumulated cushion. More on changing private health insurance

If you want to switch from private health insurance to statutory health insurance, you have to face a number of hurdles. Resumption in the statutory health insurance is possible if privately insured persons with their gross annual income fall below the compulsory insurance limit again . If a policyholder meets the conditions for family insurance , it is also possible to switch back to statutory insurance. There are special regulations for individual professional groups, which are regulated in the Social Security Code 

Deadlines in private health insurance for change and termination

There are not only various reasons for terminating private health insurance, there are also certain deadlines that must be met. The conditions and differences for a regular - i.e. ordinary termination - in contrast to an extraordinary contract termination, also called special termination, are explained below:

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