Navigating the private health insurance system with PrEP use can be challenging. In this article, we'll explore eligibility for German private health insurance while taking PrEP and suggest potential solutions.

PrEP, a preventive medication, substantially reduces the risk of HIV transmission. It's a critical tool in the fight against HIV. Nevertheless, PrEP faces resistance from many private health insurance providers in Germany. The reason? Most private insurers consider both pre-existing medical conditions and ongoing medications when determining eligibility and premiums for prospective policyholders.

German private health insurers operate under the banner of risk assessment. They have the discretion to choose whom to cover based on financial eligibility and health status. Sadly, PrEP often falls into a category where private insurers are reluctant to offer coverage. This is not an isolated issue; individuals with various pre-existing conditions, such as asthma, also encounter difficulties in securing private insurance coverage.

For those who encounter obstacles getting accepted by private health insurance due to their history of PrEP, there is an alternative – the public health insurance system in Germany. Unlike private insurers, the public system doesn't discriminate against individuals undergoing treatment or those with pre-existing medical conditions, making it a viable option for those denied private coverage.

If you're already privately insured and are seeking coverage for PrEP-related expenses, it is essential that your physician is affiliated with dagnä, which is a network of physicians specializing in the treatment of HIV-infected or at-risk patients. Additionally, coverage for PrEP is usually extended if prescribed for the first time after the policy starts. To find out which healthcare practitioners in your area are part of the framework agreement, we recommend contacting dagnä for the most up-to-date information on participating doctors.

Contact Information for dagnä

dagnä e.V.

Nürnberger Str. 16, 10789 Berlin

Tel.: 030/3980193-0

Fax: 030/3980193-20

Mail: [email protected]

What if I am not eligible for public health insurance?

While public health insurance offers a solution, it may not always align with your eligibility. We understand the frustration this situation can cause and are committed to helping you find alternative solutions. Simply reach out to us and we will happily discuss other options.

Is PeP (Post-Exposure Prophylaxis) covered under my health insurance plan?

PeP or any other medicine must be recommended by a qualified healthcare provider to be covered by your insurance. If this requirement is fulfilled, you will be reimbursed according to your tariff.