When you apply for private health insurance (PKV) in Germany, we review your medical history in a process called risk assessment. The result can be full coverage at the standard price, coverage with a risk surcharge, coverage that excludes treatment related to an existing condition, or a rejected application. Certain chronic, psychiatric, and complex diagnoses usually lead to a rejected application. Complete and accurate health information is required, because missing details discovered later can lead to your policy being canceled. Applicants who don't qualify for private health insurance can look at public health insurance, expat health insurance, or long-term expat health insurance instead.
What is the risk assessment for private health insurance in Germany?
The risk assessment is the medical review we carry out when you apply for private health insurance (PKV) in Germany. We look at your medical history, including current conditions, past treatments, and ongoing medication. The result of this review determines both the coverage you're offered and the monthly price of your private health insurance policy.
What outcomes are possible after the risk assessment for private health insurance?
The risk assessment for private health insurance (PKV) can lead to 4 different outcomes:
Full coverage at the standard price. Many health conditions have no effect on your policy, and your monthly price is the one shown for your chosen plan.
Coverage with a risk surcharge. If you have an ongoing health condition or injury, you may be offered full coverage at a higher monthly price. The surcharge is an additional amount added to your premium because of the increased medical risk.
Coverage with an exclusion. Your monthly price stays at the standard level, but treatment related to your existing condition isn't covered and you pay for it yourself. An example is dental treatment related to a missing tooth.
A rejected application. We can't offer you private health insurance, and you need to look at other health insurance options.
Which health conditions usually lead to a rejected private health insurance application?
Applications for private health insurance (PKV) that involve the following conditions or treatments are usually rejected:
Asthma, arthritis, and autoimmune disorders
Diabetes
Cancer
Multiple sclerosis and epilepsy
Hepatitis and HIV
Taking PrEP (pre-exposure prophylaxis)
Drug addiction
ADHD and other mental health conditions
Ongoing or recent psychotherapy, defined as more than 5 sessions in the last 5 years or more than 25 sessions in total
A combination of these conditions, or other complex diagnoses
Can the coverage and price change after you submit your private health insurance application?
The coverage and price shown to you when you apply for private health insurance (PKV) are usually the final ones. In some cases the risk assessment leads to a different result, such as a risk surcharge or an exclusion. If anything changes after you submit your application, we inform you before your policy starts.
Why do you need to give complete and accurate health information?
Your private health insurance (PKV) offer is based on the health information in your application, so every question needs a complete and accurate answer. If information is missing or incorrect and this is discovered after your policy has started, your coverage can be canceled and finding a new insurer afterward is much harder. If you notice that something was left out or entered incorrectly, it needs to be corrected as soon as possible. You can contact our support team for more assistance or additional resources.
What are your options if you don't qualify for private health insurance?
A rejected private health insurance (PKV) application doesn't leave you without coverage. Depending on your situation, employment status, and how long you're staying in Germany, public health insurance (GKV), expat health insurance, or long-term expat health insurance may be available to you. Our recommendation tool compares the policies you're eligible for and shows which ones fit your situation.