On the Private Health Insurance in Germany (Private Krankenversicherung in Deutschland / PKV)

Lately I’ve got quite a lot of questions about pros and cons of private health insurance vs statutory health insurance in Germany (both from my friends and colleagues living in Germany), so I’ve decided to share my experience and some knowledge I’ve got while switching from GKV to PKV last year, I hope it might be interesting for a wide audience as well. Feel free to ping me if you are interested in any additional information.

Please note that there is no better for everyone — it really depends on your personal situation. So some pros and cons of this or that health insurance scheme can be actually very different for you. I’ve initially based this information on my personal experience and opinion, so please choose wisely and ask your insurance agent, lawyer or advisor before proceeding. There might be some mistakes in the information provided here (well, you know, it’s all quite complicated here when it comes to actual legal clauses and conditions, I might have missed smth).

Terminology I use here:

  • Gesetzliche Krankenkassen / Krankenversicherung = GKV = Statutory Health Insurance
  • Private Krankenkassen / Krankenversicherung = PKV = Private Health Insurance

In my case I’ve been first insured in GKV (Techniker Krankenkasse / TK) and switched to PKV (Allianz PKV), so I’ll be giving examples from what I know as for me (single, 25 years old at this time, employed specialist in IT/Marketing) this scheme made a lot of sense.

First of all, let’s overview major requirements for switching to the private insurance:

  • You have a gross salary of more than 54.900 EUR yearly / or 4,575 EUR monthly (for 2015 year, changes every year). I assume you are an employee, as conditions are different for self-employed.
  • You don’t have any additional restrictions which prevent you from changing your statutory health insurance to private health insurance (e.g. getting a free worldwide travel insurance from TK (yes, there is such an option) can require you to stay in the TK for another three years without cancellation options as special conditions apply).

(see this page for more information)

Let’s have a look at some of the major advantages and disadvantages of the PKV.

Pros of switching to the private health insurance (PKV) from the statutory health insurance (GKV):

  • PKV is cheaper in most cases when you have a high salary. GKV always charge up to 15,5% from your salary and there is no way to decrease it as it’s based on the salary, not on your risks. PKV price is calculated based on your risks, not your salary, so if you’re young and healthy, it’s cheaper than statutory health insurance in most cases. So if you have a high salary you pay more for the statutory health insurance, but don’t get any increase in services provided. With PKV you can either save some money on it, or get much better coverage.
  • PKV usually provides better coverage (of course, depends on your plan) — e.g. for dentistry and more high-qualified (and more pricey) doctors. (In my case it covers 100% of dentistry (most of cases) and up to 85% for dental implants. Also it covers glasses, contact lenses, and other useful stuff).
  • Many good doctors work only with PKV patients, others work with both PKV & GKV, but prefer PKV (as PKV pays more, so PKV patients normally get appointments much faster);
  • PKV usually provides worldwide travel insurance with very good coverage out-of-the-box.
  • PKV normally gives you a bonus (pays some money back) if you don’t use your health insurance. The more years you don’t use it, the bigger bonus you get.

Cons of switching to the private health insurance vs statutory health insurance:

  • Once you switched to PKV it’s very hard to get back to the GKV (your salary should drop below the minimal limit, or you should become unemployed).
  • Your (unemployed) partner and kids are not insured with your PKV (in GKV they are insured by your insurance, so in PKV you should pay for them. Might be pricey in many cases. Otherwise, your partner most probably can keep statutory health insurance and cover kids with it too, but I haven’t investigated this option though and don’t know whether it’s legal to do so).
  • Usually there is a Selbstbehält (self-paid amount of money, in my case until I reach a yearly payment of 500EUR from my own funds, I pay 10% of all treatment s— a kind of protection from going to the doctors the way too much).
  • The system of PKV might be very complicated if you’re really into it (you need a lot of time to understand what’s going on there).
  • You need to deal with payments to doctors on your own and then reimburse it from the insurance company submitting all the documents. Normally you get money from insurance company in a couple of weeks before due date on the doctor payment, so it’s not a big problem. Also if you’re really undertaking a huge and pricey treatment, in most cases the insurance company will deal directly with the hospital (depends on the conditions).

That’s the workflow I’d recommend (again, based on my experience):

0.0 Decide if switching to PKV make sense to you. If you haven’t thought it through good enough, think again — it might be a costly mistake if you’re not sure.

0.1 Be ready to spend some time and efforts on making this switch happen (in my case I spent about 6 months for entire process — of course, passively getting back to this task from time to time and reviewing intermediary results and input from external sources).

1. Decide on your strategy for the health insurance. I’d say there are two: (again, very subjectively)

  • Get the same level of the health insurance in PKV as you get in GKV (all of PKVs have it, most probably it’ll be cheaper for you, again depends on your risks, salary and conditions);
  • Get higher level of the health insurance in PKV than you have in GKV (that was my case — I pay about 5% less than in GKV now, but have much more benefits).

2. As soon as you understand what do you want, make a homework and research what companies are there on the market (you can probably start here), create a list of criteria and criteria priority for insurance company selection. (I had many criteria: overall company capital, stock stability, growth, time on the market, international expansion, rating, total number of insured clients, quality control reports, etc).

3. As soon as you have a short list of the insurance companies, get an agent from every of them and ask them for offers. You can start with the first one and get an offer, get it modified by the agent to match all of your parameters, get the price and full conditions, and then ask other agents to provide you similar insurance program from their company as well. Most of the agents can also provide you a special report comparing different programs of different insurance companies.

You can also get some “generic” agents working for different insurance companies, but I haven’t found a good one of this kind, so enjoyed much more communicating to the agents representing single insurance company. You can also look at check24, especially if the price is major criteria.

I end up talking to a few insurance companies making a kind of an “offer competition” between them.

4. When you choose the company you want to proceed with, start talking to them about full conditions and workflows, it might depend on your situation as well. I met an agent of my current PKV about 5 times to discuss the details, he was available on a short notice to come over for a coffee, and brought German-speaking specialist on health insurance to answer some of the most difficult questions I had.

If you’ve decided to start the process — go for it!

5. Send a cancellation (Kündigung) to your current GKV (it takes 2 full months to cancel the insurance, they should get confirmation from your new insurer during this timeframe, see 9). Please note that they’ll also call you to confirm the cancellation in person and ask some questions (TK called me and had only German-speaking operators, so that was fun back then).

In most cases you can ask an agent from your new PKV to file all the cancellation documents to the GKV (worked in my cases — just needed to sign the papers, they sent it on their own).

6. Submit all the necessary documents to the PKV you’re applying to. Sign the agreement which is valid only if you go through risk assessment and agree to the offered conditions (if there are any conditions changed after the risks assessment). Please note that they’re assessing your risks, that means that if they think the risk is too high, they can either offer you a very high insurance cost, or refuse to accept you. You’ll need to provide some standard documents such as passport, Anmeldung (registration), residence permit, etc.

(!) In case you’ve moved from Russia as I did (and some other countries, don’t know where to look the list up) and haven’t been insured in the German health insurance company for at least 18 months (might depend on the PKV — don’t know), they’ll send you for a full health-check before processing your application. In some cases (that was my case too) you have to pay for it on your own. You need to make a general inspection at your Family Doctor / General Practitioner (cost me ~150EUR with different blood tests, etc) and a dentist (didn’t cost me anything, as they just provided data from the last check). PKV will give you special forms which you need to pass to your doctor and then back to PKV. Took me ~4 business days to do that, mostly waiting for the papers back.

7. Wait for the application processing in the PKV risk assessment center (took 5 business days for me).

8. Get an answer and further instructions and documents. Agent is usually very happy to provide you more information on the workflows and further steps.

9. Your new PKV will send information about your new insurance to your previous insurer — GKV (otherwise, they can’t cancel your contract). They’ll also send information to the employer (you’ll need to tell to the HR department that you’ve switched to the PKV, they’ll need some numbers from your documents).

Please note that in case you’re insured with GKV, all monthly payments are deducted from your salary and paid to the insurance company by the employer on your behalf. In case of PKV monthly payments are transferred to you with the salary, and the PKV gets money from you directly (usually via direct debit).

Your employer pays a half of your PKV monthly payment (same for GKV), but not more than 307 EUR monthly (2015 year, changes yearly).

I’d also recommend you this article which also points out many of things I’ve been talking about. There is also a very good web site about all the peculiarities of health insurance in Germany (in German only, of course).

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