Private Health Insurance in Germany with Pre-Existing Conditions (2026)

Private health insurance (PKV) prices risk. That is why age and health at entry matter so much, and why a pre-existing condition changes what you are offered. This guide explains each possible outcome, and what the law says.

What can a private insurer decide about my health history?

The insurer assesses your answers and then offers one of four outcomes. Outside the Basistarif, it may agree a suitable risk surcharge or an exclusion of benefits for an increased risk (§ 203 Abs. 1 VVG). Whether it accepts at all is the insurer's own decision.

Each insurer calculates differently, so the same history can give a surcharge at one insurer and an exclusion at another. That is the main reason to compare the whole market rather than ask one company.

What counts as a pre-existing condition?

A pre-existing condition is anything the insurer's health questions ask about, not only chronic disease. A fracture that healed without after-effects usually weighs far less than a chronic condition, ongoing medication or psychotherapy. Each question has its own look-back period, and most insurers ask about the last 3 to 10 years (Signal Iduna).

• Healed and finished: a broken bone that healed, a routine check-up with no findings. Often unproblematic, but still answer the question if it falls inside the period.
• Ongoing or recurring: a chronic condition, regular medication or repeated treatment. These raise expected costs and are the usual reason for surcharges or exclusions.
• Psychotherapy: usually has the longest look-back. Even trial sessions can count (see the table).

The look-back periods below come from each insurer's own form or page. They are examples, not a market standard, so always read the form you are given.

Why are private health insurance applications declined?

Private cover is a voluntary contract, so insurers may decline. According to the PKV-Verband, most declines are due to serious pre-existing conditions, and insurers may also run a credit check. A decline by one insurer does not decide the others, because each assesses risk on its own terms. The Basistarif exists for those who qualify.

How honest must I be on the health questionnaire?

Fully honest. You must report the risk circumstances you know about when the insurer has asked for them in text form before you submit your application. If you breach that duty, the insurer may withdraw from the contract (§ 19 VVG). A milder breach lets it terminate with one month's notice.

The questions usually cover hospital stays, operations, current medication, chronic illness and therapy. The form states how far back each question reaches. Collect your records first: names of doctors, dates, diagnoses and medication. A consultant can help you read a question correctly, but never help you leave something out.

Is a surcharge or an exclusion better?

It depends on the condition. A surcharge keeps your cover complete but raises the premium, and that premium is then part of your long-term cost. An exclusion keeps the premium lower but leaves you paying for that condition yourself. Neither is universally better, so ask each insurer for both options.

• Choose a surcharge if the condition may need ongoing or costly treatment you do not want to carry yourself.
• Choose an exclusion if the condition is limited, stable and cheap to treat, or unlikely to recur.
• Ask about reviews. Check whether the insurer will reconsider a surcharge after a period without symptoms. Do not assume it will.

Remember that exclusions can also reduce the value of related benefits. Read the wording of the clause, not only the summary. See our guide to private health insurance costs for how premiums are built.

How big is a risk surcharge, and can it be removed later?

According to Signal Iduna, risk surcharges are usually 10 to 20 percent. That is one insurer's statement, not a market statistic, and the real figure depends on the condition and the insurer. If the reason for the surcharge later disappears, you can ask for a reasonable reduction from the date the insurer receives your request (§ 41 VVG).

The burden of proof is on you, so keep medical evidence that the risk has ended.

Illustrative example: surcharge or exclusion

Illustrative example with a hypothetical premium of €500 a month and the 10 to 20 percent range quoted above. These are not real offers.

The surcharge is paid every year whether or not you need treatment. The exclusion costs nothing until the condition flares up, and then the bill is yours. If the condition is stable and cheap to treat, the exclusion can come out ahead. If it may need costly care, the surcharge protects you.

Can my premium rise because I get ill later?

No. Your premium cannot rise because you personally fall ill (§ 203 VVG). It changes only when claims costs or life expectancy in the whole tariff shift lastingly, and an independent trustee must approve. The PKV-Verband says an individual increase because of an illness does not exist.

Tariff-wide increases do happen, so this is not a promise of fixed premiums. An agreed risk surcharge can also move with the premium if your contract says so.

What is the Basistarif, and can it be my fallback?

The Basistarif is an industry-wide standard tariff with benefits comparable in type, scope and amount to statutory cover. Insurers must offer it to defined groups, including residents without other cover and certain private policyholders (§ 152 VAG). Outside the Basistarif, surcharges and exclusions are allowed. Inside it, health checks are limited to specific purposes (§ 203 Abs. 1 VVG).

• The Basistarif premium may not exceed the GKV maximum contribution, at any deductible level.
• If you would need social assistance because of the premium alone, it is halved for that period.
• An application can be refused only if you were insured with that insurer before and it rescinded the contract for fraud or coercion, or withdrew from it because you intentionally breached the disclosure duty (§ 193 Abs. 5 VVG).

Who qualifies depends on your status, and not every newcomer to Germany does. The tariff is also much narrower than a full private tariff, so see it as a safety net, not a first choice. Our switching guide covers how it fits into the wider decision.

How should I prepare my application?

1. Gather medical records for the period the form asks about, with doctor names and dates.
2. Write down all medication and any ongoing treatment, including therapy.
3. Compare surcharge and exclusion offers, then review the exact clause wording.
4. Do not cancel your current cover until the new policy is confirmed in writing, because everyone resident in Germany must be insured (§ 193 Abs. 3 VVG).

For expats weighing GKV against private cover, see public vs private health insurance in Germany. If your income or job status is the open question, start with who qualifies for private health insurance.

Frequently asked questions

Sources

• § 19 VVG (pre-contractual duty to disclose)
• § 193 VVG (duty to be insured, Basistarif acceptance)
• § 203 VVG (premium, risk surcharge, exclusion)
• § 152 VAG (Basistarif)
• § 41 VVG (premium reduction when the risk ceases)
• PKV-Verband: declined applications and premium calculation
• Look-back periods: Hallesche form VG 10/2E, HanseMerkur form MK 003, Signal Iduna advice page, ottonova health questions

Rules checked in October 2026. This guide is general information, not medical or individual insurance advice. Each insurer decides on its own risk assessment.