Private Krankenversicherung | Spezialist Dehua Chen

Dehua Chen
Specialist for Health Insurance
02.04.2020

Private Health Insurance

Every employee who regularly earns above the annual income threshold (JEAG) can switch to private health insurance (PKV). As of 2023, the JEAG is set at a gross annual salary of €66,600. In addition, the self-employed, freelancers, civil servants, and civil servant trainees can take out private insurance regardless of income.

Private health insurance is a privilege. The advantage lies in the fact that the insured person can choose comprehensive and individualized medical care. Private health insurance scores with shorter waiting times for doctor’s appointments or treatments by specialists. These are just two of the many advantages private health insurance offers.

Private health insurance can offer a wide range of benefits. On the one hand, it provides strong services, and on the other, affordable premiums. Of course, unlike statutory health insurance, private health insurance does not only have advantages. The disadvantages must also be considered. Here, life planning and the insured person’s health condition play an important role. A decision for private health insurance should not be made lightly. Therefore, seeking professional and competent advice is highly recommended.

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Who Can Take Out Private Insurance:

✔ Employees with a gross income above the annual income threshold of €66,600 (as of 2020)
✔ Self-employed
✔ Freelancers
✔ Athletes
✔ Civil servants and civil servant trainees
✔ Students
✔ Children

The Target Group

Private Health Insurance for Every Profession.

Bild als dekoratives Element zur Finanzberatung

Plans for the Self-Employed

- As a self-employed person, you can choose private health insurance right from the start. There are entry-level plans that are affordable yet still provide strong benefits.

- You can also secure an additional option called the switch option. This allows you to move into a better plan later without new health checks.

- You can benefit from bonus programs. If you don’t submit invoices, you can receive up to 45% of your premiums back.

Private Health Insurance for the Self-Employed

Plans for Employees

- As an employee, you can switch to private health insurance if your regular gross income is above the JEAG annual income threshold. This was €62,550 in 2020.

- The advantage for you: your employer usually covers half of your premium, up to the maximum employer contribution.

- With premium relief tariffs, which are also subsidized by employers, your premiums can be reduced in retirement.

Private Health Insurance for Employees

Plans for Civil Servants

- As a civil servant or civil servant on probation, your employer pays you a subsidy (Beihilfe) in case of illness. However, this does not cover all medical expenses. To close the gap, we recommend a supplementary subsidy plan.

- Affordable and high-performing for civil servants on probation.

- Mandatory acceptance (obligation to contract) applies if the application is submitted within 6 months after official appointment as a civil servant.

Private Health Insurance for
Civil Servants

The Advantages of Private Health Insurance

The benefits of private health insurance can be tailored individually to personal needs. For example, if you want treatment by the chief physician, specialists, or higher coverage for dental prosthetics in the event of a hospital stay, you can customize it accordingly.

A financial test by Stiftung Warentest found that good private health insurance providers cover (almost) everything prescribed by a doctor in outpatient, inpatient, and dental care. The article also mentions that the biggest difference between private and statutory patients lies in hospital care. The decisive factor here is not single or double rooms, but rather the right to be treated by the chief physician or a specialist. Some insurers even cover fees above the official GOÄ (fee schedule for doctors), meaning exceptionally high doctor or hospital bills are also paid.

For civil servants, choosing private health insurance makes absolute sense. For everyone else, it should be carefully considered whether switching to private health insurance is worthwhile, and above all, which private insurer to choose. This depends on the situation. Main factors include health status, pre-existing conditions, age, marital status, life planning, and wishes for retirement. If many people were to set aside the premium savings from private insurance compared to statutory insurance right from the beginning and invest them profitably and long term, private health insurance could be essentially free in retirement. If you are interested in private health insurance, you should definitely seek comprehensive advice.

The earlier you decide, the better!

You should always get thorough advice. Private health insurance or statutory health insurance? If you are interested, you should decide quickly. The earlier you switch to private health insurance, the more reserves you build up for retirement.

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Info

Benefits Are Contractually Agreed

The scope of benefits in private health insurance is contractually guaranteed. Covered services cannot be reduced by the insurer.

The amount of your premium depends on the scope of benefits agreed upon. In private health insurance, the rule applies: the better the benefits, the higher the premiums. Premiums can be reduced through higher deductibles. The deductible determines up to which amount the insured person pays their own bills. For those who rarely visit the doctor in the long run, a plan with a higher deductible is worthwhile. For employees, however, it often makes more sense to choose a lower deductible, since the employer usually covers almost half of the insurance premium. The deductible, on the other hand, is paid entirely by the insured.

The Most Important Benefits

Outpatient Benefits

General practitioner treatments as well as specialist treatments are often covered 100%. Some plans differ, for example with the “family doctor principle,” which means you must be referred to a specialist by your GP, similar to statutory health insurance. With better plans, you can go directly to a specialist. There are also differences in the German medical fee schedule (GOÄ). Good plans even cover fees beyond the 3.5x rate of the GOÄ. All prescription medications, as well as subsidies for visual aids, are covered by private health insurance.

Inpatient Benefits

If a hospital stay becomes necessary, private health insurance allows you to decide whether you want treatment by the chief physician or a specialist. Do you prefer a single, double, or shared room? Here, you can choose freely. There are also good plans that cover costs beyond 3.5 times the standard medical fee schedule (GOÄ). If medically necessary, these can be paid by private health insurance with prior approval.

Dental Benefits

Private health insurance is significantly better when it comes to dental care. Very good plans cover 90% of dental treatment costs as well as 75% of the costs for more expensive dental prosthetics. Some plans even cover dental services beyond 3.5 times the standard fee schedule for dentists (GOZ). When choosing private health insurance, it’s important to pay attention to the dental benefit scale. It’s also advisable to choose a plan without annual or long-term benefit limits.

Beitragsentlastungstarife

Every private health insurance provider offers the option of contribution relief plans. These guarantee benefits such as a fixed reduction of premiums (e.g., €400 less starting at age 63, 65, or 67) or a guaranteed percentage reduction of premiums in old age. These contribution relief options are especially worthwhile for employees who have not yet reached the maximum deductible contributions — since in this case, the employer pays half of the premium. In retirement, however, the employer no longer contributes to the premiums.