Private health insurance in Germany, known as Private Krankenversicherung or PKV, offers individually tailored coverage.
Benefits and limits are defined by the tariff selected at the time of contract, not by a standardized benefits catalog like statutory health insurance.
Guaranteed contract benefits are a central feature of private coverage. Once benefits are agreed upon in the contract, an insurer cannot change them unilaterally.
Adjustments to premiums may occur according to legal and actuarial requirements, but agreed benefits remain contractually protected.
Most insurers offer three main benefit tiers.
Let us take a look at them.
Core Coverage Components
Core coverage components form the foundation of every private health insurance contract in Germany.
Scope and reimbursement levels depend on the tariff selected, yet outpatient care, inpatient treatment, and dental services remain central building blocks in most plans.
Outpatient Medical Care
Outpatient medical care represents one of the most frequently used parts of a private policy. Access to physicians is generally broad and flexible compared to statutory insurance.
General practitioners and specialists are typically accessible without referral requirements in many private tariffs.
Insured individuals often consult dermatologists, orthopedists, cardiologists, gynecologists, and other specialists directly.
Billing follows the German physician fee schedule, known as GOÄ.
Higher level tariffs may reimburse up to 3.5 times the standard GOÄ rates, which allows physicians to apply higher multipliers for complex or time intensive treatments.
- Consultations with general practitioners and medical specialists
- Preventive examinations and follow up visits
- Minor outpatient procedures
- Prescribed medications, depending on tariff rules
Diagnostics and therapies are covered according to the selected tariff.
Laboratory services, imaging procedures such as MRI, CT scans, ultrasound, and X-rays, and therapeutic treatments like physiotherapy are generally included.
Reimbursement limits depend on contract terms and the applicable GOÄ multiplier.
Higher tariffs often accept elevated billing rates, which can expand access to advanced diagnostic methods.
Prescription drugs are typically reimbursed in line with medical necessity. Some tariffs reimburse 100% of eligible medication costs, while others include cost-sharing elements or deductibles.
Alternative medicine may also be part of outpatient coverage.
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- Acupuncture
- Osteopathy
- Homeopathy
Annual financial caps or session limits frequently apply to alternative treatments. Exact reimbursement conditions are defined in the tariff documentation.
Inpatient Hospital Services
Inpatient services address situations that require hospitalization, surgery, or extended medical monitoring. Level of comfort and physician choice depend heavily on the tariff category.
Hospital stays and surgical procedures are covered under inpatient benefits.
Treatment may take place in public or private hospitals, as long as facilities are recognized and treatment is medically necessary.
Reimbursement generally includes hospital accommodation, operating room costs, anesthesia, physician services, and required medical supplies.
Higher-level tariffs often include additional comfort options, referred to as Wahlleistungen.
Basic tariffs may restrict hospital accommodation to standard shared rooms and assign treatment to on-duty hospital physicians.
Pre and post-hospital services are sometimes included as part of inpatient coverage. These may cover preoperative examinations or short-term follow-up visits connected to hospitalization.
Transport coverage may apply in cases of medical necessity. Ambulance services to the nearest suitable hospital are often reimbursed.
Some plans also include medically required return transport to Germany after treatment abroad.
Reimbursement ceilings, approval requirements, and geographic limitations depend on tariff conditions.
Dental Coverage
Dental coverage forms a separate but essential component of most private health insurance plans. Scope of reimbursement can vary widely between Basic, Comfort, and Premium tariffs.
Routine dental services typically include preventive and minor restorative care.
- Dental checkups
- Professional cleanings
- Fillings and simple restorative procedures
- Diagnostic X rays
Reimbursement percentages differ by tariff. Higher level plans may reimburse 80% to 100% of eligible costs, while Basic tariffs may reimburse lower percentages or apply annual limits.
Prosthetics and implantology represent a major cost factor in dental treatment. Premium tariffs often reimburse high-quality materials, laboratory work, and advanced implant procedures at elevated rates.
Coverage may include crowns, bridges, dentures, and implant-supported restorations.
Basic tariffs may impose monetary caps, reduce reimbursement percentages, or exclude implantology entirely.
Waiting periods commonly apply to extensive dental procedures.
Approximately eight months is standard for prosthetics, crowns, implants, and complex restorative work.
Preventive services and minor treatments may have shorter waiting periods or none at all, depending on contract provisions.
Plan Features That Affect Coverage
Structural elements of a private policy influence how benefits function in daily practice.
Tariff level, geographic validity, provider access, and premium calculation shape overall value.
Tariff Benefit Levels
Basic plans focus on essential benefits and lower premiums. Comfort and Premium tariffs expand reimbursement levels and hospital privileges.
Because tariff differences significantly affect long-term costs and coverage quality, many applicants seek independent advice from Audelio to compare options before choosing a plan.
- Increased GOÄ multipliers, up to 3.5 times standard rates
- Enhanced inpatient room options
- Broader dental reimbursement percentages
The scope of services directly affects monthly premium amounts.
Geographic Scope
Coverage is valid throughout Europe in most contracts.
Temporary worldwide protection is commonly included, often limited to a set number of months per trip outside Europe.
Extended stays abroad may require notification or additional coverage arrangements.
Choice of Provider
Free choice of doctors and hospitals is a significant feature of private insurance.
Insured individuals generally select physicians and clinics without referral restrictions, provided treatment is medically necessary and recognized under the tariff terms.
Premium Calculation
Premiums are calculated using risk based principles.
Age at entry and health status at application play a central role in pricing. Income level does not determine contribution amounts.
- Selected tariff level
- Chosen deductible amount
- Optional benefit modules
Individual underwriting applies at the time of application, and accepted risk conditions influence long term premium structure.
Optional and Supplemental Benefits
Optional and supplemental benefits expand coverage beyond core medical services. Availability and scope depend on the tariff selected.
Preventive Care
Preventive care plays an important role in early detection and long-term health maintenance. Private tariffs often include screenings and examinations that exceed statutory minimum requirements.
Vaccinations generally cover routine and age-appropriate immunizations. Travel vaccinations may also be reimbursed, subject to annual caps or defined financial limits.
Psychotherapy and Mental Health Care
Mental health services are frequently included but structured with clear contractual limits.
Psychotherapy coverage typically requires prior approval by the insurer.
Contracts often define a maximum number of sessions per calendar year or per treatment case.
Reimbursement amounts depend on tariff level and GOÄ billing rates.
Higher tariffs may allow reimbursement at elevated multipliers, while Basic tariffs may restrict session numbers or reimbursement percentages.
Medical Aids and Remedies
Medical aids, referred to as Hilfsmittel, support recovery, mobility, and daily functioning.
Covered items may include wheelchairs, prosthetic limbs, hearing aids, orthopedic braces, and compression devices.
- Open coverage for all medically necessary aids, subject to medical prescription
- Fixed catalogs listing specific approved devices, sometimes combined with financial caps
- Choice of tariff determines level of flexibility and reimbursement limits.
Rehabilitation and Follow-Up Care
Rehabilitation can be critical after serious illness, surgery, or injury. Some private plans include inpatient or outpatient rehabilitation following hospital discharge.
- Maximum duration of inpatient rehabilitation stays
- Approved rehabilitation facilities
- Financial caps per treatment episode
Scope varies significantly between Basic and Premium tariffs.
Coverage Outside Germany
International protection is an important feature for many policyholders. European coverage is generally included across most tariffs without time limitations for temporary stays.
Worldwide coverage outside Europe is often limited to a defined period per trip. Common limits range between one and six months.
Long-term stays outside Europe may require separate international health insurance or an extension of existing coverage.
Approval requirements and reimbursement limits depend on tariff rules.
Summary
Private health insurance plans in Germany are contract-specific and defined by the selected tariff.
- Preventive care
- Mental health treatment
- Rehabilitation
- Temporary international protection
Benefit scope, reimbursement levels, waiting periods, and premiums depend on tariff selection and individual risk factors established at entry into the contract.