This article was translated from the original human-written German version. While we strive for accuracy, we cannot guarantee it is error-free. We recommend consulting the German original for the most precise information. This content is for informational purposes only and does not constitute financial or legal advice. Always consult with a qualified professional before making insurance or financial decisions.
Contribution Increase in Private Health Insurance (PKV): Your Options and the Path to Relief
This article explains the reasons for contribution adjustments in private health insurance (PKV). We will shed light on the legally regulated background and show you the concrete options for managing and reducing your contributions in the event of a PKV contribution increase.
1. Basics: Reasons for Contribution Adjustments in the PKV
To understand the options during a contribution increase, one must know the fundamental way the PKV works. Unlike statutory health insurance (GKV), which operates on a pay-as-you-go system, the PKV is based on the funded system.
The Principle of Old-Age Reserve
A significant portion of your contribution is set aside from the beginning as an old-age reserve. These reserves are intended to compensate for the expected rising healthcare costs in old age, so that your contribution does not increase significantly solely due to aging.
Despite this provision, contribution adjustments are unavoidable in both systems – GKV and PKV. The main reasons are:
Medical and technological progress: New and improved diagnostic and treatment methods lead to higher treatment costs.
Increasing life expectancy: People are living longer, which increases the duration of benefit utilization.
General cost increases in healthcare.
Important: A contribution increase due to an individual illness is contractually and legally excluded. Adjustments are always made for an entire tariff and must be approved by an independent trustee.
2. Detailed Analysis: Your Options During a Contribution Increase
If you receive a notification of a contribution adjustment, several paths are open to you, which should be carefully considered.
Option 1: Internal Tariff Change According to § 204 VVG
This is often the most effective option. The law grants you the right to switch to another tariff with equivalent insurance coverage within your insurer. The decisive advantage: Your accumulated old-age reserves are fully credited. Possible change options include:
Switching to a newer, possibly cheaper tariff.
Switching to a tariff with reduced benefits.
Switching to a tariff with a higher deductible.
Option 2: Adjusting the Deductible in the Existing Tariff
Many tariffs offer different deductible levels. By choosing a higher level, you can directly reduce your contribution. A later reduction of the deductible often involves a new health assessment.
Option 3: Utilization of Contribution Reduction Tariffs
Some insurers offer special tariffs for contribution reduction in old age. If you have concluded such a tariff, the accumulated funds can be used to cushion contribution increases in retirement or to specifically reduce the contribution.
Option 4: Switching to the Standard or Basic Tariff
For policyholders who switched to the PKV before 2009, there is the standard tariff. For all others, the basic tariff is available.
Benefits: The scope of benefits is comparable to that of the GKV.
Contribution: The contribution must not exceed the maximum GKV contribution. In cases of proven need, it can be reduced or covered by the social assistance provider.
Switching to these tariffs often involves a significant reduction in benefits compared to the original tariff and should therefore be carefully considered.
3. Recommendations for Action: How to React Correctly
A contribution increase is the ideal time to review your insurance coverage.
Checklist for Your Procedure:
Observe deadlines: After receiving the notification, you have a special right of termination. However, do not act hastily. Changing insurers is usually the worst option, as you lose your old-age reserves (especially with old contracts).
Analyze needs: Which benefits are truly important to you? What could you do without?
Request offers: Contact your insurer and actively request proposals for an internal tariff change (§ 204 VVG).
Think long-term: Short-term savings can be more expensive in the long run if important benefits have to be paid for privately later.
FAQ: Frequently Asked Questions
Will I lose my old-age reserves if I change tariffs internally? No, when changing within your company, the accumulated reserves are fully credited.
Is changing insurers worthwhile? In most cases, no, because changing providers means losing old-age reserves in whole or in part and requires a new health assessment.
Summary: The Most Important Key Messages
Contribution increases are regulated: They are a consequence of cost increases in the healthcare system and are not arbitrary.
You have active options: You have legally established rights to react to an adjustment.
Internal tariff change is the strongest option: According to § 204 VVG, you can switch to a cheaper tariff without losing your old-age reserves.
Act deliberately: A hasty change of provider is almost always associated with financial disadvantages.
Use a contribution adjustment as an opportunity to optimize your insurance coverage. Well-founded, neutral advice can help you find the best solution for your situation.