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.
The Emergency Tariff in Private Health Insurance (PKV): Who Uses It and What It Provides
Private health insurance (PKV) offers individually selectable benefits, with premiums based on personal risk. For insured individuals who fall into financial difficulties and can no longer pay their premiums, there is a legally mandated protection mechanism: the emergency tariff.
This article sheds light on the role and functioning of this tariff within the context of PKV.
1. Fundamentals of the Emergency Tariff in PKV
The emergency tariff is not an optional choice but a legally enshrined tariff (§ 153 VVG) into which PKV insured individuals are automatically transferred if they are in qualified arrears with their premiums (usually after several unsuccessful reminders).
It serves as a final social safety net to fulfill the statutory health insurance obligation, even in case of payment default, and to ensure basic care. It fundamentally differs from other tariff options such as the basic tariff, which can be chosen voluntarily.
2. Who is Transferred to the Emergency Tariff?
The transfer occurs when an insured person fails to pay their premiums for an extended period. The process is regulated by law and includes several reminder stages. Only when the premium debts reach a certain amount is the contract transferred to the emergency tariff. The goal is to maintain insurance coverage while drastically reducing the premium burden for the debtor, allowing them to settle their debts.
3. Benefits and Costs in the Emergency Tariff
Benefits:
The scope of benefits in the emergency tariff is severely restricted and limited to what is medically absolutely necessary. It essentially includes:
Treatment of acute illnesses and pain conditions.
Benefits for pregnancy and maternity.
For children and adolescents, additionally, preventive examinations and vaccinations according to the recommendations of the Standing Vaccination Commission (STIKO).
Chronic diseases are only treated in acute cases. Planned operations or treatments that do not serve to alleviate acute pain are not covered. Doctors are also only allowed to bill according to a reduced rate of the scale of fees (GOÄ/GOZ).
Costs:
The premium for the emergency tariff is significantly lower than in normal tariffs and is typically around 100 to 150 Euros per month. During the period in the emergency tariff, no new old-age reserves are built up. Already accumulated reserves can be used to reduce the premium by up to 25%.
4. Classification Compared to the Basic Tariff
The emergency tariff is not to be confused with the basic tariff:
Feature | Emergency Tariff | |
Access | Automatic upon premium arrears | Voluntarily selectable upon application |
Benefits | Acute and pain treatment only | Comparable to statutory health insurance (GKV) level |
Premium | Approx. 100-150 € / month | Max. GKV maximum premium (2025: approx. 988 € + long-term care insurance) |
No new buildup | Continue to be built up |
5. Recommendations for Action in Case of Payment Difficulties
Due to the severely limited scope of benefits, the emergency tariff should be the last resort. In case of financial bottlenecks, PKV insured individuals should act proactively:
Contact the Insurer: Seek dialogue early to arrange solutions such as deferral or installment payments.
Check Tariff Change: Exercise your legal right (§ 204 VVG) to switch to a cheaper tariff within your company (e.g., with a higher deductible).
Switch to Basic Tariff: Check if switching to the basic tariff is a viable option, as it offers more comprehensive coverage.
Check for Need of Assistance: If receiving citizen's income or social assistance, the premium in the basic tariff can be significantly reduced.
As soon as all premium debts are settled, the contract will be reverted to the original tariff, and full insurance coverage will be restored.
6. Summary
The emergency tariff in PKV is a legally mandated protection mechanism for insured individuals with significant premium debts. It is not an optional choice but an automatic consequence of non-payment. With a very low premium and a scope of benefits drastically reduced to acute cases, it ensures that the insurance obligation is met. However, due to the significant limitations in benefits, it should absolutely be avoided by utilizing other options such as tariff changes early on in case of financial difficulties.