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.
Private Health Insurance (PKV): Who Can Get Insured and What Are the Requirements?
Choosing health insurance in Germany is an important decision for certain groups of people. While statutory health insurance (GKV) represents the standard provision, private health insurance (PKV) is only open to a specific group of individuals. This decision depends on clear legal requirements.
This article examines the basic principles of private health insurance and the specific criteria that must be met to be able to obtain private health insurance. We analyze the different target groups – from employees and the self-employed to civil servants and students – and explain the role of the annual income threshold (JAEG) and the health assessment.
1. Fundamentals of Health Insurance Systems in Germany
Two independent health insurance systems exist in Germany: the GKV and the PKV. Both meet the requirements of the insurance obligation.
A. The Solidarity Principle of the GKV
The GKV is based on the solidarity principle. Contributions are based on income, while benefits are based on medical need. In a pay-as-you-go system, current income is used directly to finance current healthcare costs. No old-age reserves are formed. The scope of benefits is legally defined in the Social Code Book (SGB V).
B. The Equivalence Principle of the PKV
The PKV follows the equivalence principle. Benefits are contractually agreed upon, and contributions are based on individual risk (entry age, health status) and the chosen tariff. In a funded system, a portion of the contribution is saved as an old-age reserve to stabilize contributions in old age.
C. The Annual Income Threshold (JAEG) and Contribution Assessment Ceiling (BBG)
Two important thresholds are relevant for the insurance obligation and freedom of choice:
Contribution Assessment Ceiling (BBG): The upper limit up to which contributions to GKV are levied on income.
2025: €69,300 annually (€5,775 monthly).
2026 (Forecast): approx. €72,000 annually.
Annual Income Threshold (JAEG), also known as the insurance obligation threshold: Determines for employees whether they are subject to mandatory insurance in the GKV.
2025: €73,800 annually (€6,150 monthly).
2026 (Forecast): approx. €76,800 annually.
For employees who were already privately insured on December 31, 2002, a special JAEG applies, which corresponds to the BBG (2025: €69,300).
2. Who Can Get Insured in the PKV? Detailed Requirements
The possibility of obtaining private health insurance is linked to specific legal and personal requirements.
A. Employees
For employees, the annual income threshold (JAEG) is the decisive threshold:
Exceeding the JAEG: An employee can obtain private health insurance if their regular gross annual income exceeds the currently applicable JAEG. Regular annual income includes, in addition to the monthly gross salary, one-off payments such as holiday and Christmas bonuses.
Timing of the Switch: If the JAEG is exceeded during the course of a year, the obligation to be insured in the GKV ends at the end of the calendar year. The switch to the PKV is then possible from January 1st of the following year, provided that the income also exceeds the JAEG applicable for the following year.
Change of Employer: When changing employers with a salary above the JAEG, there is immediate insurance exemption and the possibility to enter the PKV.
B. Self-Employed and Freelancers
Self-employed individuals and freelancers are generally exempt from mandatory insurance and can obtain private health insurance regardless of their income level.
C. Civil Servants, Judges, and Temporary Soldiers
These professional groups can also obtain private insurance. Due to the entitlement to the subsidy (a contribution from the employer towards health costs), the PKV is often a financially suitable solution for them, as only the remaining costs need to be insured.
D. Students
Upon enrollment, the obligation to be insured in the student GKV usually begins. However, students can irrevocably opt out of this for the duration of their studies within three months of this obligation beginning, in order to obtain private insurance.
E. Health Assessment and Its Importance
A health assessment is required for admission to the PKV. Insurers may reject an application or charge risk surcharges on the premium due to pre-existing conditions. This is a significant difference from the GKV, which must accept everyone. To avoid rejection, which could be recorded in a central file, an anonymous preliminary risk assessment through an advisor is recommended.
F. Option Tariffs: The Bridge to PKV
For individuals who do not currently meet the requirements for PKV, option tariffs offer a solution. They secure the current health status for a later, exam-free switch to a full PKV tariff.