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The Basic Tariff in Private Health Insurance (PKV): Benefits, Costs, and Target Groups
Private Health Insurance (PKV) is legally obligated to offer a social tariff as a safety net: the Basic Tariff. It is a statutorily anchored tariff option that ensures insured individuals do not lose their insurance coverage even in financial emergencies.
The Basic Tariff is designed as a legal solution for situations where regular premiums can no longer be afforded. This article explains the exact function of this social tariff. First, the basic benefit features will be explained, then the legal regulations for premium amounts will be analyzed, and finally, the target groups for whom the Basic Tariff is designed will be described.
1. Basics: The Function of the Basic Tariff
The Basic Tariff is a legally regulated social tariff within the PKV. It is designed as a safety net for privately insured individuals who can no longer afford their premiums in regular tariffs or who require basic, guaranteed protection for other reasons. In addition to the Basic Tariff, other social tariffs exist, such as the Standard Tariff (for long-standing customers) and the Emergency Tariff (for premium arrears).
The Legal Entitlement
Every person who must be or is insured in the PKV has a legal entitlement to be admitted to the Basic Tariff of their own or another company. Unlike regular PKV tariffs, where admission depends on a health check, acceptance into the Basic Tariff is guaranteed without a health check and without exclusions of benefits or risk surcharges.
2. Detailed Analysis: Benefits and Cost Limitation
The special features of the Basic Tariff lie in its strict regulation, which defines both the scope of benefits and the maximum premium amount.
Benefits at the Level of Statutory Health Insurance (GKV)
The scope of benefits in the Basic Tariff is legally linked to the benefits of Statutory Health Insurance (GKV). It offers comprehensive insurance coverage that is comparable to GKV benefits in type, scope, and amount.
The GKV scope of benefits is defined in the Social Code Book V (SGB V) and is subject to the efficiency requirement (§ 12 SGB V). Individual benefits that can be chosen in classic PKV tariffs (e.g., chief physician treatment, single room, or dental prosthetics beyond standard provision) are not included in the Basic Tariff.
Costs: The Statutory Premium Cap
The premium in the Basic Tariff is strictly limited by law:
The premium must not exceed the maximum premium of Statutory Health Insurance (GKV).
The amount of this GKV maximum premium is based on the contribution assessment ceiling (BBG) and the applicable contribution rates. For the year 2025, the calculation is as follows:
BBG: €5,775 per month
Health Insurance Contribution: €5,775 * (14.6% general contribution rate + 1.7% average supplementary contribution) = €941.33
Long-term Care Insurance Contribution (childless): €5,775 * 4.0% = €231.00
Capped Maximum Premium 2025: approx. €1,172.33
The limits and contribution rates are adjusted annually. The final figures for the year 2026 are expected to be determined in the autumn of 2025 based on wage development.
Special Regulation for the Needy
A significant social component concerns individuals who are demonstrably in need (e.g., recipients of Bürgergeld):
The insurer is legally obligated to reduce the premium by half.
The responsible social welfare office (e.g., the Jobcenter) covers the remaining premium.
This can reduce the actual premium burden for the insured person to zero Euros.
3. Target Groups and Use Cases
The Basic Tariff is primarily designed as a social safety net and is suitable for specific situations:
Individuals in Financial Distress: It is an option for privately insured individuals whose premiums are no longer affordable, even with the use of other mechanisms (such as internal tariff changes).
The Needy: It is the statutory safety net for insured individuals eligible for social benefits.
Late Entrants with Pre-existing Conditions: Since no health check is required, the Basic Tariff offers an entry option for individuals who would be rejected in regular PKV tariffs due to age or severe pre-existing conditions, or who would only be insured with very high risk surcharges.
4. Alternatives Before Switching to the Basic Tariff
Before considering the Basic Tariff, privately insured individuals should check if other measures to reduce premiums are possible while maintaining a higher level of benefits:
Internal Tariff Change: The statutory tariff change right according to § 204 VVG allows switching to a cheaper tariff (e.g., with a higher deductible) within their own insurance company. The accumulated reserves for old age remain fully preserved.
Review of Benefits: Switching to a tariff without comfort benefits (e.g., chief physician treatment) can reduce the premium.
Deductible Adjustment: Increasing the deductible leads to a reduction in the monthly premium.
FAQ: Frequently Asked Questions
Can I switch to the Basic Tariff if I lose my job?
Yes, the legal entitlement to admission to the Basic Tariff exists regardless of professional situation.
What are the disadvantages of the Basic Tariff compared to regular PKV tariffs?
The Basic Tariff only offers benefits at the GKV level. Switching from a more comprehensive PKV tariff therefore usually involves a reduction in benefits (e.g., for elective hospital treatments or dental prosthetics).
Summary: Key Takeaways
Definition: The Basic Tariff is a legally regulated social tariff in the PKV with a guaranteed right of admission.
Cost Limitation: The premium is capped at the maximum GKV premium.
Benefits: The scope of benefits is comparable to that of the GKV.
Social Safety Net: For individuals proven to be in need, the premium can be reduced to zero Euros.
Recommendation: Before switching to the Basic Tariff, the internal tariff change right according to § 204 VVG should be considered, as it preserves old-age reserves and allows for premium reduction in a tariff with potentially higher benefit levels.