Why PKV Requires a Health Check
Unlike statutory insurance (GKV), which must accept everyone at an income-based contribution, private health insurance (private Krankenversicherung, PKV) prices each policy individually based on risk. To do that, insurers ask applicants to complete a health assessment (Gesundheitsprüfung) — a questionnaire about your medical history. The answers determine whether you are accepted, and on what terms.
The golden rule: answer every question fully and truthfully. Withholding or misstating information can let the insurer reduce benefits, add surcharges retroactively, or even rescind the contract years later when you make a claim.
What the Questionnaire Asks
Health questions typically cover a defined look-back period — often the last three years for outpatient treatment and up to ten years for inpatient or psychotherapy treatment. Expect questions on:
- Chronic illnesses and ongoing treatments
- Past operations and hospital stays
- Psychotherapy or mental-health treatment
- Regular medication
- Current complaints and planned procedures
- Dental status (for dental cover)
Possible Outcomes
Based on your answers, an insurer may respond in one of four ways:
| Outcome | What it means |
|---|---|
| Standard acceptance | Normal premium, full cover |
| Risk surcharge (Risikozuschlag) | A higher premium reflecting elevated risk |
| Exclusion (Leistungsausschluss) | A specific condition is not covered, premium otherwise normal |
| Rejection | The application is declined |
Importantly, different insurers assess the same history differently, so a condition that triggers a surcharge at one company may be accepted at standard rates elsewhere. This is a strong reason to compare across insurers rather than applying to just one.
Handling Pre-Existing Conditions
A pre-existing condition does not automatically bar you from PKV. Options include accepting a modest surcharge, agreeing a targeted exclusion, or choosing an insurer whose underwriting is more favourable for your particular history. For more complex cases, an anonymous pre-enquiry (anonyme Risikovoranfrage) lets an adviser test how insurers would respond without creating a formal application record — which matters, because declined applications can themselves complicate future applications.
Practical Tips Before You Apply
- Request your records — obtain your doctor's notes so your answers match what is documented
- Be precise — describe conditions accurately rather than guessing or downplaying
- Use a pre-enquiry — let an adviser sound out insurers anonymously first
- Apply while healthy and young — the cleaner your history and the younger your entry age, the better your terms
Done carefully, the Gesundheitsprüfung is simply the gateway to a policy priced fairly for your situation. Done carelessly, it can undermine your cover exactly when you need it — so take the time to get it right.
Frequently Asked Questions
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