An Exclusion Rather Than a Surcharge
When the health assessment flags a condition, an insurer can respond with a premium surcharge or, sometimes, a Leistungsausschluss, an exclusion that removes cover for treatment related to that specific condition. The rest of your cover is full and normal; only the named area is carved out.
How It Differs From a Surcharge
- A surcharge: you pay more, and the condition is covered. Costs are higher but the risk is insured.
- An exclusion: you pay the standard premium, but treatment for the named condition is not covered, so those costs fall to you.
- Scope: an exclusion should be defined precisely, so check exactly what it does and does not remove.
- Duration: some exclusions can be reviewed later if the condition resolves.
Read the exclusion’s wording carefully: a narrow, precisely defined exclusion may be perfectly acceptable, while a broad one could leave a real gap. The exact scope is what you are agreeing to, so understand it before you sign.
Your Options
If you are offered an exclusion, weigh whether the excluded area is likely to matter for you and how broadly it is drawn. A broker can often place your application with an insurer that offers a surcharge or clean acceptance instead, since insurers assess conditions differently. Where an exclusion was set for a condition that has since resolved, you can ask the insurer to review it. Do not accept a broad exclusion without first testing whether better terms are available elsewhere.
Frequently Asked Questions
Compare PKV Tariffs for Your Situation
Our independent advisors help expats and professionals find the right private health insurance — personalised to your age, health, and budget.
Get My Free Quote