Contents (9 sections)
- Private health insurance in Germany with pre-existing conditions: how underwriting works
- The health questions: what you must disclose
- The possible outcomes – and what they mean
- Risk surcharges: how they work and what they cost
- Why an anonymous pre-application check comes first
- If the answer is no: your alternatives
- After you sign: what can and can't change
- Newcomers: health records from abroad and later moves
- When public insurance is the simpler route
- Private insurers in Germany ask health questions in the application; you must disclose everything they ask about in text form until you sign (§ 19 VVG).
- Depending on the answers, an insurer can accept you as you are, with a risk surcharge or an exclusion, defer or decline the application; there is no legal maximum for surcharges in normal tariffs, only the rule that they must be appropriate (§ 203 VVG).
- An anonymous pre-application check through a broker lets several insurers assess your situation without your name and without a formal application.
- Every private insurer must offer the basic tariff without risk surcharges; its premium is capped at the public maximum – €1,017.18 a month in 2026 (PKV association).
- Public insurance asks no health questions – for many newcomers with a health history it is the simpler route.
With pre-existing conditions, private health insurance in Germany is often still possible – frequently with a risk surcharge or an exclusion. The insurer decides after the health questions in the application, which you must answer completely (§ 19 VVG). An anonymous pre-application check through a broker shows how several insurers would decide before you apply, and the basic tariff remains as a fallback without risk surcharges (as of October 2026).
No health questions on this website.This page only explains the process. We never ask about your health online – not in the decider, not in the calculators, not in our forms. Health information is only discussed in a personal consultation with a specialised expert from our partner network, with your separate, explicit consent.
Private health insurance in Germany with pre-existing conditions: how underwriting works
Private health insurance (private Krankenversicherung, PKV) prices your individual risk at the start. That is why every application includes health questions – the underwriting or health assessment (Gesundheitsprüfung). Public health insurance (gesetzliche Krankenversicherung, GKV) asks none.
1. Application with health questions
The insurer asks in writing about certain treatments, diagnoses and medication within set periods. Many applications ask about outpatient treatment in the last three years and hospital stays in the last five to ten years (Allianz); the exact periods differ between insurers.
2. Assessment by the insurer
The insurer evaluates your answers and, only with your consent, may request information from doctors or hospitals (§ 213 VVG).
3. Decision
Acceptance without restriction, with a risk surcharge, with an exclusion, a deferral – or a rejection.
4. Policy
Any surcharge or exclusion is written into your insurance policy. Check it before your withdrawal period ends.
The health questions: what you must disclose
The legal rule is clear: you must disclose all circumstances you know of that the insurer has asked about in text form – up to the moment you sign your application. If the insurer asks further questions before it accepts you, these count as well (§ 19 (1) VVG).
- The wording of the question decides. You must answer what is asked, for the period that is asked.
- Not asked, not required – but deliberately concealing something remains open to challenge (§ 22 VVG).
- Language is no excuse. If an application is in German, make sure you understand every question before you answer – see private health insurance in English.
- Documents help. You can ask your doctors for a copy of your records – the first copy is free of charge (§ 630g BGB) – and your public fund for information about the services it paid for (§ 305 SGB V).
If an answer was wrong or incomplete, the insurer's rights depend on fault: withdrawal in cases of intent or gross negligence, otherwise cancellation or an adjustment of the contract, for example a retroactive surcharge (§ 19 (2)–(4) VVG). In health insurance, an adjustment is excluded if you were not at fault (§ 194 VVG). The insurer only has these rights if it warned you about the consequences in a separate notice in text form (§ 19 (5) VVG).
The possible outcomes – and what they mean
| Outcome | What it means | What you can do |
|---|---|---|
| Acceptance without restriction | Normal premium, full tariff benefits | Check the policy and keep your application copy |
| Risk surcharge (Risikozuschlag) | A percentage on top of the premium for a higher risk | Compare with other insurers; later ask for a reduction if the reason no longer applies |
| Exclusion (Leistungsausschluss) | Certain treatments are not covered | Weigh the exclusion against a surcharge elsewhere |
| Deferral | The insurer decides later, for example after a treatment has ended | Keep your current cover until there is a decision |
| Rejection | No contract in normal tariffs with this insurer | Other insurers, an exclusion, the basic tariff – or public insurance |
Except in the basic tariff, the law allows insurers to agree an appropriate risk surcharge or an exclusion for a higher risk (§ 203 (1) VVG). There is no fixed legal maximum for normal tariffs.
Risk surcharges: how they work and what they cost
A risk surcharge is set as a percentage of the premium when you join. The PKV association describes it as a percentage surcharge that may only be charged at the start or when you change to a tariff with more benefits. The percentage stays stable, but because it applies to the premium, the euro amount rises with every premium adjustment (§ 203 (2) VVG).
How high it is depends on the individual case. As an orientation only: guides by consumer sites and brokers often mention around 10–20% or 15–30% of the premium (Finanztip; transparent-beraten.de, September 2026). One insurer illustrates a 25% surcharge as a premium of €800 rising to €1,000 (Allianz). These are experience values from guides – not a statistic, and not a forecast for you.
A surcharge can be reduced later.If the circumstances that led to a surcharge no longer apply, you can ask the insurer to reduce the premium appropriately from the date of your request (§ 41 VVG). Insurers usually ask for medical evidence.
Why an anonymous pre-application check comes first
A formal application that ends in a rejection can follow you: many application forms ask whether you were ever declined or deferred elsewhere. A pre-application check through a broker (anonyme Risikovoranfrage) avoids this. Here is how it usually works:
1. First consultation
Without health details: your status, goals, timing and budget. Free of charge.
2. Consent and documents
Only with a broker agreement and your separate, explicit consent to process health data. You collect records, doctors' letters and your fund's information.
3. Questions answered together
Through a secure channel – never through a website form.
4. Pseudonymised enquiry
The broker asks several suitable insurers how they would decide – without your name and without an application.
5. Compare the answers
Acceptance, surcharge, exclusion, deferral or rejection – side by side. According to broker guides, insurers often answer within five to ten working days; collecting documents can take some weeks.
6. Formal application
Only with the insurer you chose – with exactly the same, complete information.
“Anonymous” here means without your name and without a formal application; strictly speaking, the data is pseudonymised. A detailed German-language source on this process: Pre-existing conditions: anonymous pre-check (in German).
If the answer is no: your alternatives
- Another insurer: insurers assess risks differently. The PKV association itself names other insurers and agreed exclusions as alternatives after a rejection.
- The basic tariff (Basistarif): every private insurer offering full cover must provide it, with benefits comparable to public insurance and without risk surcharges (§ 152 VAG). Its premium is capped at the public maximum – €1,017.18 a month in 2026 (PKV association). Access is restricted to certain groups and deadlines.
- Public insurance: no health questions at all. If you are an employee below the income threshold, you are in public insurance by law anyway. In your first job in Germany, public insurance stays open for three months even above the threshold (§ 9 (1) no. 3 SGB V) – see private health insurance for employees.
- Civil servants: many insurers accept newly appointed civil servants on special opening conditions within six months, with surcharges of at most 30% (PKV association).
After you sign: what can and can't change
| Question | Rule |
|---|---|
| You fall ill after signing | Your individual premium and cover don't change because of it |
| Can the insurer cancel your full cover? | Not in the ordinary way (§ 206 VVG) |
| Premiums of your tariff rise | Possible for everyone in the tariff; a surcharge rises proportionally |
| A mistake in the application comes to light | Insurer must act within one month of learning of it; rights usually expire after three years, after ten years in cases of intent or fraud |
| Reason for a surcharge no longer applies | You can ask for a reduction from the date of your request (§ 41 VVG) |
Newborns are a special case: if a parent is privately insured, the insurer must cover the child without surcharges and waiting periods when registered within two months of the birth (§ 198 VVG) – more in private health insurance with a family.
Newcomers: health records from abroad and later moves
For international professionals, two practical points come up again and again:
- Records from your home country. Health questions refer to your history within the periods asked – not to the country where you were treated. If a question covers treatment you had abroad, it has to be answered as well. Records from abroad can take weeks to obtain and may need a translation, so request them early, ideally before you move.
- Leaving Germany for a while. If you are already privately insured and move abroad temporarily, a small dormant policy (Anwartschaft) keeps your health status – you don't face new health questions when you return. According to Allianz it costs about 5 to 10% of the previous premium. If you cancel instead and come back later, you apply again with your then health history. Details: leaving Germany with private health insurance.
When public insurance is the simpler route
Public insurance doesn't ask about your health, doesn't charge surcharges and covers family members without income free of charge. For newcomers with a health history who have the choice, that is a serious argument – especially if the stay in Germany is limited or a family will follow. If you are eligible and private insurance still interests you, the pre-check shows the real terms before you commit.
The general comparison is in public vs private health insurance in Germany; the steps of a switch are in switching from public to private. The 60-second decider works without any health questions and tells you whether private insurance is worth a closer look at all.
Frequently asked questions
Can I get private health insurance in Germany with a pre-existing condition?
Often yes – frequently with a risk surcharge or an exclusion for certain treatments. Whether and on which terms an insurer accepts you depends on the individual case. If no insurer accepts you in a normal tariff, the basic tariff remains, which insurers must offer without risk surcharges.
How does underwriting work in German private health insurance?
The insurer asks health questions in the application, usually about treatments, diagnoses and medication within certain periods. Based on your answers it accepts you without restrictions, with a surcharge or an exclusion, defers or declines. You must answer everything it asks completely and truthfully (§ 19 VVG).
How high is a risk surcharge in private health insurance?
There is no legal maximum in normal tariffs – it must be appropriate (§ 203 VVG). Guides by brokers and consumer sites often mention surcharges of around 10–30% of the premium; this is an experience value, not a statistic and not a forecast for any individual case. The percentage usually stays the same, so in euros it rises with every premium increase.
What is an anonymous pre-application check (Risikovoranfrage)?
A broker sends your health information without your name and without a formal application to several insurers and asks how they would decide. You can then compare the answers and apply only where the terms fit. Strictly speaking the data is pseudonymised, not anonymous in the data protection sense.
What happens if I forget to disclose something in the application?
Depending on fault, the insurer may withdraw from the contract, cancel it or adjust it, for example with a retroactive surcharge (§ 19 VVG). In private health insurance these rights usually expire three years after the contract was concluded, and after ten years in cases of intent or fraud (§ 21, § 194 VVG). If you notice a mistake, get advice quickly.
Will my private premium rise if I get ill after signing?
No. Illnesses that occur after you sign do not change your individual premium or cover, and the insurer cannot cancel a full private health insurance in the ordinary way (§ 206 VVG). Premiums can still rise for everyone in your tariff when medical costs rise.
Sources
- § 19 VVG – duty to disclose before conclusion
- § 21 VVG – deadlines for the insurer's rights
- § 194 VVG – special rules for health insurance (three-year period)
- § 203 VVG – risk surcharge, exclusion, premium adjustment
- § 41 VVG – reduction of the premium
- § 206 VVG – no ordinary cancellation by the insurer
- § 152 VAG – basic tariff
- PKV association: maximum premium of the standard and basic tariff 2026
- PKV association: rejection and cancellation
- PKV service portal: glossary – risk surcharge
- PKV service portal: does my premium rise if I fall seriously ill?
- § 22 VVG – fraudulent misrepresentation
- § 213 VVG – collection of health data from third parties
- Allianz: private health insurance despite pre-existing conditions (look-back periods, surcharge example) – insurer information, updated 28 September 2026
- Finanztip: lowering private health insurance premiums (typical surcharges) – secondary source
- transparent-beraten.de: risk surcharge in private health insurance – broker guide, 4 September 2026 (secondary source)
- § 630g BGB – inspection of medical records
- § 305 SGB V – information from your public health insurance fund
This article provides general information on health insurance in Germany (as of 13 October 2026). It does not replace individual advice. Which solution suits you depends on your personal situation, e.g. age, health, income, family and length of stay. Despite careful review we cannot guarantee completeness and accuracy; laws and tariffs change. It is not immigration advice: whether your insurance is sufficient for a visa or residence permit is decided by the German mission abroad or your immigration office. Publisher: German-PKV.de. German-PKV.de is not an insurance broker and does not provide insurance, legal or tax advice; individual advice is provided exclusively by specialised cooperation partners licensed under § 34d GewO.