What is a PCN number health insurance

What is private health insurance?

There is a dual health insurance system in Germany. That means: in addition to statutory health insurance (GKV), private health insurance (PKV) exists as a second system. Depending on the constellation, private health insurance protection is possible instead of or in addition to the statutory health insurance. The following is an overview of the main aspects of private health insurance.


Private health insurers in Germany

PKV is offered in Germany by private insurers specializing in this business. Some of these are companies that operate independently and focus on the health insurance business, and others are subsidiaries with a corresponding focus or affiliated companies of broader insurance groups. The companies are subject to surveillance by the Federal Financial Supervisory Authority (BaFin).

The private health insurers are in PKV association organized as a lobby group. The association has (as of 2020) 42 full members and 8 extraordinary members. About 8.8 million German citizens have a private one Full health insurance , around 26 million private Supplementary health insurance. Insurance is provided through corresponding private law contracts. The regulations of Insurance Contract Act (VVG).

Full health insurance and / or supplementary health insurance

The PKV enables both Full health insurance as well as Supplementary health insurance. Full health insurance coverage is offered in comprehensive health insurance. Supplementary health insurances, on the other hand, are predominantly based on the services of the statutory health insurance and fill gaps in benefits by either adding to the statutory health insurance benefits or offering benefits for which the statutory health insurance does not provide.

Requirements for insurance coverage

In Germany there is basically Compulsory insurance with regard to (full) health insurance. Self-employed, Freelancers, civil servants and private individuals who have not opted for voluntary membership in the GKV therefore need full private health insurance. students can choose between GKV and PKV at the beginning of their studies, but are then bound by their decision for the duration of the studies

At Officials there is the special feature that you only need partial insurance coverage in the private health insurance, since your employer has the Aid bears a significant part of the medical expenses. For this, the insurers offer special Civil service tariffswhich provide for particularly low premiums due to the proportional insurance cover. This makes the private health insurance very attractive for civil servants, even if some federal states provide incentives for voluntary statutory membership in the statutory health insurance.

The situation is different Workers out. As long as the labor income is not the so-called Compulsory insurance limit statutory health insurance coverage is mandatory. An exemption from the statutory insurance obligation and a decision in favor of private health insurance is only possible if you earn beyond the mandatory insurance limit. It is an option for higher paid workers. the compulsory insurance limit is set anew every year and is based on the general income trend.

a Family insurance as in the GKV does not exist in the PKV. that means: every family member needs extra insurance coverage. In contrast to the GKV, there is no obligation to contract in the PKV. Insurers can reject applications for insurance cover, exclude benefits or levy risk surcharges. a Health examination and waiting times are common with new insurance relationships.

Once you have decided on private full health insurance, you can only return to GKV under certain constellations. A return is hardly possible beyond 55.

In contrast to private full health insurance, there are no access restrictions with private supplementary health insurance. In principle, they can be completed by anyone and are voluntary. With regard to the acceptance of applications, health checks and waiting times, the same applies as for full health insurance.

Private health insurance benefits

The benefits of private comprehensive health insurance are generally above the level of benefits provided by private health insurance, but also depend on the tariff chosen. Many tariffs have a modular structure. This means: insured persons can assemble their insurance cover themselves according to the modular principle, whereby a minimum protection which corresponds to the performance level in the GKV is always guaranteed. More services automatically mean higher contributions and vice versa.

With supplementary health insurance, a very specific health risk is insured, the scope of the benefits in turn depending on the respective tariff. the most common supplementary health insurances are:

  • Supplementary dental insurance;

  • inpatient supplementary insurance (for optional services in hospitals);

  • various outpatient supplementary insurances (remedies and aids, naturopaths, etc.);

  • Health insurance abroad;

  • Daily sickness benefit insurance (to cover sickness benefits not provided for in the PKV).

In contrast to the statutory health insurances, the private health insurers do not settle accounts directly with the service providers. the policyholder normally has to make an advance payment and will be reimbursed the costs by his insurance company against proof.

Contribution calculation

In contrast to the GKV, the contributions in the private health insurance are not based on the economic performance (= income) of the insured but on the insured risk. This is a general principle of the private insurance industry. Tariffs are calculated in such a way that the expected income covers the expected expenses (including profit contribution). It is also called Equivalence principle. Be there individual risk factors When concluding the contract, such as age at entry, previous illnesses and health behavior are taken into account. In addition to the insured benefits, the amount of the contribution is determined by these individual factors and, if applicable, by an agreed deductible.

If the calculation bases change over time, are Contribution adjustments required - mostly upwards due to the trend towards increasing health expenditure. The premium adjustment mechanism is regulated by law, the insurers are not free here. The adjustments are often made in leaps and bounds because a recalculation may or must only be carried out when certain change thresholds are exceeded. Nonetheless, over the last ten years (2009 - 2019) the contributions in private health insurance have increased less sharply than in statutory health insurance.

Many health insurers pay their policyholders Premium refundsif they do not use the services or only use them to a limited extent for a long time.

Aging provisions

Normally, insurance premiums would have to rise with age because the risk of illness increases. In order to avoid disproportionate age-related contribution burdens, provisions for aging are set up in the private health insurance scheme. For this purpose, a 10-percentage premium surcharge has been levied on the insured since 2000. It is payable up to the age of 60 and is used to stabilize contributions from the age of 65. This means that the contributions remain affordable even after retirement. If you change provider, you can only take your retirement provisions with you according to the basic tariff - a loss for many insured persons. It is often better to switch to a cheaper tariff with your own provider. By the end of 2019, pension provisions in private health insurance had reached a total of a good 260 billion euros.

Private long-term care insurance

In private health insurance, as in statutory health insurance, the principle applies: long-term care insurance follows health insurance. Anyone who has private comprehensive health insurance also needs one private compulsory long-term care insurance. Long-term care insurance does not necessarily have to be taken out with the contract partner of the health insurance company. There is a six-month period for choosing another provider. In practice, however, health insurers and compulsory long-term care insurers are almost always identical, because long-term care insurance benefits are the same for every provider.

Freely selectable for everyone and are fundamentally voluntary, however private supplementary long-term care insurance. They complement the range of private supplementary health insurance. Typical configurations are Daily care allowance insurance (Payment of a cost-independent daily rate) and the Nursing care insurance (Reimbursement of costs analogous to health insurance).

Statutory tariffs

In principle, private health insurance companies are free to choose which tariffs and which services they offer their insured persons in health insurance. There are, however, a few exceptions to this principle. Some tariffs are regulated by law in order to ensure adequate insurance cover even for those insured who are economically disadvantaged. This is all the more important since many insured persons are not allowed to return to the GKV. Every private health insurer must provide these tariffs:

  • Basic tariff: the basic tariff was introduced in 2009 as a uniform private health insurance tariff throughout the industry. It provides a level of performance as in the GKV - is therefore “less powerful” than most private health insurance tariffs. The premium set individually by each insurer may not exceed the maximum premium in the statutory health insurance scheme. A change to the basic tariff is possible at any time.

  • Standard tariff: the standard tariff is similar to the basic tariff, but has some advantages in comparison. It is only accessible to older insured persons who had been insured with private health insurance for at least ten years as of January 1, 2009 and who also meet a few other conditions.

  • Emergency tariff: the emergency tariff is not a freely accessible tariff. It is automatically used as part of a multi-stage dunning procedure for defaulting contributors and only pays for emergency medical care. If the arrears are paid, the original tariff applies again.