What is it?
Unlike GKV, whose contribution structure is generally linked to income within legal limits, a PKV premium is based on the selected benefits and underwriting factors such as age and health at entry. An insurer may accept an application, request a risk surcharge called a Risikozuschlag, or offer different terms. The contract may also include a Selbstbeteiligung, meaning deductible. The policyholder normally pays treatment invoices according to the contract and seeks reimbursement, so cash-flow arrangements matter. Returning to GKV later is not always straightforward, particularly after circumstances or age change. Family members also do not automatically receive free cover through a PKV policy; each person's arrangement must be considered.
Why it matters
A decision that looks attractive during a high-income year can feel different after a career break, family change, illness, or move abroad. Compare benefits in writing, exclusions, deductibles, claims procedures, premium development assumptions, and available internal tariff options. Check whether the employer subsidy, if relevant, is capped and what portion you would pay yourself. Eligibility and insurer conditions depend on current law and the specific contract, so obtain individual advice before cancelling or changing existing cover. No single system is automatically better or cheaper for everyone.
Practical example: A fictional self-employed designer compares voluntary GKV membership with two PKV tariffs. One has a lower starting premium but a higher deductible and narrower benefits. The designer also asks how a future partner or child would be insured, what happens during a period of lower income, and whether treatment abroad is included. A salaried applicant first confirms that the employment status permits a PKV choice, then completes an accurate health assessment instead of selecting a tariff from the headline price alone.
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