What brokers often do not explain to employees about switching to private health insurance

A typical sales talk sounds simple. In 2026, statutory health insurance costs a childless employee at the maximum contribution about €1,261 for health and long-term care insurance, and private health insurance in the example costs €1,000. On paper, there is €261 between them. Concluding from this that the employee saves €261 a month is wrong.

The statutory maximum contribution to health insurance in 2026 is €1,017.19 with the average Zusatzbeitrag (i)ZusatzbeitragThe additional contribution each statutory health insurance fund charges on top of the general rate. Its level differs from fund to fund.More about Zusatzbeitrag →, and social long-term care insurance costs childless people €244.13 at the maximum. The basis is the Beitragsbemessungsgrenze (i)BBG · BeitragsbemessungsgrenzeThe contribution ceiling of statutory health and long-term care insurance. Income above this amount is not used to calculate contributions.More about BBG → of €5,812.50 that applies in 2026 and the contribution rates of the official social insurance figures for 2026. Employer and employee share the health insurance contribution, while the employee pays the surcharge for childless people in long-term care insurance alone.

With a private premium of €1,000 in total and components that are fully eligible for the employer contribution, an employer with a sufficient contribution limit would generally pay €500. The employee then initially pays €500 himself. In statutory health insurance, his own burden in the example described is about €648 before the tax effect. The difference is therefore about €148, not €261.

That still does not finish the calculation. Under § 10 (1) No. 3 EStG, only the parts of a private premium that are comparable to the statutory level are treated for tax purposes as basic cover. Comfort benefits are not fully included. Even if statutory and private payments are similar, a higher wage tax can arise after the switch, because the premiums taken into account for tax purposes differ.

An almost identical health insurance premium after switching to private health insurance can still lead to a lower net income. The exact effect depends on the plan, the deductible basic cover share, the employer contribution, refunds and your personal tax situation. An individual tax assessment belongs with a tax advisor, not in insurance advice.

A no-claims refund can also change the tax picture. § 10 EStG is based on premiums paid and premiums refunded. A high no-claims refund is therefore not simply a tax-free extra gain.

PKV-Welt rule: For employees, we compare the actual burden for the employee and the tax effect. Comparing the total statutory contribution with the total private premium is not enough.

A common argument for private health insurance is that the benefits agreed in the contract are guaranteed. The core is true. An insurer cannot cut the agreed benefits at will. But the statement becomes too general if it suggests that all values in the contract stay unchanged forever.

Under the legal conditions, § 203 (2) VVG allows a premium adjustment and expressly provides that a deductible set as a fixed amount may be adjusted, as far as this has been agreed. Under strict conditions, § 203 (3) VVG also allows changes to the policy conditions if the situation in the healthcare system changes permanently and an independent trustee confirms the conditions.

A no-claims refund is also not the same as a guaranteed medical plan benefit. Whether a performance-based refund is paid, and how much, depends on the conditions and on what the insurer decides. If you choose private health insurance, you should therefore not base your calculation on a refund that stays the same forever.

A premium relief component can be interesting for employees, because it builds up a later premium reduction during your working life. But it should not be seen as savings that you can use freely.

If you switch to another private health insurer, you cannot simply take such a relief component with you one to one to the new company. The premium relief plan of your previous insurer does not continue unchanged with the new company.

If you return to statutory health insurance, you should also clarify in advance what happens to the relief component financed up to that point. From our advice practice, the plan conditions of some insurers allow existing values to be used for supplementary insurance with the previous company or to reduce the premium for supplementary insurance there. Whether and how this works must be checked before signing, based on the specific plan conditions.

For us, this question therefore comes before signing. A client should know what consequences a later change of system or change of insurer has for the premium relief component.

For us, the most serious advice mistake does not happen in a premium comparison but in the health questions. We regularly see clients who contact us after their insurer has examined a breach of the pre-contractual duty of disclosure or has already taken action.

When we then review the health history again, in our experience we repeatedly find diagnoses, complaints or treatments that were downplayed or not stated in the earlier application. For the client, this first feels convenient when signing. The risk does not disappear because of it.

§ 19 (1) VVG obliges the policyholder to state the circumstances known to him that are relevant to the risk and that the insurer has asked about in text form. Depending on fault and the facts, § 19 VVG provides for different consequences, including withdrawal, termination or a retroactive change to the contract. In the case of fraudulent misrepresentation, the rules of § 22 VVG also apply.

That is why we review health data completely before an application. If a diagnosis needs explaining, it is explained. It is not softened in wording until it looks harmless on the application.

Our experience: Answering the health questions properly takes more time before the application. Answering them carelessly can put your entire cover at risk years later.

Plan conditions show what is insured under the contract. But they do not fully show the client how strictly an insurer checks bills, medical justifications and claims in daily practice. That is exactly why we bring our experience from claims into our advice.

From our advice practice, we experience ARAG and Hallesche as insurers that check bills and the conditions for benefits comparatively strictly. This does not mean that justified benefits are not paid. It describes our practical experience with how intensive the checks are.

In our advice practice, we experience Alte Oldenburger, SIGNAL IDUNA, Bayerische Beamtenkrankenkasse and Barmenia as strong in claims handling. This assessment is not a statistical ranking either, and not a guarantee for an individual claim. It describes our experience from supporting clients and their claims.

This information is relevant for the client, because strong wording in the policy conditions and pleasant claims handling are two different levels. For us, both belong in the choice of an insurer.

Private health insurance can suit employees very well. But it should not be sold through an artificially large saving, embellished health information or incomplete statements. If you decide for private health insurance, you are making a long-term decision about the system.

We therefore think it makes more sense to discuss possible disadvantages openly before the application. If the client is still convinced afterwards, and health, plan, insurer and long-term financing fit, the decision is more solid.