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Know the typical amount
In our advice experience, the surcharge in most cases is 15 to 30 percent of the plan premium. With serious pre-existing conditions, higher surcharges are possible. A complete rejection remains the exception.
Risk surcharge in private health insurance: amount, reasons and ways to avoid it
A risk surcharge in private health insurance is an extra charge on the plan premium that the insurer asks for because of a pre-existing condition, usually as a percentage. It does not have to apply forever. If the reason no longer applies, you have a right under § 41 VVG to have it reduced appropriately, and the request concerns only this one circumstance. If you have been paying the surcharge for years, you should know this: with every premium adjustment it grows in euros as well.
Guide
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What you should know about the amount, the effect and the avoidance of the risk surcharge.
Contents
- Which condition leads to which result in the health questions?
- What it is
- Typical amount
- Calculation
- Anonymous enquiry
- Reduce the surcharge
- From our advice work
- Employer contribution
- With adjustments
- Automatic removal?
- Statutory surcharge
- Surcharge or exclusion
- Having a risk surcharge reduced: the route through § 41 VVG
- How long the surcharge applies: premium adjustment and plan change
- Risk surcharge and tax
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How does the consultation work? →Which condition leads to which result in the health questions?
Choose a condition Usually accepted Usually accepted Usually accepted Usually accepted Usually accepted Risk surcharge likely Benefit exclusion likely Benefit exclusion likely Risk surcharge likely Risk surcharge likely Rejection likely Rejection likely Risk surcharge likely Risk surcharge likely Risk surcharge likely Risk surcharge likely Risk surcharge likely Risk surcharge likely Risk surcharge likely Rejection likely Rejection likely Rejection likely Rejection likely Rejection likely Rejection likely
Usually acceptance on standard terms, because the injury has healed and no follow-up risk remains.
- What it depends on
- Complete healing without lasting complaints.
- How long
- An exclusion is generally not to be expected here.
- How it can be resolved
- Not necessary.
Usually standard terms, because healed and without follow-up risk.
- What it depends on
- A completed operation without complications.
- How long
- Generally no exclusion.
- How it can be resolved
- Not necessary.
Usually standard terms. If complaints remain, a risk surcharge is possible.
- What it depends on
- Time since the operation and whether you are currently free of complaints.
- How long
- If an exclusion is agreed, it applies without a time limit.
- How it can be resolved
- After a lasting period without complaints, you can request a review.
Usually standard terms. With repeated episodes, a risk surcharge is possible.
- What it depends on
- A single event or recurring complaints.
- How long
- Rarely an exclusion.
- How it can be resolved
- Not critical if you are free of complaints.
Mild, well controlled allergies usually count as non-critical and are often accepted without conditions.
- What it depends on
- Severity of the allergy and need for treatment.
- How long
- Rarely an exclusion.
- How it can be resolved
- Usually not required.
If healed without after-effects, a risk surcharge is more likely.
- What it depends on
- Treatment status, how long you have been free of complaints and the individual insurer.
- How long
- A risk surcharge remains in place. A review makes sense after several years without complaints.
- How it can be resolved
- A medical certificate confirming that it has healed, then a new assessment by the insurer.
Teeth that have not been replaced often lead to a surcharge or a benefit exclusion in the dental area. Replaced teeth are usually unproblematic.
- What it depends on
- Number of gaps and the planned dental restoration.
- How long
- The exclusion applies specifically to the dental area.
- How it can be resolved
- After the restoration, the exclusion can be reassessed.
During ongoing treatment, an exclusion usually applies. Afterwards, regular acceptance is possible.
- What it depends on
- Completion of the treatment.
- How long
- Limited until the treatment ends.
- How it can be resolved
- Open to reassessment as soon as the treatment is finished.
A risk surcharge is more likely than standard terms.
- What it depends on
- Course of treatment and insurer.
- How long
- A risk surcharge remains in place. A later review is possible.
- How it can be resolved
- A new assessment after a stable course without complaints.
Manifest chronic diagnoses tend to lead to a risk surcharge rather than acceptance on standard terms. Severe cases can lead to rejection.
- What it depends on
- Severity and stability of the course.
- How long
- A surcharge remains in place permanently.
- How it can be resolved
- If your condition has demonstrably improved, you can request a review.
Ongoing or recently completed psychological treatment usually leads to rejection or to the application being deferred. A benefit exclusion is rarely an option in that case.
- What it depends on
- Time since the last treatment and type of diagnosis.
- How long
- After a sufficient period without complaints, a reassessment is possible.
- How it can be resolved
- Reassessment after a period without complaints, ideally through an anonymous enquiry.
Regular acceptance is usually not possible. A benefit exclusion is then not an option, because the contract is not concluded at all.
- What it depends on
- Course and accompanying conditions.
- How long
- Acceptance generally fails.
- How it can be resolved
- Options are the Basistarif BasistarifA statutory social plan that every private insurer must offer. Its benefits are comparable to statutory health insurance, and its premium is capped at the statutory maximum contribution.More about Basistarif → as the fallback plan and an anonymous enquiry to several insurers.
Many insurers accept asthma with a risk surcharge. Some providers do not insure asthma and exclude it. A rejection is rather rare.
- What it depends on
- Severity and frequency of complaints and the individual insurer.
- How long
- A surcharge remains in place. An exclusion applies without a time limit. With a stable course, a review is possible.
- How it can be resolved
- An anonymous enquiry to several providers. There you will often find insurers with a moderate surcharge.
Well controlled high blood pressure is usually accepted with a risk surcharge. High readings, several medications or damage to the cardiovascular system make the assessment clearly worse.
- What it depends on
- Level of the readings, number of medications, accompanying diagnoses and the individual insurer.
- How long
- A surcharge remains in place permanently. An exclusion applies without a time limit.
- How it can be resolved
- Prove stable readings over a longer period, then request a review from the insurer.
An underactive thyroid that is well controlled with medication is often accepted with a moderate risk surcharge. Some insurers assess it more mildly than others.
- What it depends on
- Stable blood values under treatment, the cause of the underactive thyroid and accompanying findings.
- How long
- A surcharge remains in place until it is reduced on request.
- How it can be resolved
- An anonymous enquiry to several providers. The differences are often large here.
Endometriosis usually leads to a risk surcharge. With active treatment, the assessment is stricter.
- What it depends on
- Stage, need for treatment, past operations and the individual insurer.
- How long
- A risk surcharge remains in place permanently.
- How it can be resolved
- After a longer period without complaints and without treatment, you can request a review.
Mild cases are often accepted with a surcharge. With regular treatment with cortisone or modern active substances, a higher risk surcharge for skin conditions is likely.
- What it depends on
- Severity of flare-ups, treatment interval and the medications used.
- How long
- A risk surcharge remains in place permanently.
- How it can be resolved
- Have several years without treatment confirmed by a doctor, then a new assessment.
Mild acne usually has no consequences. Cases that need treatment, especially with prescription medication, often lead to a surcharge for the skin area.
- What it depends on
- Severity, current treatment and type of medication.
- How long
- A risk surcharge remains in place permanently and applies specifically to skin conditions.
- How it can be resolved
- Have it reassessed once the treatment is finished and the skin has healed.
A single event that healed without after-effects often leads only to a small surcharge, sometimes also to standard terms.
- What it depends on
- Number of episodes, time since the last event and current findings.
- How long
- A risk surcharge remains in place permanently.
- How it can be resolved
- After several years without a new event, request a review from the insurer.
Regular acceptance is usually not possible. The course and the time since treatment are decisive.
- What it depends on
- Type of disease, course and time since therapy.
- How long
- Acceptance generally fails.
- How it can be resolved
- After a long period without complaints, a reassessment can make sense.
These diagnoses are among the common reasons for rejection. Excluding individual benefits does not replace regular acceptance in that case.
- What it depends on
- Diagnosis and course.
- How long
- Acceptance generally fails.
- How it can be resolved
- The Basistarif as the fallback plan, plus an anonymous enquiry.
Chronic bowel diseases are among the common reasons for rejection, but the assessment varies from insurer to insurer.
- What it depends on
- Course, need for treatment and provider.
- How long
- Acceptance often fails.
- How it can be resolved
- An anonymous enquiry to several insurers.
A documented ADHD diagnosis often leads to rejection, especially with ongoing medication.
- What it depends on
- Time since the last treatment, medication and the individual insurer.
- How long
- Acceptance generally fails.
- How it can be resolved
- An anonymous enquiry to several providers, plus the Basistarif as the fallback plan.
Treated sleep apnea often leads to rejection, especially with ventilation at night.
- What it depends on
- Severity, type of therapy and accompanying diagnoses.
- How long
- Acceptance generally fails.
- How it can be resolved
- An anonymous enquiry to several insurers. The assessment differs from insurer to insurer here.
Information about drug use generally leads to rejection. The time since the last use is decisive.
- What it depends on
- Type and frequency of use and the time since the last use.
- How long
- Acceptance generally fails.
- How it can be resolved
- After a longer documented period without use, a reassessment is possible, ideally through an anonymous enquiry.
Typical outcome based on more than 5,000 applications with health questions that we have supported. This is not a promise. Only an anonymous enquiry to several insurers gives you a binding answer for your case.
Risk surcharge: amount, calculation and ways to reduce it
What is the risk surcharge and when is it charged?
The risk surcharge is an extra charge on the plan premium that the insurer sets after the health questions, agreed as a percentage or as a fixed amount in euros. The reason is a pre-existing condition that, based on the answers in the application (§ 19 VVG), statistically suggests higher treatment costs. It is not a penalty. The insurer calculates in the same way as life insurance and balances a higher individual risk through the premium, so that it can grant full cover. The alternative would be a benefit exclusion, which removes the condition in question from cover completely.
Statutory health insurance has no such surcharges. It accepts everyone at an income-based contribution, while private health insurance prices in the individual risk and in return guarantees the benefits by contract. We recommend that you do not see a risk surcharge as a defect but as information. It shows how the insurer has calculated your health risk, and it is a basis for negotiation.
How high is the surcharge typically?
The typical range for a risk surcharge in private health insurance is 15 to 30 percent. Mild findings, findings that are well controlled or findings without symptoms for a long time often come out at five to ten percent. More serious pre-existing conditions are higher, up to the limit at which an insurer no longer accepts the application. The law sets no fixed upper limit. § 203 VVG only requires an appropriate surcharge. In the Basistarif, a risk surcharge is excluded completely. A worked example: with a plan premium of €600 per month, a surcharge of 30 percent means a total premium of €780. These premiums are guide values. Important for the assessment: the surcharge is charged on the plan premium of the health insurance, not on the Pflegepflichtversicherung .
What this means in euros is shown by values from our advice work for common triggers. Each insurer, however, assesses by its own standards.
| Pre-existing condition (example) | Typical surcharge per month (experience value) |
|---|---|
| Hay fever, well controlled | €0 to €40, often standard rates |
| Underactive thyroid, controlled with medication | about €25 to €60 |
| High blood pressure, well controlled | about €45 to €150 |
| Bronchial asthma | about €60 to €250, depending on severity |
| Overweight, back problems, skin conditions | mild to moderate surcharge, depending on the course |
How does the insurer calculate the surcharge?
The calculation is based on the health questions in the application, on medical reports requested where needed and on the insurer's internal mortality and cost statistics. These statistics are not harmonized, and this is exactly the most important lever for applicants.
The same diagnosis can result in a 15 percent surcharge at one insurer and 35 percent at another. Some insurers have their own experience with certain conditions and assess them more mildly, others more strictly. If you ask only one insurer, you never find out whether you are accepting the most expensive assessment on the market.
How does the anonymous risk enquiry protect you before the application?
In an anonymous risk enquiry, the health data goes to several insurers without a name, usually through a specialized broker, because the questionnaires of the insurers are structured differently. The result is an assessment from each insurer: acceptance at standard rates, an expected risk surcharge, a benefit exclusion or a rejection.
The decisive advantage: a rejected enquiry creates no record. A formally rejected application, by contrast, is stored internally by the insurer in question and must be stated in later applications. The private health insurers do not keep a shared industry register, but the duty to disclose in later applications remains.
How can a surcharge be reduced or removed?
If the pre-existing condition has healed, it pays to look at the law. Under § 41 VVG, policyholders can demand that the premium is reduced appropriately if the circumstance that increased the risk no longer exists. The common claim that a risk surcharge disappears automatically after five years, on the other hand, is a myth. Without a request and proof, it stays.
You make the request for a reduction informally with a current medical certificate. The lower premium applies from the day the request reaches the insurer. A second route is the internal plan change, where a percentage surcharge in a cheaper plan can be smaller in euros.
What do we see in our advice work?
We have supported more than 5,000 applicants through the health questions. The most common pattern: applicants go into the formal application without an enquiry, receive a high surcharge and accept it out of relief at being accepted. In doing so, they give away exactly the room that the market offers.
We recommend that you make at least five enquiries in parallel before an application with a pre-existing condition, because the range between insurers for the same diagnosis is often 15 to 20 percent. How individual diagnoses are typically assessed in the health questions is covered on our pages on health questions.
Does the risk surcharge count towards the employer contribution?
Yes. The employer pays its share of half of the actual total premium including the risk surcharge, capped at the maximum employer contribution of €508.59 per month (2026, expected to be €557.81 from 2027). Only above this limit do you pay the surcharge alone.
Does the risk surcharge rise with premium adjustments?
Usually yes. The surcharge is normally agreed as a percentage of the plan premium and grows in proportion with a premium adjustment. If a fixed amount in euros is agreed, it stays unchanged.
Is a risk surcharge ever removed automatically?
No. There is, however, a statutory right to a reduction under § 41 VVG if the circumstance that increased the risk has demonstrably ceased to exist. You must make the request yourself and prove the recovery with a medical report.
How does the risk surcharge differ from the statutory surcharge?
All policyholders with comprehensive private health insurance pay the statutory surcharge, from the calendar year after their 21st birthday until the year in which they turn 60. It is 10 percent of the gross premium, goes into the ageing reserves and later lowers the premium in old age (§ 149 VAG). It has nothing to do with your health. The risk surcharge depends only on the pre-existing condition, and only the risk surcharge can be reduced under § 41 VVG.
Risk surcharge or benefit exclusion: which fits better?
The surcharge keeps full cover, including for the pre-existing condition, and costs premium every month. The benefit exclusion costs nothing extra but leaves exactly the condition uncovered that is most likely to need treatment again. What matters is how likely further treatment of this condition is and what it would cost. The higher both are, the more the surcharge pays off.
Having a risk surcharge reduced: the route through § 41 VVG
The right is in the law. The lower premium applies from the day your request reaches the insurer, not retroactively.
Get proof from your doctor
Ask for confirmation that the condition has healed or no longer needs treatment: a current medical certificate, lab values, proof that the medication has ended. Typically this is after three to five years without symptoms. The doctor should name the diagnosis for which the surcharge was agreed.
Request the reduction in writing
An informal letter is enough: policy number, the diagnosis, a reference to § 41 VVG and the proof attached. Send it in a way that lets you prove receipt, because the lower premium counts from that day.
Get the answer in writing
The insurer reduces the surcharge, removes it or refuses. Ask for written confirmation of the decision, with the date from which it applies.
If the insurer refuses
You must prove that the risk has ceased to exist. But if you submit lab results and a medical statement, the insurer in turn must explain in more detail why it keeps the surcharge. This is how the Regional Court of Munich I decided on March 7, 2023 in the case of a privately insured person (case no. 12 S 12059/22). A refusal without a comprehensible reason is therefore not the final word.
We check with you whether the request is worth it, based on your insurance certificate, the last adjustment letter and your medical findings.
How long the surcharge applies: premium adjustment and plan change
A risk surcharge runs as long as the contract, until you have it reduced. It has no expiry date.
With a premium adjustment, it grows as well. If the surcharge is agreed as a percentage, it rises in euros with every premium adjustment. An example with the values from above: plan premium €600, surcharge 30 percent, that is €180 per month. If the plan premium rises, let us assume by 10 percent to €660, the surcharge is €198, although nothing about your health has changed. Especially after an adjustment letter, it is therefore worth asking whether the reason for the surcharge still exists.
With a plan change, the additional benefits count. If you switch to another plan of your insurer under § 204 VVG, your acquired rights and your ageing reserves are kept. If the new plan offers more benefits, the insurer may ask for a surcharge for this extra. You can avoid it by agreeing a benefit exclusion for the additional benefits. In a cheaper plan, a percentage surcharge is often much smaller in euros.
A switch to another insurer, by contrast, triggers completely new health questions. An existing, old surcharge is then often cheaper than the new assessment of an applicant who is older by then.
Risk surcharge and tax
The risk surcharge is part of your health insurance premium. Under § 10 (1) no. 3 EStG, you can deduct the parts of the premium for benefits comparable to those of statutory health insurance, without the share for Krankengeld KrankengeldStatutory sick pay from the statutory health insurance fund. It starts when the employer stops paying wages, usually from the seventh week of illness. or Krankentagegeld KrankentagegeldPrivate sick pay: a daily allowance from private insurance while you are unable to work. It replaces lost income from an agreed day of illness.More about Krankentagegeld →. Your insurer states how high this share is in your contract.
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Switching to private health insurance is probably not advisable for you.
From the age of 55, admission to private health insurance is often possible only with restrictions. A late switch can also mean higher premiums.
It matters to us that a switch pays off for you in the long run. That is why we do not recommend a consultation when your answers already show that the conditions are rather unfavorable.
Not sure, or want to correct your answers? Feel free to contact us. We will help you assess your situation.
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