Obligation to accept: when the private insurer must take you

In the private health insurance market, each insurer decides for itself whom it accepts into its regular comprehensive plans. There is no general obligation to accept. The common belief that private insurers may not reject anyone persists stubbornly, especially after the health questions. In fact, insurers may reject applications for medical reasons, add risk surcharges or exclude certain benefits. For regular plans all of this is legally permitted, and there is no obligation to contract in private health insurance.

The only exception is the Basistarif (i) prescribed by law. In this plan the obligation to accept applies, regardless of pre-existing conditions or risks. If you are in principle eligible for private health insurance, you have a legal right to it. This is not a voluntary service of the insurers, but a duty by law.

The obligation to accept in the Basistarif (i) is set out in § 152 VAG. All private health insurers based in Germany are obliged to accept people who are in principle eligible for private health insurance into this plan. This includes employees who exceed the Jahresarbeitsentgeltgrenze of €77,400 in 2026, as well as the self-employed and civil servants.

There are no health questions at all in the Basistarif (i). Neither pre-existing conditions nor individual risks can lead to a rejection. This secures your cover, but at the same time limits the scope of benefits to a level comparable with statutory health insurance. Nobody can force access to a higher-quality plan with the special benefits usual in private health insurance through the Basistarif.

The premium in the Basistarif (i) is capped by law. In 2026, the statutory maximum contribution to health insurance is €1,017.18 per month. The Pflegepflichtversicherung (i) is added separately.

This maximum corresponds to the maximum contribution of statutory health insurance. For comparison: if you pay the maximum contribution including long-term care insurance in statutory health insurance, you pay €1,226.44 per month in 2026. Depending on age and gender, the actual premium in the Basistarif (i) can be below the statutory cap, but not above it.

Younger policyholders usually pay much less than the maximum premium. The responsible insurer will tell you the actual premium for your own situation on request.

If you cannot afford the premium of the Basistarif (i), you have a right to have it halved under certain conditions. The basis is § 152 (4) VAG. If your need for assistance within the meaning of social law is proven, the monthly premium falls to half of the maximum premium.

The responsible social welfare agency pays the difference. You apply for the halving under § 152 (4) VAG at the social welfare office. You need proof of income and an overview of your assets. If you already receive basic income support, you are in many cases entitled directly.

The scope of benefits in the Basistarif (i) corresponds to that of statutory health insurance. Special private fee rates, a single room and chief physician treatment are not included. If you are used to these benefits, you will clearly notice the difference from a regular comprehensive plan.

Doctors bill patients in the Basistarif (i) at 2.3 times the fee rate of the GOÄ, not at the 3.5 times rate otherwise usual in private health insurance. This corresponds to the billing level of statutory health insurance. Some practices treat patients in the Basistarif just as willingly as patients with statutory insurance, while others still prefer regular policyholders.

As a safety net after systematic rejection in the regular private health insurance market, the Basistarif (i) fulfils the purpose the law intends. For healthy applicants who want to join directly, it is not a suitable alternative to a regular comprehensive plan.

In our advice, we often see that the Basistarif (i) is chosen as the first solution without an anonymous enquiry. In many cases, regular plans with a risk surcharge would have been cheaper and offered better benefits. We therefore advise carrying out an anonymous risk enquiry before every formal application. If you want to switch with pre-existing conditions, this shows you which plans are actually open to you and on what terms, without a rejection being documented by the insurer.

If you are already insured in the Basistarif (i) and can no longer afford this premium either, you have a right to the Notlagentarif. It only covers benefits for acute illness, pain and pregnancy. The premium is well below that of the Basistarif.

Further options, depending on your situation:

• Voluntary membership in statutory health insurance under § 9 SGB V, possible within certain deadlines.
• Family insurance through a spouse with statutory insurance, if your own income is below the family insurance limit of €565 per month (2027 according to the cabinet decision: €590).

Both routes have specific requirements. If you are in this situation, you should have it clarified individually in a personal consultation.