Requirements for private health insurance for employees

The income check and the health questions answer different questions. Only when both are settled can you judge whether a switch can actually go ahead.

An income above the JAEG therefore does not yet mean that every private plan is open to you. Pre-existing conditions can affect the terms of acceptance. In turn, good health does not help as long as your income is not high enough for the exemption from compulsory insurance.

Before a contract is signed, private health insurers may ask about health circumstances that matter for their acceptance decision. Under § 19 (1) VVG, you must answer the health questions asked in text form completely and truthfully.

A pre-existing condition does not automatically rule out a switch. Insurers can assess a medical history in different ways. Depending on the risk assessment, the result can be a normal acceptance, changed terms of acceptance or a rejection. The insurer in question decides on acceptance.

From more than 5,000 applications with health questions that we have handled, we know that the way your health history is prepared already makes a big difference. This is why we do not submit a formal application first.

We usually work in this order:

1. Gather your complete health history.
2. Prepare relevant diagnoses, treatments and findings so that they are easy to follow.
3. Check your insurability through anonymous risk enquiries.
4. Compare the responses and terms of acceptance.
5. Only then submit a formal application.

This way, you know how the insurers in question assess you before a binding application is made.

For employees, the Jahresarbeitsentgeltgrenze (i), JAEG for short, determines whether their employment makes them subject to compulsory insurance in statutory health insurance. For this, § 6 (1) No. 1 SGB V looks at the regular annual pay.

The general JAEG (i) in 2026 is €77,400, or €6,450 per month, set by the Social Insurance Calculation Values Regulation 2026 of the Federal Ministry of Labor and Social Affairs.

For 2027, the threshold rises sharply. In addition to the regular update, the JAEG (i) is raised once by an extra €3,600. The Federal Ministry of Health names an extraordinary increase of €300 per month for 2027, on top of the regular adjustment. On October 7, 2026, the Federal Cabinet set the JAEG for 2027 at €84,150. The Bundesrat still has to agree.

The JAEG (i) is not the same as the Beitragsbemessungsgrenze. The JAEG is what matters for the question whether you as an employee can leave compulsory statutory insurance.

If you are not sure whether you are currently compulsorily insured in statutory health insurance or already exempt from compulsory insurance, ask your HR department. Your employer must assess your employment under social insurance law and send the required reports to the responsible collecting agency. The employer's reporting duties are set out in § 28a SGB IV.

Especially after a pay rise or a change of employer, your HR department is therefore a good first point of contact. It can tell you which insurance status your employment currently has.

For the JAEG (i), your regular annual pay counts. The fixed salary in your employment contract is the starting point, but it does not always answer the question completely.

Pay components that can regularly be expected can also be taken into account. Under § 6 (1) No. 1 SGB V, family-related supplements are expressly not taken into account.

Variable pay and bonuses in particular should be checked before the assessment. What was actually paid out last year is not the only thing that matters. What counts is the annual pay that can regularly be expected.

This means an employee with a base salary below the JAEG (i) can still be above the threshold. A high one-off bonus, on the other hand, does not automatically lead to exemption from compulsory insurance.

A pay rise in your current employment does not automatically make you exempt from compulsory insurance in the month of the rise. If you exceed the JAEG (i) during ongoing employment, compulsory insurance ends at the end of the calendar year under § 6 (4) SGB V. In addition, your regular annual pay must exceed the JAEG of the following calendar year.

This second check matters especially for the transition from 2026 to 2027.

An employed lawyer first earns less than €77,400 a year. During 2026, her employer raises her regular annual pay to €82,000.

This means she does exceed the JAEG (i) 2026 of €77,400. Even so, it is not enough for a switch on January 1, 2027.

Her regular annual pay of €82,000 is below the JAEG 2027 of €84,150. Under § 6 (4) SGB V, her compulsory insurance therefore does not end at the turn of the year.

In this example, a switch to private health insurance on January 1, 2027 is not possible.

When you start a new job, on the other hand, your situation is assessed again. If the expected regular annual pay is above the relevant JAEG (i) from the start, you can be exempt from compulsory insurance as soon as the new job begins.

For employees close to the income threshold, it therefore matters not only how high the salary is, but also what caused the income to change.

If you are already voluntarily insured in statutory health insurance and want to switch to private health insurance, you should know about September 30. Once the commitment period has been met, a voluntary membership can be canceled under § 175 (4) SGB V with effect from the end of the month after next. Canceling by September 30 therefore allows a regular start of cover on December 1.

The December date can pay off financially in the long term. Under § 10 KVAV, private health insurers calculate the premium by age. Depending on the plan, a start of cover on December 1 can therefore secure a more favorable entry age than a start on January 1 of the following year.

September 30 is not a general statutory deadline for switching to private health insurance. We see it as a sensible last planning date for people with voluntary statutory insurance who still want to switch on December 1.

Do not cancel your existing statutory health insurance before your insurability and your choice of plan are settled.

With an employed client, we therefore first check the regular annual pay and the health history. If the income is close to the JAEG (i), we also look at special payments, variable pay and the timing of a pay rise or a change of employer.

On the health side, we check your insurability before the formal application. Only once it is clear that the insurance law requirements are met, and which terms of acceptance the insurers offer, does the actual choice of plan begin.

This way, it is clear before the switch whether private health insurance can actually go ahead, and on what terms.

• Federal Ministry of Labor and Social Affairs, Social Insurance Calculation Values Regulation 2026.
• Federal Ministry of Health, Contribution Rate Stabilization Act for statutory health insurance and FAQ on the extraordinary increase of the JAEG (i) 2027.
• Social Code Book Five, § 6 SGB V, exemption from compulsory insurance.
• Social Code Book Five, § 175 SGB V, exercising the right to choose.
• Social Code Book Four, § 28a SGB IV, the employer's reporting duty.
• Insurance Contract Act, § 19 VVG, duty of disclosure.
• Health Insurance Supervision Regulation, § 10 KVAV, premium calculation.
• PKV-Welt, own experience from more than 5,000 applications with health questions.