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Insurers assess differently
The same diagnosis can lead to acceptance with a moderate surcharge at one provider and to rejection at the next. There are no uniform industry standards.
Private health insurance with pre-existing conditions →Chronic conditions and private health insurance: what is possible
A chronic condition only rarely leads to a blanket rejection. More common are acceptance with a risk surcharge, a benefit exclusion for the diagnosis concerned or, as a safety net, 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 → guaranteed by law.
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The key points about the health questions with a chronic condition at a glance.
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How does the consultation work? →Which condition leads to which outcome 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 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.
Chronic conditions and health questions: the details
Is private health insurance possible with a chronic condition?
With most chronic conditions, private health insurance is possible, only in different forms. Whether someone is chronically ill and is still accepted on standard terms or pays a surcharge depends on the individual case.
A blanket statement such as 'chronically ill means no private health insurance' is not true and needlessly misleads many people who are interested.
How do chronic conditions show up in the health questions?
The health questions are a questionnaire, not a physical examination. With chronic conditions, however, they practically always apply. Long-term medication, regular check-ups and ongoing treatment fall within every look-back period that insurers ask about.
Unlike a condition that healed years ago, a chronic diagnosis cannot be kept off the application simply because time has passed. If necessary, the insurer asks for medical reports and classifies the condition on that basis.
Which paths are there on acceptance?
The insurer weighs the expected risk and decides on one of several paths. The following overview puts them in order:
| Path | What it means | When it is typical |
|---|---|---|
| Acceptance on standard terms | insurance as for healthy people, without a surcharge | mild or long stable conditions, for example allergies |
| Acceptance with a risk surcharge | extra cost, typically 15 to 30 percent | a controlled condition with stable medication, for example an underactive thyroid |
| Acceptance with a benefit exclusion | the diagnosis concerned is excluded from cover | a clearly defined diagnosis with moderate follow-up costs, for example missing teeth or impaired vision |
| Basistarif | acceptance secured by law with a capped premium | several serious diagnoses, high expected costs |
How are typical chronic conditions assessed?
How a diagnosis fares in the health questions is best shown with common examples. The following values are experience values from our advice work, not fixed catalogs, because every insurer assesses according to its own standards:
| Example | Typical assessment |
|---|---|
| High blood pressure, well controlled | acceptance with a moderate surcharge |
| Asthma, mild form | surcharge for respiratory diseases, depending on course and medication |
| Type 2 diabetes | clear surcharge, with secondary conditions also rejection |
| Underactive thyroid, controlled | small surcharge, with some insurers also standard terms |
| Rheumatic diseases | from surcharge to rejection, depending on disease activity and medication |
| Atopic dermatitis or psoriasis, mild form | small surcharge or standard terms |
| Mental illness in ongoing treatment | often rejection |
What stands out again and again is that the diagnosis itself does not decide, its course does. High blood pressure that has been well controlled for years is routine for many insurers. Untreated high blood pressure with fluctuating values, by contrast, is a real warning sign.
For the decision, what counts most is which diagnosis it is, how serious and how recent it is and how stable the course of treatment looks. A condition that has been well controlled with medication for years seems more calculable than a new diagnosis with an open course. Follow-up risks also play a role, meaning the question of which further treatments can arise from the underlying condition.
How does the risk surcharge come about?
The insurer estimates the expected extra costs of the condition and adds them to the normal premium as a risk surcharge. Usual values are 15 to 30 percent, less with very mild courses, and considerably more with several combined diagnoses.
The surcharge remains in place until it is reduced and changes with the same adjustments as the main premium.
When is a benefit exclusion an option instead of a surcharge?
Instead of a surcharge, the insurer sometimes excludes the diagnosis concerned from cover. All other illnesses remain fully insured. This makes sense if the condition is clearly defined and only limited follow-up costs are to be expected.
The risk is that you have to pay for the treatment of the excluded condition yourself if it gets worse later.
How do I prepare the application properly?
Good preparation clearly improves your chances of acceptance. Before an application with a chronic condition, you should have the following ready:
- Current medical reports from recent years, especially those that show a stable course.
- Clear documentation of your treatment status, meaning controlled and stable, or active and changing.
- The anonymous enquiry with several insurers, whose answers you can then compare calmly.
Only on this basis does a formal application make sense. We recommend that you only make the enquiry after a stable phase of at least twelve months, because new treatments or changes in the diagnosis are rated as a higher risk.
What happens if all applications fail?
If no insurer offers a regular plan, the Basistarif applies. Under § 152 VAG, there is an obligation to accept everyone who is eligible for private health insurance.
The premium is capped. In 2026 it is at most €1,017.18 per month, and if you prove that you are in need of assistance, it is halved under § 12 VAG. The benefits correspond to those of statutory health insurance.
What do we advise our clients?
It starts with clarity, meaning which diagnosis, which phase of treatment and which medical reports there are. Instead of risking one application after another, we ask several insurers anonymously at the same time and assess the answers together with the client.
In our advice work we often see that a well prepared enquiry with current reports and a stable phase of treatment noticeably increases the chances of acceptance, while a quick, unprepared enquiry almost always leads to worse terms. The experience from more than 5,000 applications with health questions that we have supported goes into each of these assessments.
Does the risk surcharge remain in place permanently?
As a rule, yes. Once agreed, the surcharge applies for the term of the contract and changes with the same adjustments as the rest of the premium. If the reason ceases to apply or demonstrably loses its significance, you can demand an appropriate reduction under § 41 VVG.
What does a benefit exclusion mean in a claim?
You pay for treatment of the excluded diagnosis yourself, and all other conditions are covered as normal. How much this matters depends on how much treatment the excluded condition needs over time.
Does the assessment improve if the condition has been stable for a long time?
Often, yes. Documented treatment that has been stable over a longer period lowers the calculated risk. It can make the difference between rejection and acceptance, or between a high and a moderate surcharge.
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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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