Private health insurance with pre-existing conditions in Germany: do I have a chance?

Expert tips

The key points about private health insurance with a pre-existing condition at a glance.

Rejection is the exception

Most pre-existing conditions lead to acceptance, often on standard terms, otherwise with a surcharge or an exclusion. A real no remains rare.

Anonymous enquiry first

Before any formal application, we recommend an anonymous risk enquiry with at least five insurers. A rejection on the first attempt worsens your chances with the others.

The assessment varies

Insurers rate the same pre-existing condition differently. A side-by-side comparison almost always pays off, because the terms differ noticeably.

Chronic conditions and private health insurance →

Complete under § 19 VVG

You must answer the health questions completely and truthfully, even if the condition was a long time ago. Otherwise the insurer may contest the contract later.

Pre-contractual duty of disclosure →

Contents

Which condition leads to which outcome in the health questions?
Is it possible?
In the health questions
Possible outcomes
Common reasons for rejection
What tips the balance
Non-critical examples
More serious diagnoses
Anonymous enquiry
Basistarif
Our experience
Amount of the surcharge
Medical records
Surcharge after healing
Enquiry instead of direct application

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Which condition leads to which outcome in the health questions?

Choose a condition

Usually accepted

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.

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.

Private health insurance with pre-existing conditions: the details

Is private health insurance possible with a pre-existing condition?

With the vast majority of pre-existing conditions, private health insurance is possible, only on different terms. The insurer checks how the pre-existing condition affects the expected risk and adjusts acceptance and terms accordingly.

So how pre-existing conditions are treated in private health insurance is not decided by the diagnosis alone, but by its course and how recent it is.

How do the health questions deal with pre-existing conditions?

With pre-existing conditions, the health questions run through the insurer's questionnaire. It asks about treatments, diagnoses and medication in recent years, outpatient treatment usually for three years, inpatient treatment and serious illnesses further back.

If you release your doctors from confidentiality, the insurer can see individual medical reports directly at the doctor. On this basis, it classifies the pre-existing condition and decides on the outcome.

Which outcomes are possible?

The outcome differs depending on how the insurer assesses the risk. The following overview shows the possible results:

Outcome	What it means	When it is typical
Acceptance on standard terms	cover as for healthy people, without a surcharge	the pre-existing condition counts as healed or insignificant
Acceptance with a risk surcharge	extra cost, typically 15 to 30 percent	the pre-existing condition remains relevant but manageable
Acceptance with a benefit exclusion	the diagnosis is excluded from cover	a single, clearly defined pre-existing condition
Rejection	the contract is not concluded	several serious diagnoses or high expected costs

Which pre-existing conditions often lead to rejection?

A rejection of the application when you join private health insurance is common, for example, with these diagnoses:

AIDS
Alzheimer's disease
asthma (chronic)
epilepsy
diabetes (insulin-dependent)
mental illnesses
cancer
leukemia
multiple sclerosis
Parkinson's disease
stroke
addictions
Trisomy 21 (Down syndrome)
chronic bowel diseases

This list is not a rigid catalog. Here too, the course decides. Individual insurers assess the same finding differently.

What tips the balance on acceptance?

Whether private health insurance on standard terms succeeds despite a pre-existing condition depends mainly on the type and severity of the diagnosis, the time since the last treatment and whether you are currently free of complaints. A condition that healed years ago without follow-up treatment weighs little for the insurer. An active condition with ongoing therapy and an unclear course weighs more and makes a surcharge or exclusion more likely.

For example, if an applicant had knee surgery seven years ago, they have to state it for a health question that covers the past ten years. If the application only asks about the past five years, this operation does not have to be stated. The applicant is not hiding or concealing anything by doing so. However, if this operation left health impairments that still exist today, they must be stated on the application.

Which pre-existing conditions are usually not critical?

A pre-existing condition is often not a permanent illness but a single, completed event, for example an old sports injury, a past operation or a lost tooth. Insurers assess such cases much more calmly than many applicants expect. The following experience values show the range, but they do not replace a fixed catalog:

Example	Typical consequence
Torn cruciate ligament or knee surgery, healed	usually standard terms, with ongoing complaints a risk surcharge
Slipped disc, healed without after-effects	risk surcharge, after a long time free of complaints also standard terms
Missing or lost teeth	replaced teeth usually unproblematic, teeth not replaced often a surcharge or benefit exclusion
Ongoing dental treatment	exclusion until it is finished, then regular acceptance
Bone fracture, healed without after-effects	standard terms
Appendix or gallbladder surgery	standard terms, because healed and without follow-up risk
Sudden hearing loss or tinnitus, healed	usually standard terms, with repeated episodes a risk surcharge is possible

Mild visual impairments or well controlled allergies also belong in this non-critical category. In our advice work we see many applications with minor pre-existing conditions that are accepted on standard terms, although the applicants did not expect it.

Which pre-existing conditions more often lead to a surcharge or exclusion?

Chronic metabolic diseases, manifest cardiovascular diagnoses and chronic spinal conditions with ongoing treatment weigh more. Here a risk surcharge is more likely than acceptance on standard terms. How a permanent diagnosis is assessed in detail depends strongly on the individual insurer and the course of treatment.

Ongoing psychological treatment, or treatment that ended only recently, often leads to rejection.

How does the anonymous enquiry help?

With the anonymous risk enquiry, the insurer checks your chances of acceptance without your name or address and tells you on which terms it would accept you. The advantage is that a later formal rejection is avoided, because the enquiry is not recorded anywhere.

In our advice work we often see that the assessment of the same pre-existing condition varies between insurers by 10 to 20 percentage points on the surcharge. This is why an anonymous enquiry with several providers at the same time is almost always the better choice than a single formal application.

What happens if the application fails?

If no regular plan is available, the Basistarif applies as the fallback plan required by law. Under § 152 VAG, the insurer must 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 have we learned from more than 5,000 assessments?

With every client, we first check whether the pre-existing condition needed treatment in recent years and how stable the course is. Only then do we clarify which insurers, in our experience, assess the same finding more mildly.

This order, based on more than 5,000 applications with health questions that we have supported, avoids unnecessary rejections and regularly leads to better terms than a hasty direct application.

How high is the risk surcharge typically?

Usual values are 15 to 30 percent, depending on the pre-existing condition and the insurer also lower or higher. With very serious pre-existing conditions, rejection is more likely than a surcharge alone.

Do I have to disclose my medical records to the insurer?

Complete and truthful information is mandatory. With a release from medical confidentiality, the insurer can also see medical reports directly at the doctor. Without a release, it relies on your information and can check it in a claim.

Does the surcharge end if the pre-existing condition heals?

As a rule, not by itself. A surcharge, once agreed, remains in place. If the reason has demonstrably ceased to apply, you have a right under § 41 VVG to have it reduced appropriately, from the date your request reaches the insurer.

What does the anonymous enquiry offer compared with a direct application?

It avoids a recorded rejection and lets you compare several insurers before you commit. A direct application, by contrast, ties you to one provider early on and, if rejected, leaves traces that can put off other insurers.

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Private health insurance with pre-existing conditions: what is possible and what is not