Private health insurance in Germany with pre-existing conditions

This guide is for expats moving to Germany who have a medical history they are unsure about: a chronic condition, a past diagnosis, ongoing medication, or a previous hospital stay. It is also relevant if you are self-employed or an employee earning above the income threshold and weighing up whether private health insurance is realistic for you.

It is less relevant if you are below the income threshold and will join public health insurance (GKV) automatically, or if you have no significant medical history and expect a straightforward PKV application. For a full overview of eligibility and the difference between the two systems, see the guide to private vs public health insurance in Germany.

A pre-existing condition is any illness, diagnosis, treatment, or ongoing medication that existed before you submit your PKV application. That covers a wide range: asthma, high blood pressure, back problems, allergies, diabetes, depression, a past knee surgery, even regularly prescribed medication for a condition that feels well-managed. If a doctor has ever noted it, it is part of your medical history.

Every PKV application includes a health questionnaire (Gesundheitsfragen). Insurers ask about doctor visits, hospital stays, psychotherapy, prescribed medication, missing teeth, and planned treatments within specific look-back periods. Those periods vary by insurer and are printed directly on each application form, so there is no single universal rule. What one insurer asks about the last three years, another may ask about the last five or ten.

Treatment you received abroad counts too. Your medical history from your home country is part of what you must disclose, even if the records are in another language.

One practical note on eligibility: employees can only join PKV if their gross income exceeds the income threshold, which is €77,400 in 2026 and €84,150 from 2027 (the 2027 figure still needs Bundesrat approval). Self-employed people and freelancers can join PKV regardless of income. If you are not yet sure which system applies to you, the guide to private vs public health insurance lays out the eligibility rules in full.

The anonymous risk pre-check (anonyme Risikovoranfrage) is the most practical tool available to expats with a complex health history. A broker sends your health details to several insurers without your name attached. The insurers respond with how they would decide: accept at the standard rate, add a surcharge, add an exclusion, or decline. You see the results side by side before any formal application is submitted.

Anonymity matters for a specific legal reason. Many PKV application forms ask whether you have ever been declined by another insurer. A formal rejection must be disclosed on future applications. An anonymous enquiry never becomes a formal rejection, so it does not appear on any record and does not affect future applications.

Seeing several offers at once also gives you genuine room to choose. If one insurer would exclude your condition but another would accept it with a modest surcharge, you can make an informed decision rather than accepting the first answer you receive.

Before the pre-check or any formal application, gather the following: doctor's letters and specialist reports, diagnosis reports with dates, your current medication list with dosages, hospital discharge papers, records from your home country (translated into German or English if possible), and a short written summary from your GP if your history is complex.

Under §19 VVG, you have a duty of disclosure. You must answer all health questions truthfully and completely at the time of application. Under §§19 to 21 VVG, if you omit or misrepresent information, the insurer can withdraw from the contract, terminate it, or change the terms retroactively. In health insurance this right lasts up to three years from the contract date, or ten years if the omission was intentional or fraudulent. A claim being denied after a serious diagnosis, because of an unanswered question years earlier, is a painful and avoidable situation.

If you are genuinely unsure whether something counts, ask your doctor for a written summary of past treatments. It is better to over-disclose than to leave a gap.

A decline or a prohibitively high surcharge does not leave you without options. Three realistic paths exist depending on your employment status and health situation.