The mention of “pre-existing conditions” may send shivers down the spine of health insurance seekers. If you come from a country with a primarily privatized insurance system, then you probably know that pre-existing conditions can be a make-or-break factor when it comes to receiving coverage.
In Germany, though, the public health insurance system helps to ensure that everyone can receive the care they need. So how do pre-existing conditions factor into your health insurance options?
What is a pre-existing condition?
A pre-existing condition is any illness or injury you may have had (or still have). This can include acute conditions (e.g. a finger you fractured three years ago that’s now fully healed) or chronic illnesses (e.g. Type I diabetes).
Public health insurance
The Krankenkassen (public health funds) cannot discriminate or charge extra fees based on preexisting conditions. This means that as long as you qualify to enter the public system, your care will be covered. You cannot be denied entry into the public system based on your pre-existing conditions—in fact, public health care providers don’t even ask about your medical history when you sign up!
Private health insurance
Germany’s two-tier system means that insurance seekers also have the option of registering for a private health insurance plan, if they meet certain requirements. Private plans often provide a wider variety of care options and access to more advanced treatments or new technologies and medicines. And since monthly premiums aren’t based on income, the cost of a private plan is often cheaper than public.
However, private health insurers can discriminate based on pre-existing conditions.
How does this work?
When you apply for private health insurance, you’ll need to fill out a medical history form. This includes medical treatments you’ve received in recent years (usually in the last 3-7 years, depending on the company). You will need to let the insurance company know about any chronic conditions, as well as surgeries, in-patient hospital stays, and mental health care, among other treatments.
Based on your answers, the insurance company will determine your eligibility. If your condition is severe (e.g. an anterior cruciate ligament injury that’s required multiple surgeries and years of physical therapy), the insurance provider may add a surcharge to your monthly premium as you’re considered “high-risk”. Since covering ongoing treatments for certain conditions may be quite expensive, the risk surcharge keeps costs down for other customers. If the insurance provider determines that your health situation makes you too risky to take on, they can also choose to reject your application.
In some cases, a risk surcharge can be removed. if the insured party can show that the condition hasn’t required costly treatments over a significant period of time. For example, risk surcharges often apply to obese patients because they are at significantly greater risk for developing chronic conditions like heart disease and diabetes. But if a patient loses weight and remains in a healthy weight range for a significant period of time, then those risks have been significantly reduced and the surcharge can no longer be justified.
Rarely, the insurer may choose to accept you, but exclude treatment related to a particular pre-existing condition. Generally, though, previous treatments or chronic conditions will not result in all-out rejection or treatment exclusions.
Can my insurer raise my premium if I get sick?
Once you’re on a private plan, your monthly premium will stay about the same for the entire time that you’re a private customer. By law, private premiums can only be increased in line with inflation and increases in general medical costs. This means that if you develop an illness after you join private insurance, your provider cannot raise your premium.
However, if you try to switch to another private plan, your new provider can charge you more based on your illness. This is why we always recommend choosing a private insurer early and staying with that provider for life (or at least for your entire stay in Germany).
I have a pre-existing condition. What kind of insurance should I choose?
It’s impossible to give a one-size-fits-all answer to this question. The only way to know for sure is to get in touch with one of our insurance experts to discuss your specific situation.
Generally speaking, if you’ve had costly ongoing treatment or psychotherapy in recent years, the public system may be the cheaper option—or even your only option. But if you’ve had minor issues or chronic conditions that are cheap to treat (e.g. hypothyroidism), then private insurance may still be an excellent fit for your needs.