If you already have private health insurance (PKV) in 2026 and remain exempt from compulsory insurance, you may wonder for 2027 whether your status carries over. The draft regulation on the social insurance reference values for 2027 contains a separate rule for this, known as existing-case protection. It is tied to a cut-off date of 31 December 2026. This guide explains who the rule covers, which threshold it sets and why the cut-off date matters so much.
Short answer: For blue-collar and white-collar employees who were privately insured and exempt from compulsory insurance on 31 December 2026 because of the threshold then in force, the draft regulation for 2027 sets a separate threshold of 80,550 euros a year (6,712.50 euros a month). The cut-off date is stated in the explanatory notes to the regulation. Last updated: November 2026. The regulation is not yet in force.
The most important points
- For 2027 the draft names a general annual earnings threshold of 84,150 euros (section 6 (6) SGB V). Source: Bundesrat printed paper 576/26 of 7 October 2026.
- For existing cases, the draft sets a separate threshold of 80,550 euros a year (section 6 (8) SGB V).
- The cut-off date of 31 December 2026 appears in the explanatory notes to the regulation, not in the regulatory text itself.
- The existing-case rule applies only to people who were privately insured and exempt from compulsory insurance on that date. Anyone who was statutorily insured on the cut-off date does not fall under it.
- How the threshold affects staying, switching or returning in an individual case should be clarified with your insurer or health fund before the cut-off date.
Who does existing-case protection cover in 2027?
According to the explanatory notes to the draft, the rule covers blue-collar and white-collar employees who on 31 December 2026 were exempt from compulsory insurance because they exceeded the threshold then in force, and who at the same time were insured with a private health insurer under a substitutive health insurance. Substitutive means that the private cover replaces statutory health insurance rather than supplementing it.
The group is therefore narrowly defined, and everything depends on one single day. Anyone who was statutorily insured on the cut-off date, or who only moves to PKV later, does not belong to this group. For everyone else, the general threshold of 84,150 euros a year, as set by the draft, remains the relevant figure.
Which thresholds sit side by side in 2027
The regulation names several thresholds with different purposes. The table below groups them by function. The figures come from the draft that has been submitted to the Bundesrat as printed paper 576/26. The Bundesrat has not yet given its consent, and no date for that decision is known.
| Threshold | Legal basis | Annual value 2027 | Monthly value 2027 | Applies to |
|---|---|---|---|---|
| General annual earnings threshold | Section 6 (6) SGB V | 84,150 euros | 7,012.50 euros | In principle all blue-collar and white-collar employees |
| Further threshold | Section 6 (7) SGB V | 72,900 euros | 6,075 euros | Cases named in the regulatory text |
| Existing-case threshold | Section 6 (8) SGB V | 80,550 euros | 6,712.50 euros | People with the cut-off date of 31 December 2026 |
For context, the general threshold in 2026 was 77,400 euros a year. That figure is official and comes from the fact sheet of the GKV-Spitzenverband, the umbrella body of the statutory health insurers, status 1 January 2026. The rise to 84,150 euros is a difference of 6,750 euros a year, calculated from these two figures.
Why the 31 December 2026 cut-off date matters
The cut-off date determines who falls under the existing-case rule. It is time-critical because it falls before the turn of the year. Anyone who does not meet the conditions on that date cannot meet them retrospectively by changing their situation later. This applies regardless of how quickly the draft is finally adopted.
It is also worth noting that the cut-off date is named in the explanatory notes, while the regulatory text itself does not state it expressly. In practice, anyone relying on the rule should wait for the final regulation, published in the Federal Law Gazette, and check its wording as soon as it is available.
Three cases compared
The table shows how the rule works for different starting positions. Assumption: regular annual earnings in all three cases lie above 80,550 euros and below 84,150 euros.
| Position on 31 December 2026 | Relevant threshold | What to check |
|---|---|---|
| Privately insured and exempt from compulsory insurance | Existing-case threshold of 80,550 euros | How your earnings compare with the existing-case threshold |
| Statutorily insured | General threshold of 84,150 euros | Whether a switch is possible at all for 2027 |
| New job from 2027 | General threshold of 84,150 euros | Whether a switch makes sense, not only whether it is possible |
The consequences of exceeding the existing-case threshold follow from the regulatory text together with section 6 SGB V. The draft alone does not fully reveal these consequences. A written enquiry to the insurer you are with is therefore worthwhile before you take any decisions. An overview of the general compulsory insurance threshold can be found in our guide on the compulsory insurance threshold for students (in German).
What existing-case protection does not mean
Existing-case protection is not a lasting guarantee. It is a rule tied to a cut-off date and a threshold, and it can still change before it takes effect. Nor does it replace checking the terms of your tariff. PKV premiums depend on the tariff, your age at entry and your health, and the threshold says nothing about any of these.
If you want to keep an eye on your PKV premiums, our guide on premium adjustments (in German) explains step by step what to do after an increase. That applies whether or not you fall under the existing-case rule.
Frequently asked questions
Does existing-case protection apply automatically?
The rule works for the group described, but it is not applied for by way of an application. Whether you belong to the group depends on your insurance situation on 31 December 2026. It is therefore sensible to keep the documents that show your status on that date.
I was statutorily insured on 31 December 2026. What does that mean?
In that case the existing-case rule does not apply to you. The general annual earnings threshold of 84,150 euros applies, provided the draft is adopted in this form. Whether a switch is an option for you depends on your earnings and your age.
Is the existing-case threshold higher or lower than the general one?
It is lower, at 80,550 euros a year compared with 84,150 euros. That is a difference of 3,600 euros a year (calculated). The number alone does not tell you what legal consequence follows, however. That question belongs to the review of your individual case.
Who can help me classify my case?
Your health fund or insurer can check your situation. For a personal assessment, Academycon offers advice, see how we work (in German). A guide cannot replace that individual check.
What to do now
- Check before 31 December 2026 whether you are privately insured and exempt from compulsory insurance on that date, and document your status.
- Ask your insurer to confirm in writing how your cover was classified on the cut-off date.
- Compare your regular earnings for 2027 with the existing-case threshold of 80,550 euros and with the general threshold of 84,150 euros.
- Follow the final regulation and its wording once the Bundesrat has decided.
Related guides
- PKV 2027: limits, premiums and changes at a glance
- PKV switch 2027: what the draft thresholds mean
- Compulsory insurance threshold for students (in German)
- Private Health Insurance for Working Students in Germany
- Health insurance for students: glossary from A to Z
Sources: Bundesrat printed paper 576/26, draft regulation on the social insurance reference values for 2027 with explanatory notes (dated 7 October 2026); Federal Ministry of Labour and Social Affairs, social insurance reference values regulation 2027 (October 2026); GKV-Spitzenverband, fact sheet on reference values for contribution law (1 January 2026); Social Code Book V, section 6 (gesetze-im-internet.de, current version).
Last updated: November 2026. This guide is general information, not individual advice.
