PKV pre-existing conditions as a student are possible, but acceptance is never guaranteed. The insurer asks health questions in the application for private health insurance (PKV) and can then accept you, accept you with a risk surcharge, accept you with exclusions or decline. Ongoing treatment and recommended operations often lead to a refusal. That is why an anonymous risk enquiry should come before the application, and it should come in time: you must submit the exemption application to your health fund within three months of the start of compulsory insurance.
The key points at a glance
- The PKV application contains health questions that you must answer truthfully.
- Possible outcomes are acceptance, acceptance with a risk surcharge, acceptance with exclusions or refusal.
- An anonymous risk enquiry shows in advance how insurers would probably decide.
- The exemption from compulsory insurance only takes effect if you prove other cover, and it cannot be revoked.
How do PKV pre-existing conditions affect your application?
The insurer assesses your health risk based on what you tell it about diagnoses, treatments and medication. Depending on the result, the decision differs. Whether a particular condition leads to a surcharge or an exclusion cannot be said across the board, because it differs from insurer to insurer.
| Outcome of the assessment | What it means for you |
|---|---|
| Acceptance on normal terms | The tariff applies without a surcharge and without restrictions. |
| Acceptance with a risk surcharge | You pay a higher premium than without the pre-existing condition. |
| Acceptance with an exclusion | The tariff does not reimburse costs for the affected body region or condition. |
| Refusal | No contract is concluded. |
How the health questions work in detail is explained in the health check in PKV (in German). Whether there is a route with fewer questions is covered in the guide on the simplified health check (in German).
What is an anonymous risk enquiry?
With an anonymous risk enquiry you pass your health data to insurers without your name and find out whether, and on what terms, they would accept you. Only then do you submit the binding application. This step makes sense because ongoing treatment and recommended operations otherwise quickly lead to a refusal in the binding application.
For the enquiry you need a clean summary: diagnoses, periods of treatment, current and past medication, and whether you are currently free of symptoms. If details are missing, ask practices and clinics for reports. The steps after acceptance are described in the route into private health insurance (in German).
What happens if private health insurance refuses you?
The exemption from compulsory insurance takes effect only if you prove that you have another entitlement to cover in case of illness, which in practice means a private contract. Without a PKV acceptance you have no such proof, and you remain in student compulsory insurance. The basic contribution in 2026 is €87.38 per month nationwide, plus long-term care insurance and your fund’s additional contribution.
| Age | Health plus long-term care insurance (student cover, 2026) |
|---|---|
| Under 23 or with a child | €118.16 plus the fund’s additional contribution |
| From 23, childless | €123.29 plus the fund’s additional contribution |
A second option is free family insurance. It may be possible for children of statutorily insured parents up to age 25 while studying, if total income in 2026 does not exceed €565 per month. The conditions are set out in section 10 SGB V.
How honest do you have to be in the health questions?
Completely. Under section 19 VVG you must disclose circumstances known to you that are significant to the insurer and about which it has asked in text form. If you breach this duty, the insurer can withdraw from the contract. If you were neither intentional nor grossly negligent, withdrawal is excluded, but the insurer can then terminate with one month’s notice.
The insurer has these rights only if it has informed you of the consequences in a separate notice in text form. It must assert them within one month of becoming aware. They lapse five years after the contract is concluded, or after ten years in cases of intent or fraud. If you leave out a diagnosis, you put at risk for years the protection you wanted to secure with the contract.
Is the decision for PKV with pre-existing conditions reversible?
Hardly. The exemption cannot be revoked and normally applies to the whole course of study. A return to the GKV is usually possible only after your studies, for example through employment subject to compulsory insurance, and in narrow cases also with a second degree. In addition, premiums in PKV can rise over the years. The Verbraucherzentrale summarises the options.
If you want to end an existing PKV, you should terminate only once the continuous cover is certain. For a contract that fulfils the insurance obligation, termination takes effect only if seamless cover is proven within two months. The deadlines and process are explained in the guide on terminating PKV during your studies (in German).
Frequently asked questions
Can I get private health insurance as a student with pre-existing conditions?
It is possible, but not certain. The insurer decides based on your answers to the health questions. With ongoing treatment and recommended operations, a refusal is likely. In other cases, a surcharge or an exclusion may come into question. An anonymous risk enquiry clarifies this in advance.
What is an exclusion in PKV?
An exclusion removes a particular condition or body region from the tariff. The insurer then does not reimburse costs for it, while everything else remains covered. Alternatively, the insurer may charge a risk surcharge on the premium. Which variant applies is shown in the offer.
What happens if PKV refuses me because of a pre-existing condition?
Without other insurance cover, the exemption does not take effect. You then remain in the student compulsory insurance of a statutory fund. Family insurance may also apply if the conditions are met, for example the income limit of €565 per month.
May I leave out a pre-existing condition?
No. You must disclose significant circumstances about which the insurer asks. If you breach this duty, it can withdraw from the contract or terminate it. These rights lapse five years after the contract is concluded, or only after ten years in cases of intent or fraud.
So proceed now
- Compile diagnoses, periods of treatment, medication and whether you are currently free of symptoms.
- Start an anonymous risk enquiry before you apply for anything.
- Keep the three-month deadline for the exemption application in view and plan for the insurers’ responses.
- Answer the health questions in the application completely and truthfully.
- Terminate an existing insurance only once the new one is certain.
If you want to talk through your situation, you will find the way to advice on the Academycon homepage.
Experiences with us can be found on ProvenExpert, Trustlocal and Trustindex. Academycon was mentioned, among other places, in a report by VersicherungsJournal. An overview of all mentions is on the press page.
Related reading
- PKV or statutory insurance as a student: which pays off more? (in German)
- Drawbacks of PKV for students: what to know beforehand (in German)
- Requirements for PKV during your studies: who can join? (in German)
- Finding a GP as a student: choosing a doctor in a new city (in German)
Last updated: October 2026. This guide is general information, not individual advice. The German version is authoritative.
