PKV hospital coverage usually works through direct billing: The clinic normally settles with your insurer, so you do not have to pay the inpatient treatment up front. What your insurer covers is set by your tariff. In addition to the general hospital service, depending on the tariff there are optional services such as treatment by the chief physician and choice of room. The full range is shown in our overview of PKV benefits for students (in German).
PKV hospital coverage at a glance
- For inpatient treatment, direct billing between hospital and insurer is the rule.
- Optional services such as chief physician treatment and choice of room are only available if your tariff includes them.
- Statutory insured people pay a 10-euro co-payment per calendar day in hospital, for at most 28 days. According to the Federal Ministry of Health, co-payments are planned to rise by 50 per cent, which would mean 15 euros per day in hospital.
- Whether a deductible, maximum amounts or benefit exclusions apply is stated in the tariff conditions.
How does PKV bill for inpatient treatment?
For outpatient doctor visits you pay first and then submit the bill. In hospital it works differently: Billing between clinic and insurer is the rule for inpatient treatment. Medical services are billed under the GOÄ, the scale of fees for doctors. For personal medical services, the threshold rate is 2.3 times the basic rate, and the maximum rate is 3.5 times.
What belongs to standard care, and what to optional services?
Standard care covers the medically necessary treatment in hospital. Optional services go beyond that. Common examples are treatment by the chief physician and accommodation in a single or double room. Both are only available if your tariff provides them. Our article chief physician treatment for students (in German) explains whether it is worthwhile for you, and single or double room in PKV (in German) covers the choice of room.
| Service | Where it is governed |
|---|---|
| General hospital service | Tariff, scope based on medical necessity |
| Chief physician treatment | Only with the corresponding optional service in the tariff |
| Single or double room | Only with the corresponding optional service in the tariff |
| Hospital invoice | Direct billing with the insurer is the rule |
| Deductible and maximum amounts | Tariff conditions |
What do statutory insured people pay in hospital?
For comparison: In GKV, the hospital co-payment is 10 euros per calendar day for at most 28 days. Under the GKV Contribution Rate Stabilisation Act (GKV-Beitragssatzstabilisierungsgesetz), co-payments are to rise by 50 per cent, which would mean 15 euros per day in hospital. The Federal Ministry of Health does not state a date for the entry into force on its page of 10 July 2026. The statutory cap limits co-payments overall to 2 per cent of annual gross income for living costs, and to 1 per cent for people with chronic conditions.
Is there a daily hospital allowance in PKV?
A daily hospital allowance is a separate building block that pays an agreed amount for each day in hospital. It does not replace reimbursement of treatment costs. Whether your tariff includes a daily hospital allowance, or whether it has to be booked as an add-on, is stated in the conditions.
What applies to private clinics?
For private clinics, clarify in advance whether your tariff covers the costs and to what amount. Details are in our article on benefits for private clinics (in German).
What should you check in your tariff?
- Are chief physician treatment and single or double room included?
- Is there a deductible, and does it also apply to hospital stays?
- Which maximum amounts and benefit exclusions appear in the conditions?
- Is a daily hospital allowance included, and at what amount?
- What does the tariff cover for rehabilitation and aftercare?
The more optional services a tariff includes, the higher its premium usually is. How PKV premiums are made up (in German) is explained in a separate article. For your share of costs, it is worth building up a reserve, as described in our article on long-term health costs (in German).
Which risks come with PKV during your studies?
The exemption from statutory insurance cannot be revoked and normally applies to the whole course of study. A switch back to GKV is normally only possible after your studies. Contributions may rise if the insurer adjusts them.
Frequently asked questions
As a privately insured patient, do I have to pay in hospital myself?
For inpatient treatment, direct billing between hospital and insurer is the rule. You pay what your tariff does not cover yourself, such as a deductible or uninsured optional services.
What are optional services in hospital?
Optional services go beyond the general hospital service. Typical examples are chief physician treatment and a single or double room. Whether your tariff covers them, and to what extent, is stated in the conditions.
What does the GKV hospital co-payment cost?
Statutory insured people pay 10 euros per calendar day for at most 28 days. Co-payments are planned to rise by 50 per cent, which would mean 15 euros per day in hospital. The Federal Ministry of Health does not state a date for the entry into force. As a privately insured person, the rules of your tariff apply instead.
Does PKV pay a daily hospital allowance?
Only if your tariff or an add-on provides for it. It is an agreed amount per day in hospital. Check the tariff conditions or ask your insurer.
So what should you do now
- Read the hospital benefits in your tariff conditions.
- Check whether chief physician treatment and room choice are included.
- Before a planned stay, clarify what the insurer will pay.
- Build up a reserve for your deductible and any uncovered items.
If you want to talk through your situation, you will find the way to advice on the Academycon homepage.
You can read about our work on ProvenExpert, Trustlocal and Trustindex. Academycon was mentioned, among other places, in a press release by Kurier. An overview of all mentions is on the press page.
Related reading
- Chief physician treatment for students: Is it worth it? (in German)
- Single or double room in PKV: What suits you? (in German)
- Doctor appointments as a privately insured patient: How fast? (in German)
- Wanting children and PKV: What students should know (in German)
Last updated: October 2026. This article provides general information and does not replace individual advice.
