The private health insurance benefits you receive are set out in your tariff. You pay your doctor and your hospital first and receive the bill reimbursed by your insurer, to the extent your tariff provides for it. The tariff determines whether you receive optional hospital services and how far therapy and aids are reimbursed. This article compares doctors, hospitals and therapy with statutory insurance. The benefits of private health insurance at a glance (in German) are covered in our basic article.
The key points in brief
- Privately insured patients pay the bill first and submit it to the insurer. The doctor bills under the GOÄ fee schedule.
- Optional hospital services such as treatment by the chief physician and choice of room are only available if your tariff includes them.
- For psychotherapy and aids, the wording of the tariff counts: scope, procedures and reimbursement rates differ from provider to provider.
- The exemption from statutory insurance during your studies is irrevocable. Returning to statutory insurance later is difficult.
How do privately and statutorily insured patients differ at the doctor’s?
The biggest practical difference is billing. Statutorily insured patients show their health insurance card, and the practice bills the health insurer directly. Privately insured patients receive a bill, pay it and submit it to their insurer. The amount of reimbursement depends on the tariff, and there is no direct contractual relationship between doctor and insurer.
The GOÄ applies to the bill. For personal medical services, the threshold value is 2.3 times the basic rate and the maximum rate is 3.5 times. Up to the threshold value, the doctor needs no justification. Above it, they must justify each service in writing. If you want to submit a bill, you have three years from the end of the year in which it was issued. A bill from March 2026 can therefore be submitted until 31 December 2029. The Federal Agency for Civic Education describes the fee schedule in detail.
Do privately insured patients get an appointment faster?
How quickly a practice gives appointments is up to the practice itself. There is no statutory entitlement to shorter waiting times. Statutorily insured patients, on the other hand, have the appointment service 116117. It is available around the clock and should offer a specialist appointment within one week, and the waiting time must not exceed four weeks. For the referral you usually need a referral slip, except for eye doctors and gynaecologists as well as general practitioners and paediatricians. There is no entitlement to a specific doctor. The Federal Ministry of Health describes the rules. How appointments are handled for privately insured patients is covered in doctor’s appointments as a privately insured patient (in German).
What advantages does private health insurance offer in the hospital?
In hospital, optional services matter. Typical are treatment by the chief physician and accommodation in a single or double room. Both are only available if your tariff includes them. Whether chief physician treatment is worthwhile for you is explained in chief physician treatment for students (in German). The choice between a single or double room in private health insurance (in German) depends on the tariff and the premium.
In statutory insurance, a hospital stay usually leads to a co-payment, and the hospital generally bills the insurer directly. Statutorily insured patients pay a co-payment of €10 per calendar day for up to 28 days. According to the law as passed, it rises to €15 per day from 1 January 2027.
What does psychotherapy look like as a privately insured patient?
Whether and to what extent your private health insurance covers outpatient psychotherapy is set out in the tariff. Above all, check which procedures are included, whether the number of sessions per year is limited and which reimbursement rates apply. For people with existing complaints, this is not a side issue, because you only notice a gap in cover when you need the therapy.
In statutory insurance, the route usually starts with a psychotherapy consultation. The appointment service must arrange an appointment within a week for this. Acute treatment comprises up to 24 units of 25 minutes each, short-term therapy up to 24 units of 50 minutes each, and long-term therapy up to 60 units of 50 minutes each. More on the private side is in PKV and psychotherapy: what is covered? (in German)
What does private health insurance pay for aids and glasses?
The decisive factor is whether your tariff has an open or closed list of aids. With an open list, all medically necessary aids are reimbursed. With a closed list, only those explicitly named are. The statutory aids directory is not binding in private health insurance, except in the basic tariff. Typical reimbursement rates are 75, 90 or 100 percent, often with maximum amounts. Why the open list of aids (in German) may matter to you is explained in a separate article.
For glasses, the position in statutory insurance is narrow. Adults are only entitled in cases of serious visual impairment, or if they have short-sightedness of more than 6.0 dioptres, long-sightedness of more than 6.0 dioptres or astigmatism of more than 4.0 dioptres. Frames are never covered by the health insurer. The consumer advice centre explains the rules. In private health insurance, it depends on the tariff whether private health insurance pays for glasses (in German), and in what amount.
Private health insurance benefits compared with statutory insurance
| Area | Statutory insurance (GKV) | Private insurance (PKV) |
|---|---|---|
| Billing | Benefit in kind, the practice bills the health insurer | Bill under the GOÄ, you pay and submit it to the insurer |
| Appointment service | Appointment service 116117 with a one-week target for specialist appointments | No statutory entitlement to shorter waiting times, allocation lies with the practice |
| Hospital | Co-payment €10 per day, up to 28 days (from 2027: €15 per day) | Chief physician and choice of room only with the appropriate tariff |
| Psychotherapy | Consultation, then acute, short-term or long-term therapy with fixed limits | Scope and procedures as set out in the tariff |
| Aids | Co-payment 10 percent, at least €5, at most €10 (from 2027: €7.50 to €15) | Open or closed list, often reimbursement at 75, 90 or 100 percent |
What disadvantages should you know about?
The exemption from compulsory insurance cannot be revoked and generally applies for the whole course of study. A return to statutory insurance is normally only possible after your studies, for example through employment subject to compulsory insurance. Premiums may also rise if the insurer adjusts them. How to deal with this is explained in the article on premium adjustments in private health insurance (in German).
The application for exemption must be submitted to the statutory health insurer within three months of the start of compulsory insurance. In the application to the private insurer, answer health questions truthfully. An anonymous risk enquiry before applying helps avoid surprises.
Frequently asked questions
What advantages does a privately insured student have?
The advantages depend on the tariff. Possible are treatment by the chief physician and choice of room in hospital, as well as broad reimbursement for aids and therapy. Against this stand obligations: you pre-finance bills, premiums can rise, and the exemption from statutory insurance is irrevocable.
Are privately insured patients given preference for appointments?
That is up to the practice. Private health insurance does not entitle you to an earlier appointment. For statutorily insured patients, the appointment service 116117 arranges a specialist appointment within one week, and the waiting time must not exceed four weeks.
Can I choose the chief physician as a privately insured patient?
Only if your tariff includes the optional service of chief physician treatment. The tariff conditions set out which costs the insurer covers. Check there also whether the optional service applies only in hospital and whether it has maximum amounts, before you rely on it. Whether it is worthwhile for you is explained in the article on chief physician treatment.
Does private health insurance pay for every therapy?
No. Reimbursement covers what the tariff provides and what is medically necessary. For psychotherapy, pay attention to procedures, number of sessions and reimbursement rates. A service excluded in the tariff is not reimbursed.
So what should you do now?
- Decide which services matter to you: optional hospital services, psychotherapy and aids.
- Read the tariff conditions on exactly these points, for example the list of aids and psychotherapy.
- For pre-existing conditions, make an anonymous risk enquiry before applying.
- Observe the three-month deadline for the exemption application and the consequences of irrevocability.
If you want to talk through your situation, you will find the way to a consultation on the Academycon homepage.
You can find experiences with us on ProvenExpert, Trustlocal and Trustindex. Academycon was also mentioned in a press release by Nachrichten Heute. An overview of all mentions is on the press page (in German).
Related articles
- Doctor’s appointments as a privately insured patient: how fast? (in German)
- Chief physician treatment for students: is it worth it? (in German)
- PKV and psychotherapy: what is covered? (in German)
- Benefits with student status: what the student ID gets you (in German)
Last updated: October 2026. This guide is general information, not individual advice. The German version is authoritative.
