The private health insurance deductible (Selbstbeteiligung in der privaten Krankenversicherung, PKV) is the amount you pay yourself for treatment each year before your plan starts to pay. In return, your monthly premium falls. With a deductible of €500, you pay the first €500 of medical bills in a year yourself, and your insurer covers the rest, as far as your plan provides.
For students, this is a trade-off, because the premium you save has to be weighed against a reserve you may need in an emergency. If your budget is tight, the key question is whether you could pay the full amount at once.
Key points at a glance
- Deductible, self-retention and SB all mean the same thing. With an annual deductible, the amount applies per year.
- The higher the deductible, the lower the premium tends to be.
- In private health insurance, you pay your bills first and then submit them to your insurer.
- Lowering your deductible later counts as an upgrade. The insurer may then charge a risk surcharge, exclude benefits or impose a waiting period.
- In the statutory health insurance (gesetzliche Krankenversicherung, GKV) that students usually have, there is no deductible. Instead, there are co-payments, usually 10 percent of the retail price (at least €5, at most €10).
What does a private health insurance deductible mean?
The deductible is a contractually agreed share of your treatment costs that you cover yourself. The insurer takes on less risk and charges a lower premium in return. The usual form is a fixed annual amount, the annual deductible. How exactly it applies and to which services is set out in the policy terms.
The deductible should not be confused with the co-payments in statutory health insurance. It belongs to your plan and is set when you take out the policy.
How does the annual deductible work?
You visit the doctor, receive a bill and pay it yourself. You then submit the bill to your insurer. The insurer checks what your plan reimburses and deducts the deductible that is still outstanding. There is no direct contract between doctor and insurer. For inpatient treatment, the hospital usually bills the insurer directly.
Example: Jonas, 25, has an annual deductible of €500. Assume his plan reimburses the bills at 100 percent. Over the year, three bills arrive.
| Bill | Amount | Paid by Jonas | Reimbursed by the insurer |
|---|---|---|---|
| General practitioner | €120 | €120 | €0 |
| Dentist | €380 | €380 | €0 |
| Specialist | €260 | €0 | €260 |
| Total | €760 | €500 | €260 |
Jonas pays €500 himself, and the insurer reimburses €260. Had the bills totalled only €300 in the year, he would have paid everything himself and received nothing back. In return, he paid a lower premium over the year than he would have in a plan without a deductible.
You can submit bills within three years from the end of the year in which they were issued. A bill from March 2026 can therefore be submitted until 31 December 2029.
What are the advantages of a deductible in private health insurance?
The main advantage is the lower monthly premium. If you rarely see a doctor, this pays off over the years.
Some plans also include a premium refund. If you submit no bills for a year, the insurer then pays back part of your annual premiums. As a guide, this can be up to around 50 percent of an annual premium. It is not guaranteed, however, because it depends on the insurer’s surplus. The refund reduces your tax-deductible special expenses in the year it is paid out.
What are the disadvantages of a deductible in private health insurance?
- You need to be able to pay the deductible in an emergency. If the money is not in your account, you can quickly come under pressure.
- You pre-finance every bill and wait for the reimbursement.
- A later reduction counts as an upgrade. The insurer may charge a risk surcharge, exclude benefits or impose a waiting period.
- A deductible does not protect you against premium adjustments. Insurers must check at least once a year whether benefits and calculations still match, and adjust premiums if necessary, with the approval of an independent trustee.
Does a deductible make sense as a student?
As a student, you usually have a tight budget. A high deductible lowers the premium, but a sudden visit to the dentist or a hospital stay can then eat into your savings. Before you sign up, work out whether you could pay the full deductible at once.
It is also worth comparing with statutory health insurance. In 2026, students pay roughly €143 to €148 a month there for health and long-term care insurance, but they have no annual deductible. Instead, co-payments apply: 10 percent of the retail price, at least €5 and at most €10 per item, and in hospital €10 per calendar day for up to 28 days. From 1 January 2027, these co-payments rise by about 50 percent, to at least €7.50 and at most €15. The cap is 2 percent of annual gross income, or 1 percent for people with chronic conditions. The Verbraucherzentrale consumer advice centre explains the rules for exemption from co-payments.
| Feature | Student statutory health insurance (GKV) | Private health insurance with deductible (PKV) |
|---|---|---|
| Out-of-pocket cost | Co-payment per service, usually 10 percent of the retail price, at least €5 and at most €10 (2026) | The annual deductible you choose in your plan |
| Upper limit | Cap of 2 percent of gross income | The amount agreed per year |
| Billing | Benefits in kind through your sickness fund | You pay and submit the bills |
Anyone who wants private health insurance first needs an exemption. The steps from the application to the contract are explained in how to switch to PKV as a student (in German). How the exemption application (in German) works is covered in a separate article. The deadline is three months, and the exemption cannot be revoked. What this means for you is shown in the deadline when you start your studies (in German).
Can I change my deductible later?
Yes, under the plan-switching rules of § 204 VVG. You can switch to other plans with similar cover at your own insurer, and your accrued rights and ageing provisions are credited. If you lower your deductible, this counts as an upgrade, and the insurer may charge a risk surcharge, exclude benefits or impose a waiting period. You can avoid the surcharge and the waiting period by agreeing an exclusion for the additional benefit. The plan-switching guidelines of the PKV Association govern the process. Which level suits you is explained in how to choose the right deductible (in German).
What happens if I cannot pay my premiums?
A higher deductible eases the premium, but it does not replace solid planning. If you fall behind with your premiums, the first reminder follows after two unpaid monthly premiums, and a second reminder two months later. If one monthly premium, including late-payment surcharges, remains unpaid, the policy is suspended and you move into the emergency tariff (Notlagentarif). It only covers acute illnesses and pain, as well as pregnancy and childbirth, plus cover for children and young people. If you have payment problems, contact your insurer early. More is explained in the article on payment problems in private health insurance (in German).
Frequently asked questions
What is an annual deductible?
The annual deductible is the amount you pay yourself for treatment each year. Only once your reimbursable bills exceed this sum does the insurer pay. The higher the amount, the lower your monthly premium tends to be.
Do I still get a premium refund despite a deductible?
A premium refund is possible if your plan provides for one, you submit no bills for a year and the insurer has a surplus. Whether bills below the deductible count towards this depends on the policy terms. Ask about it specifically before you sign.
Does a high deductible make sense as a student?
It only makes sense if you could cover the amount in an emergency without hardship. A tight budget and a high deductible do not go well together. Plan a realistic reserve for the worst case.
How long can I submit bills?
You can submit bills within three years from the end of the year in which they were issued. A bill from March 2026 can be submitted until 31 December 2029.
What to do now
- Work out how much you could pay at once in an emergency, and set your deductible below that amount.
- Compare plans with different deductibles, and look at more than the premium, including benefits for aids, dental prosthetics and outpatient treatment.
- Ask about the rules for premium refunds and the threshold for premium adjustments.
- If you decide to switch to private insurance, note the three-month deadline.
If you want to talk through your situation, you will find the way to advice on the Academycon homepage (in German).
You can find reviews of us on ProvenExpert, Trustlocal and Trustindex. Academycon has been mentioned, among other places, in a press release in the Frankfurter Rundschau. An overview of all mentions is on the press page (in German).
Related articles
- Premium development in private health insurance: what students should know (in German)
- How students can save on premiums (in German)
- How to find the right PKV plan as a student (in German)
- PKV plans for students compared (in German)
Last updated: October 2026. This guide is general information, not individual advice. The German version is authoritative.
