Private health insurance despite psychotherapy: your path to insurance cover
10.04.25
9
Minutes
Katrin Straub
Managing Director at nextsure
Psychotherapy in the past or present does not have to be an obstacle to switching to private health insurance (PKV). Find out what requirements apply and how you can improve your chances of being accepted.
The topic in brief and concise terms
Private health insurance is often still possible despite psychotherapy, but it depends on the individual situation and the insurer’s acceptance criteria.
Honesty when answering the health questions is crucial; premium loadings or exclusions of benefits are possible consequences of disclosing psychotherapy.
Anonymised risk pre-enquiries and good preparation with medical documents can significantly improve the chances of acceptance.
Quick overview: The key facts about private health insurance and psychotherapy
Taking out private health insurance despite psychotherapy is an important concern for many people. A health assessment is always required in this case. Insurers assess the individual risk very carefully. Psychotherapy in the past does not automatically lead to a rejection.
Understanding the Health Assessment: The Basis for Your Private Health Insurance Application
Insurers request details of treatments from the last three to five years as part of the medical assessment. For some providers, this period can also cover ten years. Providing accurate and truthful answers to all health questions is crucial for a valid contract. False statements can lead to cancellation or refusal of benefits. Routine check-ups or one-off consultations without any medical significance often do not fall under the obligation to disclose. A private health insurance policy offers many advantages. The exact questions vary depending on the insurer. This makes a careful comparison of the application forms necessary.
Insurers' acceptance guidelines: What is assessed in psychotherapy?
Acceptance guidelines regarding private health insurance despite psychotherapy vary greatly. The type of mental illness, the duration and the success of the therapy are often decisive. A successful short-term therapy completed many years ago for a specific life crisis is usually assessed differently from many years of treatment for chronic depression. Insurers check whether the therapy has been completed and whether full recovery has been certified. Ongoing psychotherapy can often lead to the application being deferred or rejected. However, some insurers also offer solutions in such cases, for example via a private health insurance option tariff. Individual risk assessment is the key here.
Risk surcharge and exclusion of benefits: Possible consequences for your contract
If psychotherapeutic treatment exists within the period queried, the insurer may apply a risk loading. Depending on the assessment of the risk, this loading can amount to between ten and fifty per cent of the premium. Alternatively, an exclusion of benefits for psychotherapeutic treatments is possible. This means that the insurer will not cover the costs of future psychotherapy. An exclusion of benefits is often the poorer option than a moderate risk loading. It is important to calculate the costs of private health insurance precisely. In some cases, especially with severe or chronic mental health conditions, the application may also be rejected. A careful review of the options is therefore essential.
Risk loading: A percentage surcharge on the normal premium, e.g. twenty per cent.
Exclusion of benefits: Certain treatments, such as psychotherapy, are excluded from cover.
Rejection: The insurer does not accept the application.
Acceptance without loading: Possible where therapies were completed long ago.
These consequences depend heavily on the individual situation and the respective insurer.
Special case: civil servants – the opening campaign as an opportunity
For civil servants and civil service trainees, there is a special regulation: the so-called PKV opening scheme. This also enables civil servants with pre-existing conditions, including mental health conditions, to access private health insurance. The risk surcharge is capped at a maximum of thirty per cent of the tariff premium. It is important to submit the application within six months of the initial appointment as a civil servant. The first legally valid application under the opening clause must not be refused. This represents a significant easing of the PKV contribution for civil servants. You should ask your reimbursement office or a specialised adviser about the exact conditions.
Cost coverage for psychotherapy: What does private health insurance cover?
Coverage of psychotherapy costs in private health insurance (PKV) depends heavily on the chosen tariff. [2,-----2] Many tariffs provide a certain number of sessions per year, for example 25 or 50. [-----5] Other tariffs have no explicit limit, but are based on medical necessity and the therapy guidelines. It is advisable to clarify cost coverage with the insurer before starting therapy. Billing is usually carried out according to the scale of fees for doctors (GOÄ) or psychotherapists (GOP). [-----2,-------3] A supplementary health insurance policy can also be relevant. Since 1 July 2024, there have been new, agreed billing guidelines intended to create greater transparency. Online psychotherapy may also be reimbursable.
The following aspects should be noted regarding cost coverage:
Check tariff details: How many sessions are covered per year?
Medical necessity: This must be present for cost coverage.
Recognised therapies: As a rule, guideline-based therapies such as behavioural therapy or psychodynamic psychotherapy are reimbursed. [-----5]
Prior approval: Often not mandatory, but advisable for safety.
Billing rates: According to GOÄ/GOP, customary rates often lie between 100 and 180 euros per session. [-----2]
Ongoing psychotherapy does not lead to a direct increase in premiums in the existing contract.
To maximise your chances of obtaining private health insurance despite psychotherapy, a strategic approach is helpful. An anonymised pre-assessment of risk, also known as a trial application, is a very useful tool. Your health data is sent to several insurers without your name being disclosed. This gives you binding information on possible acceptance conditions, without any potential rejection being recorded. Our expert tip: Obtain medical reports and a statement from your therapist before applying. These documents can help present the situation transparently and avoid misunderstandings. A non-medical practitioner psychotherapy may be subject to different conditions. The waiting period for psychotherapy in private health insurance is often eight months. [-----1] However, this can be waived if you have prior insurance periods or medical certificates. [-----4]
Legal aspects and reporting requirements: What you need to know
The pre-contractual duty of disclosure (§ 19 VVG) is a central aspect when taking out private health insurance (PKV). You are required to answer all health questions truthfully and in full. Concealing relevant pre-existing conditions, such as psychotherapy, can have serious consequences. If the insurer later discovers false statements, it may withdraw from the contract, terminate it or contest it. In the worst case, it will refuse to cover the costs of treatment. Our expert tip: Document your information and keep copies of the application. The Social Code, Book Five (SGB V) primarily regulates statutory health insurance (GKV), but the Insurance Contract Act (VVG) and the psychotherapy guidelines are also relevant. Doctors’ and therapists’ duty of confidentiality is regulated in § 203 of the German Criminal Code (StGB), but can be lifted by the insurer in the event of a claim if you consent. Occupational disability insurance after psychotherapy faces similar hurdles. Therefore, always be honest and complete in your information.
Next steps: How to find the right private health insurance
The path to private health insurance despite psychotherapy requires careful planning and open communication. Take advantage of an anonymous pre-assessment enquiry to explore your options. Compare offers from different insurers carefully, especially with regard to underwriting guidelines and benefits for psychotherapy. Professional advice can help you avoid pitfalls and find the right plan. Remember that completed therapy is often not an insurmountable obstacle. With the right preparation, you can often obtain the cover you want. We at nextsure will be happy to support you in analysing your individual situation and finding the best solution for your needs. Request an individual risk analysis now: Have your insurance situation checked free of charge and receive specific suggestions for improvement.
More useful links
The Federal Ministry of Health offers comprehensive information on psychotherapy in Germany.
A press release from the Association of Private Health Insurance (PKV) highlights progress in private psychotherapy care.
The official website of the Federal Chamber of Psychotherapists (BPtK) provides insights into the work and positions of psychotherapists in Germany.
The National Association of Statutory Health Insurance Physicians (KBV) provides information on psychotherapy within the framework of contracted medical care.
The Psychotherapy Report 2021 by the German Psychotherapists Association (DPtV) provides detailed insights into the current situation of psychotherapy in Germany.
The federal health portal, gesund.bund.de, provides reliable information on psychotherapy.
FAQ
Is private health insurance possible despite ongoing psychotherapy?
An ongoing course of psychotherapy makes obtaining private health insurance considerably more difficult. Many insurers reject applications in such cases or defer them until the therapy has been completed. However, there are exceptions or special option tariffs that can be reviewed.
How high is the risk surcharge for psychotherapy in private health insurance?
The risk surcharge can vary, but is often between ten and fifty per cent of the normal premium. The exact amount depends on the insurer’s assessment of the individual risk.
Do I also need to disclose a one-off psychological consultation?
This depends on the exact question asked in the application. Pure preventive measures or one-off consultations without any medical significance often do not need to be disclosed. However, once a diagnosis has been made or treatment has begun, this is usually subject to declaration.
Is there private health insurance without health questions for psychotherapy?
No, private health insurance without a health check is generally not available. The health check is a fixed part of the application process.
What role does the type of mental illness play for private health insurance?
The nature and severity of the illness are very relevant. A mild, situational stress reaction is assessed differently from, for example, a severe chronic illness such as schizophrenia or a substance use disorder.
What is the opening procedure for civil servants for psychotherapy?
The opening scheme enables civil servants (including those with pre-existing mental health conditions) to access private health insurance on easier terms, with a maximum risk loading of thirty per cent, provided the application is submitted on time.
