Private health insurance despite psychotherapy: your path to insurance coverage
10 Apr 2025
8
Minutes
Katrin Straub
CEO at nextsure
A past or present psychotherapy does not necessarily have to be an obstacle to switching to private health insurance (PKV). Find out what conditions apply and how you can improve your chances of admission.
The topic in brief and concise terms
A private health insurance is often possible despite psychotherapy, but it depends on the individual's situation and the insurer's acceptance guidelines.
Honesty in health questions is crucial; risk surcharges or benefit exclusions are possible consequences when declaring psychotherapy.
Anonymized preliminary risk inquiries and good preparation with medical documents can significantly improve the chances of acceptance.
Immediate Overview: The Key Facts About Private Health Insurance and Psychotherapy
Securing private health insurance despite undergoing psychotherapy is a significant concern for many. A health assessment is always required in this process. Insurers assess the individual risk very carefully. Having undergone psychotherapy in the past does not automatically lead to a rejection.
Understanding the Health Check: The Basis for Your Private Health Insurance Application
Insurers ask for details of treatments from the last three to five years as part of the health examination. For some providers, this period may even extend to ten years. Answering all health questions accurately and honestly is crucial for a valid contract. Incorrect information can lead to cancellation or refusal of benefits. Routine check-ups or one-off consultations without a medical condition often do not need to be disclosed. A private health insurance offers many advantages. The specific questions vary depending on the insurer, making a careful comparison of application forms necessary.
Insurers' Acceptance Guidelines: What is checked in Psychotherapy?
The acceptance guidelines for private health insurance despite psychotherapy vary significantly. Often critical factors include the type of mental illness, the duration, and the success of the therapy. A short-term therapy completed successfully many years ago due to a specific life crisis is usually assessed differently than a long-term treatment of chronic depression. Insurers check whether the therapy is completed and a full recovery has been certified. An ongoing psychotherapy can often lead to a postponement of the application or a rejection. However, some insurers offer solutions in these cases, for example through a PKV option tariff. The individual risk assessment is key here.
Risk surcharge and performance exclusion: Possible consequences for your contract
If there was psychotherapeutic treatment within the queried period, the insurance may impose a risk surcharge. Depending on the risk assessment, this surcharge can be between ten and fifty percent of the premium. Alternatively, an exclusion of benefits for psychotherapeutic treatments is possible. This means the insurance will not cover costs for future psychotherapies. An exclusion of benefits is often a worse option than a moderate risk surcharge. It is important to accurately calculate the costs of private health insurance. In some cases, especially with severe or chronic mental illnesses, an application may also be rejected. A careful review of the options is therefore essential.
Risk surcharge: A percentage markup on the normal premium, e.g., twenty percent.
Exclusion of benefits: Certain treatments, such as psychotherapy, are excluded from insurance coverage.
Rejection: The insurer does not accept the application.
Acceptance without difficulty: Possible for therapies that were concluded long ago and are fully resolved.
These consequences depend heavily on the individual situation and the respective insurer.
Special Case: Civil Servants: The Opening Action as an Opportunity
There is a special regulation for civil servants and civil servant candidates: the so-called PKV opening action. This also provides civil servants with pre-existing conditions, including mental illnesses, access to private health insurance. The risk surcharge is limited to a maximum of thirty percent of the tariff contribution. It is important to submit the application within six months of the initial civil service appointment. The first legally valid application under the opening clause cannot be rejected. This represents a significant relief for the PKV contribution for civil servants. You should inquire about the exact conditions from your aid office or a specialized advisor.
Coverage for psychotherapy costs: What does private health insurance offer?
The coverage of psychotherapy costs in private health insurance (PKV) largely depends on the chosen plan. [2,-----2] Many plans provide for a certain number of sessions per year, for example, 25 or 50. [-----5] Other plans have no explicit limit but are aligned with medical necessity and therapy guidelines. It is advisable to clarify the cost coverage with the insurer before starting therapy. Billing is usually carried out according to the fee schedule for doctors (GOÄ) or psychotherapists (GOP). [-----2,-------3] A supplementary health insurance can also be relevant. Since the first of July 2024, there are new, agreed billing guidelines intended to create more transparency. Online psychotherapy can also be reimbursable.
The following aspects need to be considered for cost coverage:
Check plan details: How many sessions are covered per year?
Medical necessity: This must be met for cost coverage.
Recognised procedures: Usually, guideline procedures such as behavioural therapy or psychoanalytically founded psychotherapy are reimbursable. [-----5]
Prior approval: Often not mandatory but advisable for security.
Billing rates: According to GOÄ/GOP, usual rates often range between 100 and 180 euros per session. [-----2]
An ongoing psychotherapy does not lead to a direct increase in contributions in the existing contract.
Expert Tips: Strategies for a Successful Private Health Insurance Completion
To maximise the chances of obtaining private health insurance despite psychotherapy, a strategic approach is helpful. An anonymised risk inquiry, also known as a sample application, is an excellent tool. This involves sending your health data to several insurers anonymously. This way, you receive binding information about possible acceptance conditions without any potential rejections being recorded. Our expert tip: Obtain medical reports and a statement from your therapist before submitting your application. These documents can help present the situation transparently and avoid misunderstandings. A heilpraktiker psychotherapy may have different conditions. The waiting time for psychotherapy in private health insurance is often eight months. [-----1] However, this can be waived with prior insurance periods or with medical certificates. [-----4]
Legal Aspects and Disclosure Requirements: What You Need to Know
Next steps: How to find the right private health insurance
More useful links
The Federal Ministry of Health provides comprehensive information on psychotherapy in Germany.
A press release from the Association of Private Health Insurance (PKV) highlights the progress in private psychotherapy provision.
The official website of the Federal Chamber of Psychotherapists (BPtK) offers 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 statutory medical care.
The 2021 Psychotherapy Report of the German Psychotherapists Association (DPtV) offers detailed insights into the current state of psychotherapy in Germany.
The federal health portal, gesund.bund.de, delivers reliable information on the topic of psychotherapy.
FAQ
Is it possible to have private health insurance despite ongoing psychotherapy?
Ongoing psychotherapy significantly hinders the completion of a private health insurance policy. Many insurers reject applications in such cases or defer them until the therapy is concluded. However, there are exceptions or special option tariffs that can be considered.
What is the risk surcharge for psychotherapy in private health insurance?
The risk surcharge can vary but often ranges between ten and fifty percent of the regular premium. The exact amount depends on the insurer's assessment of the individual risk.
Do I also need to declare a one-time psychological consultation?
That depends on the specific question in the application. Pure preventive measures or one-time consultations without any medical value often do not need to be disclosed. However, as soon as a diagnosis is made or treatment is started, this usually needs to be reported.
Is there private health insurance without health questions for psychotherapy?
No, there is generally no private health insurance without a medical examination. The medical examination is an integral 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 an addiction disorder.
What is the opening procedure for civil servants in psychotherapy?
The opening clause allows civil servants (including those with pre-existing mental health conditions) to access private health insurance under relaxed conditions, with a maximum risk surcharge of thirty percent, if the application is submitted within the deadline.
