PKV for employees: switching, threshold and employer subsidy

When employees can switch to PKV

Employees are exempt from compulsory statutory health insurance if their regular annual earnings exceed the annual earnings threshold (Jahresarbeitsentgeltgrenze, § 6 para. 1 no. 1 SGB V). This threshold is also called the compulsory insurance threshold (Versicherungspflichtgrenze). For 2026 it is €77,400 per year, which is €6,450 per month. It is adjusted every year on 1 January.

If the threshold is exceeded, compulsory insurance ends at the end of the calendar year in which this happens (§ 6 para. 4 SGB V). An exception applies if earnings in the following year stay below the threshold then in force. A switch is therefore usually possible at the turn of the year. Check in good time whether your income will continue to exceed the threshold on a lasting basis.

The employer subsidy

Privately insured employees receive a contribution subsidy from their employer (§ 257 para. 2 SGB V). It equals half of the general contribution rate of statutory health insurance plus half of the average additional contribution rate, but at most half of your actual PKV contribution. You pay the remaining part yourself.

The subsidy is only paid if your tariff offers benefits that correspond in kind to those of statutory health insurance. In addition, the insurance company must meet certain statutory requirements (§ 257 para. 2a SGB V), and you must submit a certificate from the insurer to your employer every three years. Before you take out a policy, ask whether a tariff meets these conditions.

Advantages and limits of PKV

What can speak in favour of PKV

• The contribution does not depend on income but, among other things, on age, state of health at entry, tariff and deductible.
• Benefits and deductible can be agreed by contract and adapted to your own needs.
• For single people and childless couples in which both partners work, PKV can make financial sense (according to the Verbraucherzentrale consumer advice centre).

What you should bear in mind

• Before you take out a policy, the insurer asks health questions. Pre-existing conditions can lead to risk surcharges, benefit exclusions or rejection.
• Contributions can rise over the years. Insurers may adjust them if costs have risen permanently and an independent trustee agrees (BaFin).
• Contributions do not fall automatically when you retire. The Verbraucherzentrale recommends building up reserves for this.
• Returning to statutory health insurance is often difficult or not possible. From the age of 55, special restrictions apply (§ 6 para. 3a SGB V).

PKV or GKV: differences and decision criteria

Family and long-term costs

In statutory health insurance, children, spouses and registered partners can be covered by family insurance (Familienversicherung) without a contribution of their own. This does not exist in PKV: every person needs their own contract with their own contribution. This also applies to children and to partners without income.

Especially when planning a family, it is worth looking ahead. How will your income develop, for example during parental leave, part-time work or a change of job? How high would the total contribution for the whole family be? And how sustainable is the contribution if your income falls in old age?

What to look out for when choosing a tariff

• Scope of benefits: compare benefits, terms and deductible, not just the initial contribution.
• Contribution development: ask about ageing reserves (Alterungsrückstellung), past contribution adjustments and affordability in retirement.
• Eligibility for the subsidy: check whether the tariff meets the conditions for the employer subsidy.
• Health questions: answer them completely and truthfully. If you have pre-existing conditions, an anonymous preliminary risk assessment can provide clarity in advance.
• Caution with cheap tariffs with reduced benefits: the Verbraucherzentrale advises against switching to PKV purely for cost reasons.
• Take your time: obtain offers without time pressure and compare them with your existing cover.

Anonymous preliminary risk assessment: process, benefits and limits

PKV for self-employed people and freelancers: tariffs, deductible and daily sickness allowance

PKV for civil servants (Beamte): Beihilfe, residual-cost insurance and family

This page is general information and does not replace personal advice. Figures such as the compulsory insurance threshold change every year; the values given apply to 2026.