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

PKV and Beihilfe: how the two work together

Civil servants, judges and soldiers are exempt from statutory health insurance if, under civil-service law, they are entitled to continued payment of salary and to government assistance with healthcare costs (Beihilfe) or free medical care (Heilfürsorge) (§ 6 para. 1 no. 2 SGB V). Beihilfe bears a percentage share of the eligible costs of illness; it does not cover all costs.

Civil servants must insure the remaining share themselves. For this, private health insurers offer tariffs tailored to the respective Beihilfe rate. This combination is often called residual-cost insurance (Restkostenversicherung). Beihilfe and PKV together are meant to cover the costs. Suitable tariffs close the gap up to the Beihilfe rate.

Beihilfe rates: federal civil servants as an example

For federal civil servants, the Federal Beihilfe Ordinance (Bundesbeihilfeverordnung) sets the assessment rates (§ 46 BBhV). As a rule they are 50 percent for those entitled to Beihilfe, 70 percent for pension recipients and for eligible spouses and registered partners, and 80 percent for eligible children. For those entitled to Beihilfe with two or more children, the rate rises to 70 percent.

For state civil servants, the Beihilfe rules of the respective federal state apply. Rates and conditions can differ. Always clarify under which rules your employer grants Beihilfe.

Civil-service candidates and civil servants on revocable appointment

Civil-service candidates (Beamtenanwärter) and civil servants on revocable appointment (Beamte auf Widerruf) are also generally entitled to Beihilfe and should clarify their health insurance cover early. According to the PKV-Verband, insurers run an opening campaign (Öffnungsaktion) for first-time entry to PKV, which makes it easier for civil servants and those starting a civil-service career to join, even if they have pre-existing conditions.

• The application must be submitted within six months of first being appointed as a civil servant. What counts is the date of application, not the start of insurance.
• Benefit exclusions are not provided for in the opening campaign; risk surcharges are limited to a maximum of 30 percent of the contribution.
• A condition is that there is not yet a private full health insurance policy.
• According to the PKV-Verband, the campaign also applies to close relatives.

This is an arrangement of the insurance industry, not a statutory entitlement. Check the current conditions and the deadline before you rely on it.

Special features for trainee teachers and lawyers (Referendare)

Whether a traineeship (Referendariat) takes place as a civil-service relationship on revocable appointment depends on the federal state and on the career path. The rules described here only apply if you have civil-servant status with an entitlement to Beihilfe. If the traineeship is served as an employee, different social insurance rules apply. Therefore clarify your status with your employer before taking out a policy.

According to the PKV-Verband, civil servants on revocable appointment are first admitted to tariffs that are open to them. Ask how the contribution develops after training and whether the tariff matches your future Beihilfe rate.

Family and children

Beihilfe and PKV depend on your family situation. Children generally receive a higher Beihilfe rate and need their own insurance cover matched to the Beihilfe rate. For spouses and registered partners, entitlement to Beihilfe depends, among other things, on their own income. The federal government and the states regulate the details.

What matters is that the insurance cover can be adjusted when things change: the birth of a child, parental leave, part-time work, a change of employer or retirement. Before taking out a policy, discuss how flexibly a tariff responds to changed Beihilfe rates.

Alternative: flat-rate Beihilfe in some federal states

Some federal states offer civil servants with statutory health insurance a flat-rate Beihilfe as a subsidy towards their health insurance contribution. According to the PKV-Verband, it amounts to half of the contribution. The decision for it is generally irrevocable. Examine the rules of your state carefully and get advice before you commit.

How to find a suitable tariff

• Beihilfe rate: the tariff must match your Beihilfe rate and be adjustable when it changes.
• Eligibility for Beihilfe: check whether the tariff covers benefits that Beihilfe reimburses only to a limited extent or not at all.
• Health questions: answer them completely and truthfully. If you have pre-existing conditions, an anonymous preliminary risk assessment can help.
• Contribution development: ask about ageing reserves (Alterungsrückstellung) and past contribution adjustments.
• Deadlines: note the six-month deadline for the opening campaign after first being appointed as a civil servant.
• Take your time: compare offers without time pressure.

Changing tariff in PKV: options within your existing contract

PKV for employees: switching, threshold and employer subsidy

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

PKV or GKV: differences and decision criteria

This page is general information and does not replace personal advice. Beihilfe rates and conditions differ depending on the employer and can change.