Internal PKV switches: assess added benefits and the route back

Make additional benefits visible in an internal switch

A client wants to stay with their German private health insurer but change policy. Your task is specific: which rights remain, which benefit is added and which decision changes the route back later? Put these questions before premium rankings. An internal switch may move benefits in different directions. Only when these movements are visible separately can the client choose the target policy and its particular conditions.

Start with the desired difference. Is it a different scope of benefits or a lower contribution towards treatment costs? Ask which existing feature must remain. A wish for change can coexist with a firm priority to preserve cover. Your comparison must address both. Saying “better overall” is too broad: a target policy may differ from existing cover in different ways across benefit areas.

Identify the statutory starting point

Section 204(1), first sentence, number 1 of Germany’s Insurance Contract Act, VVG, provides for switching within an existing insurance relationship to other policies with equivalent types of cover, crediting acquired rights and the ageing reserve. This is the basis for examining an internal switch with the existing insurer. Transfer to another company is regulated separately in the same provision. Keep the routes distinct so internal crediting is not presented as applying to every change of insurer.

First establish the actual contractual change requested. Are insurer, insured person and benefit area identified? Is this an ongoing contract or a special situation? The provision has specific rules and limits, including fixed-term relationships and particular policy routes. Such cases need the appropriate specialist assessment. A general statement about internal switching should not conceal these distinctions or replace individual legal assessment.

For an ordinary benefit comparison, put the agreed cover alongside the specific target offer. The policy schedule, relevant amendments and conditions must belong together. A current insurer product page may describe another version. Acquired rights cannot reliably be read from a similar-sounding present-day policy name. Record which contractual version you compare and which individual crediting information the insurer has supplied or still needs to supply.

Read changes by benefit area

Separate differences by their actual substance. Changed outpatient reimbursement differs from changed inpatient cover. A lower deductible concerns the sharing of costs. For each relevant item, establish what was agreed and what the target policy provides. The client should see where cover remains unchanged, where it decreases and where a higher or broader benefit arises.

This matters particularly for mixed changes. A policy can provide less in one place and more in another. A lower total premium therefore does not prove there is no additional benefit. Request an understandable allocation of the differences. If an overview merely describes a lower benefit level, ask about the items important to the client. This prevents a decisive improvement from disappearing beneath an overall label.

The PKV association’s switching guidelines expressly identify a reduced deductible as an additional benefit for which health assessment may be required. Include this when relevant to the client’s wish. To them, paying less personally may appear merely a better allocation of costs. For the internal assessment, it may mean an additional obligation for the insurer. This distinction helps explain further questions from the company.

Explain conditions for added cover

Where the target policy offers higher or broader benefits, section 204 permits an exclusion or an appropriate risk surcharge and, for that additional benefit, a waiting period. Explain the connection to the added portion. The client should understand which improvement a requested condition concerns. Ask if the link between the identified additional benefit and proposed rule is unclear. A broadly worded risk question does not itself establish that link.

Keep acquired rights visible. Assessing the additional benefit and handling existing cover are separate points. Ask the insurer to describe the target protection in light of the individual’s starting position. Clients can then distinguish a statement about the entire policy from one about a particular addition. They avoid interpreting a question about one part as a reassessment of their whole insurance.

If health questions are asked for the additional benefit, use their actual wording and stated periods. Do not copy an old answer into a differently phrased question without checking. Allow for clarification of ambiguous terms. Medical information belongs in the designated personal procedure, not a general acquisition list. Your organisational support is to identify the necessary clarification and prepare the appropriate professional route.

Understand surcharge and exclusion as substantive alternatives

The law allows an exclusion of the additional benefit to avert a risk surcharge and waiting period. This changes substance. The client is assessing whether to forgo added cover, not merely choosing a different payment. Put the proposed exclusion alongside the original improvement sought. They should see precisely whether their actual switching objective would still be achieved under that agreement.

Describe a target policy with an individual exclusion as that exact combination. The general benefit overview is insufficient. If an attractive benefit appears there but is treated differently by the individual agreement, the client must see that distinction. Have unclear scope explained before presenting the option as suitable. Transparency also shows why an apparently inexpensive alternative may fail to fulfil the original wish.

Then compare the actual routes: unchanged existing cover, a target policy with confirmed conditions, or one with a specifically agreed exclusion of additional benefits. Only options actually offered or confirmed in the case are available. Show which priority each meets and which difference remains. Clients can form a substantive preference without you presenting a hypothetical surcharge or invented available policy as a real offer.

Discuss the route back before giving up benefits

Benefits being relinquished deserve a look ahead. The PKV guidelines explain that returning to the original policy may require health assessment if it offers additional benefits compared with the target policy. Having once insured a benefit is therefore no reliable shortcut to every later reinstatement. Discuss this before a reduction so clients can weigh present relief against potential consequences for future wishes.

Ask whether the person would accept the changed cover even if they could not extend it later without further assessment. That differs from satisfaction with today’s premium and makes the time dimension clear. If they only want temporary financial relief, examine particularly carefully whether the actual option fits. Do not assume a general right to return free of charge.

The premium calculation category can also affect the route back. Section 204 excludes moving from gender-neutral pricing to gender-based pricing. If that direction is relevant, identify it using the existing and proposed policies. Explain the commonly used terms unisex and bisex. The client must understand that this is a statutory boundary, distinct from an offer question still awaiting clarification.

Understand the insurer’s selection

The switching guidelines allow participating companies to present all alternatives or use a disclosed selection system. Check whether the reply describes the full range or a selection. Where selected, ask about the criteria insofar as they matter to the client’s comparison. Do not silently treat a short list as the entire policy range. Equally, brevity alone does not establish an unsuitable selection.

The guidelines are a voluntary commitment by participating companies. Distinguish their additional practice rules from the statutory entitlement. Check applicability to the insurer before relying on a rule. Premium comparison needs the individually stated figure accounting for existing ageing reserves and relevant surcharges. A generally advertised premium is no equivalent substitute. The client should assess their actual option. Also ask whether an existing surcharge is included, so they compare the stated total premium with their actual previous payment.

Work through a request for a lower deductible

The following example is entirely fictional; it describes neither a real client nor a particular offered policy model.

A client wants to stay with her insurer and reduce her personal cost contribution. Mark this as a potential additional benefit to assess and request an actual internal offer. Also record which existing benefits she wants to retain. The decision now depends on two answers: how does the offered option differ, and what conditions does the company require for the added portion? The wish itself answers neither question.

If excluding the additional benefit is explained as an alternative, check it against that exact wish. The client can see whether the lower contribution actually remains to the extent discussed. Also consider the possible later route back if benefits are relinquished. Ask the insurer to explain the personal cost contribution remaining after the exclusion for the benefit item discussed. Neither acceptance nor a premium advantage is inferred merely from wanting an internal switch.

Confirm the exact combination chosen

Before further instructions, clearly identify target policy, individual agreements, premium and intended effective date. Check incoming documents against the discussed version. An unchanged policy name says little if an exclusion or deductible differs. Ask the client to explain the decisive improvement or reduction again. This shows whether their choice concerns the actual combination. Keep the compared versions and supporting replies together for later questions.

Advise new private health insurance contacts

Register your brokerage for private health insurance enquiries. The welcome email takes you to webRichtung Customer. Choose industry, area, delivery option and monthly limit and see the price before ordering. You assess the internal switch and its individual requirements in your advice.

Sources

Section 204 VVG, in German and PKV association: switching guidelines, in German, read in full on 18 October 2026. Distinguish statutory boundaries from participating companies’ additional rules; individual contract and offer assessment remains decisive.