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Does supplementary health insurance pay for an already planned operation in Germany?

In short

Does supplementary health insurance pay for an already planned operation in Germany? As a rule, no. Treatment recommended, planned or started before the policy begins is excluded by the usual tariffs. If the application asks about planned treatment, you must state the operation. A waiting period of up to three months also applies. Concealing it lets the insurer withdraw, and you pay everything yourself.

Does supplementary health insurance pay for an already planned operation in Germany?

What it costs

What hospital extras cost if you pay them yourself.

ExampleTypical range
Single room per nighton average about 89 to 134 euros
Double room per nighton average about 43 to 72 euros
Five nights single roomabout 445 to 670 euros
Chief physician billingusually up to 3.5 times the medical fee schedule rate

Room prices from PKV association surveys, averages by federal state.

Your hospital may differ.

Worked example

Hip operation planned for February, application in October

A 58 year old wants a hospital supplement before his planned hip operation.

Question about planned treatmentmust be answered yes
Resultrefusal or exclusion of the hip operation
Single room for six nights, self paidabout 530 to 800 euros

He pays the extras for the hip operation himself. The policy only makes sense if he keeps it for the future.

Why an already planned operation cannot be insured

Insurance covers uncertain risks. Once an operation is planned, the risk has materialised. The usual supplementary tariffs therefore exclude treatment recommended, planned or started before the policy begins.

Most applications ask about ongoing and planned treatment. You must answer truthfully what you know and are asked about (section 19 of the Insurance Contract Act, VVG). Many insurers accept you anyway but exclude the planned operation.

SituationDoes the supplement pay?
Operation recommended or scheduled before signingno
Condition found only after the startyes, after the waiting period
Accident after the startyes, without general waiting period

What happens if you conceal it

If you conceal a planned operation you were asked about, the insurer may withdraw from the contract for intent or gross negligence. For slight negligence it may cancel or continue with an exclusion. Withdrawal can come after the operation, and then you pay the bill.

What you can still do

For the planned operation, you can pay extras such as a single room privately through an agreement with the hospital (Wahlleistungsvereinbarung). A single room costs on average about 89 to 134 euros per night.

For future treatment a policy still makes sense: new conditions after the start are covered, and after an accident the general waiting period does not apply.

Step by step

  1. Check whether the operation is already recommended or scheduled.
  2. Answer all health questions fully and truthfully.
  3. If accepted with an exclusion, decide whether the policy is worth it for the future.
  4. Ask the hospital about the cost of extras for the planned operation.

Checklist

  • Planned treatment disclosed
  • Waiting periods known
  • Exclusions in the policy read
  • Cost of hospital extras known

Common mistakes

  • Concealing the planned operation
  • Believing no waiting period means planned surgery is covered
  • Buying a policy for a single operation

Questions and answers

Frequently asked

Does a tariff without waiting period cover a planned operation?

No.

Waiving the waiting period does not change the exclusion of planned treatment.

Must I disclose a planned operation if not asked?

You must disclose what the insurer asks in text form.

Most applications ask exactly this.

What if the doctor recommends the operation after the start?

Then it is usually covered after the waiting period, if you did not conceal symptoms.

Can I pay for a single room myself?

Yes, through an agreement with the hospital.

Sources

NAMMERT insurance broker

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Supplementary health insurance in Germany

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Related questions

Your broker: Norman Nammert, trading as NAMMERT.

Insurance broker licensed under section 34d(1) of the German Trade Regulation Act.

Broker register no. D-C08Q-TOSD4-37.

NAMMERT Assekuradeur GmbH is a separate company.

It does not arrange your contract.

Statutory disclosure (German) · Updated

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