Switching while ill
No public health insurer may turn you down because of an illness, ongoing treatment or pregnancy, and there is no health check. Here is what happens to sickness benefit, psychotherapy, dental prosthetics and approvals, and when it is better to wait.
The new insurer may not turn you down, including because of illness or age. That is set out in section 175 of Book V of the Social Code. It only has to be open to you: some insurers are regional or limited to certain companies.
When you switch there is normally no waiting period for statutory benefits and no exclusion of pre-existing conditions. From the switch date, the new insurer is responsible for you. From 2027, sickness benefit for the self-employed may be an exception.
After twelve months with your insurer you can switch. If it raises the additional contribution you can go earlier, provided you declare this by the end of the month for which the increase first applies. The switch takes effect at the end of the month after next: if your declaration reaches the new insurer in November, you are with it from 1 February.
You only tell the new insurer you want to switch, and it notifies the old one electronically. Then tell whoever registers you: usually your employer, or the employment agency (Agentur für Arbeit) or job centre if you receive benefits.
You can stay with practices that accept public health insurance and show your new card from the switch date. If you take part in a GP or special care contract, ask whether the new insurer offers it too. The statutory benefits you are entitled to are set by law and are the same for all insurers.
When you choose to switch, there is no general rule that your old insurer’s approvals continue. Psychotherapy and dental treatment have fixed transition procedures; much else has to be arranged again.
| Situation | What happens when you switch | Your next step |
|---|---|---|
| Sick note, sickness benefit | From the switch date the new insurer is normally responsible | Keep your sick note unbroken, tell the new insurer in advance |
| Psychotherapy | Fixed transition, no new clinical review | Continuation application to the new insurer |
| Dental prosthetics (crowns, bridges, dental prosthetics) | If treatment is under way, the practice transfers the plan | Before treatment starts, ask the new insurer in writing |
| Braces (children) | The practice transfers the treatment plan | Keep all invoices and receipts |
| Hospital, rehab | Hospital: a matter for the hospital and insurers | Rehab: avoid a switch date during your stay |
| Pregnancy, parental leave | Switching is possible | Avoid a switch date during maternity protection |
| Remedial therapies, aids, home nursing care, transport | No general transition rule | Apply again or ask the new insurer in advance |
| Chronic illness | Disease management programme ends, exemption must be renewed | Enrol again, apply for the exemption again |
You can. As long as your employer keeps paying your wages, your income does not change. If you receive sickness benefit, the old insurer pays until the switch and normally the new one after that. We found no provision covering exactly this case; it follows from the general rules. The old insurer must forward sick notes for the period after the switch to the new one. For self-employed people with a sickness benefit election this does not automatically apply; see below.
What matters: your sick note must not have a gap. Your doctor must confirm your continued incapacity no later than the next working day after the end date certified so far, and Saturdays do not count as working days here. If that does go wrong, ask your insurer immediately: in certain cases there is a longer deadline. Tell the new insurer before the switch that you are signed off, and ask for a written answer on what it needs from you.
Maximum duration: in the law, the 78 weeks of sickness benefit within three years are tied to the illness, not the insurer. As worded, a switch does not restart them.
Optional sickness benefit tariff: this binds you for three years and you normally cannot switch before then, even if your contribution goes up. Only for special hardship cases must the insurer’s rules allow cancellation.
Self-employed with a sickness benefit election: sort this out before you switch. The election binds you for three years. Whether it rules out switching insurer, or has to be made again with the new insurer, is not expressly stated in the law. A new election made while you are signed off only takes effect once that ends. From 2027 a three-month waiting period generally applies too, and the exceptions do not mention switching insurer. If you are signed off or likely to be, do not switch without a binding written commitment from the new insurer.
You don’t have to stop your therapy. A continuation application is made to the new insurer, together with the old insurer’s decision and the number of sessions already held. Under the Psychotherapy Agreement, the approved number of sessions is not clinically reviewed again. This applies to therapy with a therapist licensed by public health insurance. If your therapy runs through cost reimbursement at a private practice, ask the new insurer in writing beforehand.
Deadline: the application must arrive within four weeks of the start of the quarter following the switch, or be made at the first session of that quarter. Under the Agreement the new insurer must then recognise it retroactively. Speak to your therapist in good time.
If treatment is already under way, the practice sends the approved treatment and cost plan to the new insurer. Under the federal dentists’ agreement, the new insurer then confirms it will take over the approved subsidy without a new review of the content, and treatment need not be interrupted. You just show your new card. Your bonus booklet stays valid, because your check-ups count, not the insurer.
Approved but not started: this case is not expressly regulated. Ask the new insurer in writing beforehand whether it will take over the plan.
Especially important at the turn of the year: from 2027 the fixed subsidy from the insurer falls from 60 to 50%, and with a bonus from 70 to 60% and from 75 to 65%. Subsidies approved by 31 December 2026 keep the old rate, provided the work is fitted as approved within six months. If you receive the hardship subsidy, you keep full standard care. Whether the old rate also applies if the new insurer only confirms it in 2027 is not expressly regulated. Ask the new insurer for a binding written commitment, or let the switch take effect only after fitting.
The practice sends the approved treatment plan to the new insurer. The federal agreement provides for no new review of the content, and treatment continues. The open point is the 20% patient share, Eigenanteil (10% for the second and each further child if several children from your household are in treatment at once), which you get back if treatment is completed as planned: the law does not say which insurer refunds it after a switch.
In 2017 the Bavarian association of statutory dentists described an agreement among insurers under which the insurer responsible at completion covers the whole patient share. Don’t rely on that alone: keep all invoices and receipts and ask the new insurer beforehand for a binding written commitment.
If the switch falls during a hospital stay, billing is a matter for the hospital and the insurers. Under the 2026 agreement, with flat-rate case payments the hospital bills the whole case to the insurer you were with on the day of admission. Still, let the hospital know you are switching.
We found no express rule for rehab that is under way. If you can, avoid a switch date during rehab, or get the new insurer’s commitment beforehand.
You can, and no insurer may turn you down because of it. If you are employed, the amount of maternity pay depends on your employment and earnings, not the insurer. If you are self-employed, it depends on your entitlement to sickness benefit, so check this first. What applies if the switch falls within the maternity protection period, which normally starts six weeks before the due date, is not expressly regulated. If possible, let it take effect before that or after it ends.
You can also switch during parental leave. If you are compulsorily insured, your membership continues. If you are voluntarily insured, it simply carries on, so ask about your contributions. Tell the new insurer you are on parental leave. If you are covered through family insurance, the main member chooses the insurer.
Long-term remedial therapies: an individually granted approval, for example for ongoing physiotherapy, ends when you switch, and you then apply again to the new insurer. If your diagnosis is on the list in the Remedial Therapies Directive, you need no application. The insurer must decide on an application within four weeks, otherwise it counts as approved. If information is missing, this takes longer.
Medical aids: each insurer makes its own contracts with suppliers. For devices such as an insulin pump, a sleep apnoea device or a wheelchair, ask the new insurer in writing beforehand how it will keep you supplied and whether the provider will change.
Home nursing care and transport to treatment: we found no rule that the approval continues. Ask the new insurer early when it will process the prescription or application, so that a decision is in place by the switch date if possible. That applies, for example, to regular trips for dialysis or radiotherapy.
Disease management programme (DMP): your participation ends when you switch. Have your doctor enrol you again for the new insurer; this can also matter for the co-payment limit of 1% of your gross income.
Co-payment exemption: apply again to the new insurer and enclose the old insurer’s certificate and your receipts. The limit applies per calendar year, not per insurer. How payments count in the year of the switch is not expressly regulated, though, so ask beforehand.
Medication: each insurer makes its own discount contracts, so the pharmacy may give you a different product with the same active ingredient. If that is a medical problem, your doctor can rule out the substitution.
You can do this too, with the same deadlines. You tell the new insurer your choice and then immediately inform the employment agency (Agentur für Arbeit) or job centre. If your insurance starts anew because you begin receiving benefits, you can choose regardless of the twelve-month tie. You have two weeks; after that the agency registers you with your last insurer.
What your insurer pays beyond the legal minimum is in its own rules (Satzung) and does not automatically continue after a switch. So compare the benefits you actually use, not just the contribution.
Bonus-payment (Prämie) and cost-reimbursement tariffs tie you in for at least one year, deductible and sickness benefit tariffs for three years. You normally cannot leave the insurer before then. If it raises the additional contribution you can still leave the first three, but not the sickness benefit tariff. For special hardship cases the insurer’s rules must allow cancellation.
We found no legal duty to transfer points to the new insurer. So have your bonus paid out before you switch, if you can.
If you are receiving a lot of care right now, expect new applications and queries. Weigh that against the saving.
The contents of your electronic patient record are meant to move to the new insurer’s record. As a precaution, save important documents yourself. Your new card comes from the new insurer.
The additional contribution is not fixed. If the new insurer raises it, you can switch again even within the twelve months, provided you declare this by the end of the month of the increase. With a sickness benefit tariff you cannot.
If you have nearly reached the 78 weeks or it is unclear what comes next, get advice from your insurer or a social advice service before switching.
If you are signed off or likely to be, do not switch without a binding written commitment from the new insurer.
Especially around the turn of the year. Switch only after fitting, or with the new insurer’s written commitment.
Move the switch date or get written information from both insurers first.
If your insurer has promised you an extra benefit, use it first or check whether the new insurer offers it too.
Which treatments, approvals, optional tariffs and bonus points do you have right now? Dig out decisions and receipts.
Describe your situation and ask how it will take over your care. Explicitly ask for a binding written commitment; mere information does not necessarily bind the insurer.
Choose a date that doesn’t fall in a critical phase. If your application arrives in November, the new insurer is responsible from 1 February.
Tell your doctors, therapist and hospital, and whoever registers you, such as your employer, the employment agency (Agentur für Arbeit) or job centre.
Sort out early anything that needs a new application: ask the new insurer when it will process it. Keep sick notes unbroken.
Your new card applies from the switch date. Keep decisions and receipts from your old membership.
This page is general information based on our own research, without guarantee, and does not replace professional advice, nor information from your insurer. Where it says “not expressly regulated”, we found no provision covering exactly that case. In that case, get written information from the new insurer.
Sources: Section 175, Book V of the Social Code (choice of insurer) · Section 19, Book V of the Social Code · Section 46, Book V of the Social Code · Section 48, Book V of the Social Code · Section 53, Book V of the Social Code (optional tariffs) · Section 62, Book V of the Social Code · Section 304, Book V of the Social Code · Section 24i, Book V of the Social Code · Section 29, Book V of the Social Code · Statutory Health Insurance Contribution Stabilisation Act · BSG B 1 A 1/18 R · Psychotherapy Agreement, section 13 · Federal Framework Agreement for Dentists, annexes 4 and 6 · Bavarian dentists’ association 2017 · Flat-rate Payment Agreement 2026, section 10 · G-BA: long-term therapy needs · Federal Employment Agency, instructions
The comparison and advice on statutory health insurance cost you nothing. If a switch comes about through us, we receive remuneration from the new health insurer; our partner VGK24 may also pay us for enquiries – not you. Your contribution is the same as if you switched directly with the insurer, and you enter into no obligation.
