What's Covered

Coverage Overview

German public health insurance (GKV) provides one of the most comprehensive coverage packages in the world. The benefits are defined in the Sozialgesetzbuch V (SGB V) — the Social Code Book V — and are largely standardized across all 96 Krankenkassen. About 95% of benefits are identical regardless of which Kasse you're with.

The guiding principle is Wirtschaftlichkeitsgebot — services must be sufficient, appropriate, and economical (ausreichend, zweckmäßig, wirtschaftlich). Translation: you get what's medically necessary, but not luxury upgrades.

Coverage is based on Sachleistungsprinzip (benefits in kind): you show your insurance card, receive treatment, and the Krankenkasse pays the doctor directly. You generally don't see a bill (with some co-pay exceptions).

Outpatient Care (Ambulante Versorgung)

This covers everything that happens outside a hospital:

• Hausarzt (GP/Family Doctor): Unlimited visits, no referral needed for most specialists. Consultations, examinations, basic procedures, blood work, ECG, ultrasound — all covered.
• Fachärzte (Specialists): Dermatology, cardiology, orthopedics, ENT, ophthalmology, urology, gynecology, neurology — direct access without referral (though Hausarztmodell may offer bonuses for using referral pathway).
• Laboratory tests: Blood tests, urine tests, biopsies, pathology — covered when ordered by your doctor for diagnostic purposes.
• Imaging: X-ray, ultrasound, MRI, CT scan — covered when medically indicated. Wait times for MRI can be weeks (months in some regions).
• Minor surgery: Outpatient procedures like mole removal, wound treatment, small operations — covered.
• Emergency care: Notaufnahme (ER), Bereitschaftspraxis (after-hours GP clinic), ambulance (Rettungswagen), emergency doctor (Notarzt) — covered. Call 112 for life-threatening emergencies, 116117 for after-hours non-emergency care.

Hospital Treatment (Stationäre Versorgung)

Hospital coverage in GKV is comprehensive:

• Inpatient treatment: All medically necessary hospital stays are covered, including surgery, intensive care, and post-operative care
• Room: Standard ward (Mehrbettzimmer — multi-bed room, typically 2-4 beds). Private or semi-private rooms are NOT covered.
• Doctor: Treated by the assigned hospital doctor (diensthabender Arzt). Chief physician treatment (Chefarztbehandlung) is NOT covered.
• Medications during stay: All drugs administered during hospitalization are covered at no extra cost
• Co-payment: €10/day for the first 28 days per calendar year (max €280/year). After 28 days, no more co-pay.
• Transport: Ambulance to hospital covered. Non-emergency transport (Krankentransport) covered when medically necessary.
• Follow-up care: Nachsorge appointments and rehabilitation referrals

Prescriptions & Medication

The German medication system works like this:

• Prescription drugs (verschreibungspflichtige Arzneimittel): Covered, with co-payment of 10% of the price (minimum €5, maximum €10 per medication)
• Festbetrag system: The Krankenkasse sets a fixed reimbursement amount (Festbetrag) for drug groups. If your doctor prescribes a more expensive brand, you pay the difference plus the co-pay
• Generics: Pharmacies may substitute cheaper generics unless the doctor explicitly marks "aut idem" (no substitution) on the prescription
• Rabattverträge: Your Krankenkasse has contracts with specific pharma companies. The pharmacy dispenses the contracted brand — which may differ from what your doctor wrote
• OTC medications: Over-the-counter drugs are generally NOT covered for adults. Exception: children under 12 and teenagers with developmental disorders
• Lifestyle drugs: Not covered — this includes things like Viagra/erectile dysfunction drugs, smoking cessation aids, hair loss treatment, weight loss drugs (with some recent exceptions for severe obesity)

Dental Coverage (Zahnärztliche Versorgung)

Dental is where GKV gets complicated and often insufficient (see our dedicated dental coverage guide):

• Covered fully: Regular checkups (2x/year), basic fillings (Amalgam), tooth extraction, root canal treatment (in most cases), periodontal treatment, X-rays
• Covered partially — Zahnersatz (dental prosthetics):
• Crowns, bridges, dentures: GKV pays a Festzuschuss (fixed subsidy) covering ~60% of the Regelversorgung (standard treatment)
• With Bonusheft (5+ years of annual checkups): subsidy increases to 70%
• With Bonusheft (10+ years): subsidy increases to 75%
• Hardship clause (Härtefall): 100% coverage of Regelversorgung if your income is very low
• NOT covered: Ceramic/porcelain fillings (instead of amalgam) — you pay the difference (~€50-200 per filling). Implants — GKV only pays the Festzuschuss as if you got a bridge. Professional teeth cleaning (PZR) — €80-120, some Kassen reimburse partially. Bleaching, veneers, cosmetic dentistry.

Mental Health (Psychische Gesundheit)

Germany has strong mental health coverage — on paper. In practice, access can be challenging:

• Psychotherapie: Fully covered for recognized conditions (depression, anxiety, PTSD, eating disorders, personality disorders, OCD, etc.)
• Approved methods: Verhaltenstherapie (CBT), tiefenpsychologisch fundierte Psychotherapie (psychodynamic), analytische Psychotherapie (psychoanalysis), Systemische Therapie (systemic therapy — added 2020)
• Session limits: Kurzzeittherapie: 12-24 sessions. Langzeittherapie: up to 60 sessions (CBT/psychodynamic) or 160 sessions (psychoanalysis). Extensions possible.
• Probatorische Sitzungen: 2-4 trial sessions to assess fit with therapist — covered, no approval needed
• Akutbehandlung: Up to 24 crisis sessions, available quickly without full Antrag
• Psychiatric medication: Fully covered (same co-pay rules as other prescriptions)
• Psychiatrische Tagesklinik: Day clinic for psychiatric treatment — covered
• Stationäre psychiatrische Behandlung: Inpatient psychiatric hospitalization — covered

Preventive Care (Vorsorge)

GKV invests heavily in prevention. All of these are 100% covered, no co-pay:

• Gesundheits-Check-up (ages 18-34): One comprehensive checkup (blood pressure, cholesterol, blood sugar, kidney function, BMI)
• Gesundheits-Check-up (35+): Every 3 years — same comprehensive screening
• Cancer screening:
  • Skin cancer (Hautkrebs-Screening): every 2 years from age 35
  • Cervical cancer (Gebärmutterhalskrebs): yearly Pap smear from 20, HPV test every 3 years from 35
  • Breast cancer: mammography screening every 2 years, ages 50-69
  • Colorectal cancer: stool test yearly from 50, colonoscopy at 50 (men) or 55 (women), repeat after 10 years
  • Prostate cancer screening: yearly from age 45
• Vaccinations: All STIKO-recommended vaccines — flu, tetanus, hepatitis, COVID, shingles (60+), pneumococcal (60+), HPV (9-17), and many more. All free.
• Dental checkups: 2x per year
• Children's checkups (U-Untersuchungen): U1-U9 (birth to age 5), plus U10, U11, J1, J2 for older children and teens. Developmental screening, vaccinations, hearing/vision tests.
• Pregnancy checkups: Full prenatal care program (see Maternity section)

Maternity & Childbirth

Maternity coverage in GKV is world-class:

• Prenatal care: All standard Vorsorgeuntersuchungen per Mutterschaftsrichtlinien — blood type, HIV test, rubella immunity, glucose tolerance test, 3 ultrasounds (9th, 19th, 29th week), more if high-risk
• Midwife (Hebamme): Full coverage for prenatal care, birth assistance, and postpartum visits (up to 12 weeks after birth, daily in first 10 days if needed)
• Birth: Hospital, birth center (Geburtshaus), or home birth — all covered
• Hospital stay: Average 3-5 days for vaginal birth, 5-7 for C-section — no co-pay for maternity
• Mutterschaftsgeld: €13/day from GKV during Mutterschutz (6 weeks pre, 8 weeks post-birth)
• Postnatal: Rückbildungsgymnastik (10 sessions), breastfeeding counseling, follow-up checkups
• Fertility treatment: 50% covered for married couples — 3 cycles of IUI, 3 cycles of IVF/ICSI. Age limits: women 25-39, men 25-49. Some Kassen cover additional cycles.

Rehabilitation

• Anschlussheilbehandlung (AHB): Follow-up rehabilitation directly after hospital stay (e.g., after hip replacement, heart surgery, stroke). Typically 3 weeks at a Reha-Klinik.
• Ambulante Reha: Outpatient rehabilitation near your home
• Mutter-/Vater-Kind-Kur: Parent-child health retreats — 3 weeks at a specialized facility, covered every 4 years. A uniquely German benefit for stressed parents.
• Co-payment: €10/day for inpatient Reha (waived for AHB if directly after hospital stay)

Therapies & Medical Aids

• Physiotherapie: Covered when prescribed (Verordnung). Co-pay: 10% of cost + €10 per prescription. Typically 6-10 sessions per prescription.
• Ergotherapie: Occupational therapy — covered with prescription
• Logopädie: Speech therapy — covered with prescription
• Podologie: Medical foot care — covered for diabetics and certain conditions
• Hilfsmittel (medical aids): Wheelchairs, hearing aids (up to Festbetrag), prosthetics, orthopedic shoes, walking aids, blood glucose monitors — covered with co-pay (10%, min €5, max €10)
• Hearing aids: Covered up to ~€1,800 per ear every 6 years. High-end devices cost more out-of-pocket.
• Glasses/contact lenses: Only covered for children under 18, or adults with severe vision impairment (over ±6 diopters, or visual acuity ≤30%). Everyone else pays out of pocket.

Sick Pay (Krankengeld)

One of GKV's most important benefits:

• First 6 weeks: Your employer pays your full salary (Entgeltfortzahlung im Krankheitsfall — legally mandated)
• From week 7: Krankenkasse pays Krankengeld — 70% of gross salary, capped at 90% of net salary
• Maximum: Based on Beitragsbemessungsgrenze — max ~€120/day (2026)
• Duration: Up to 78 weeks (546 days) for the same illness within a 3-year period
• Requirements: Doctor's certificate (Arbeitsunfähigkeitsbescheinigung/AU), must be submitted to employer within 3 days. Since 2023, the eAU is transmitted electronically.
• Aussteuerung: After 78 weeks, Krankengeld ends. You may qualify for Erwerbsminderungsrente (disability pension) or must find other solutions.
• Self-employed: No Krankengeld with the reduced 14.0% rate. Can opt in via Wahltarif (starting from day 15, 22, or 43 of illness) at additional cost.
• Kinderkrankengeld: Paid leave to care for sick children under 12 — 10 days/child/parent/year (20 for single parents). Extended to 30/60 during pandemic measures.

What's NOT Covered in GKV

The important gaps to know about:

• Private hospital rooms & chief physician treatment — GKV only covers standard ward (these are standard in PKV plans)
• Glasses and contacts for most adults (see above exception)
• Cosmetic procedures — nose jobs, liposuction, breast augmentation (unless medically indicated, e.g., after mastectomy)
• Alternative medicine — homeopathy, acupuncture (except for chronic back/knee pain), naturopathy, Heilpraktiker visits (some Kassen reimburse partially as Zusatzleistung)
• Dental implants — only the Festzuschuss equivalent to a bridge
• Premium dental materials — ceramic fillings, gold crowns (you pay the difference over amalgam/standard)
• Non-prescription drugs for adults — OTC medications like ibuprofen, allergy pills, etc.
• Travel vaccinations — yellow fever, typhoid, etc. for vacation travel (some Kassen reimburse voluntarily as Zusatzleistung)
• Treatment abroad — limited to EU/EEA, and even then may require prior authorization. Non-EU treatment generally not covered.
• Sick pay for freelancers at the reduced rate
• Fertility treatment beyond the covered cycles
• Sterilization (unless medically necessary)
• Osteopathy — not in standard catalog, but many Kassen reimburse €30-60 per session as Zusatzleistung

IGeL Services (Individuelle Gesundheitsleistungen)

IGeL are medical services your doctor offers that are not covered by GKV. They must be paid out of pocket. Doctors are required to:

• Inform you that the service is not covered
• Explain the costs before providing the service
• Get your written consent
• Provide a proper invoice (not just cash in hand)

Common IGeL services and whether they're worth it:

• Professional teeth cleaning (PZR): €80-120, genuinely useful, many Kassen reimburse partially
• Additional ultrasounds in pregnancy: €20-40 each, mostly unnecessary but popular
• PSA test for prostate cancer: €25-30, controversial — high false positive rate
• Glaucoma screening: €20-40, useful especially with family history
• Travel health consultation: €20-50, important for exotic destinations
• Sports fitness check: €60-100, nice-to-have

Supplementary Insurance (Zusatzversicherung)

To fill GKV gaps, you can add private supplementary insurance:

• Zahnzusatzversicherung (dental): The most popular. Covers 80-100% of dental prosthetics, ceramic fillings, implants, PZR. From €10-50/month depending on age and coverage. Best to get early before dental work is needed — Wartezeiten (waiting periods) of 8 months typical.
• Krankenhauszusatzversicherung (hospital): Upgrades to single/double room and chief physician treatment. €15-60/month. Pre-existing conditions may be excluded.
• Auslandskrankenversicherung (travel): Essential for travel outside EU. Covers treatment and repatriation abroad. €8-20/year for basic coverage. Almost universally recommended.
• Heilpraktikerversicherung: Covers alternative medicine practitioners. €10-30/month.
• Brillenversicherung (vision): Covers glasses/contacts. €5-15/month. Often not worth it unless you need expensive progressive lenses frequently.
• Krankentagegeld: Supplementary sick pay — tops up Krankengeld to closer to net salary. Important for high earners above BBG.
• Pflegezusatzversicherung: Supplementary nursing care insurance. Government-subsidized option: Pflege-Bahr (€5/month from state). Increasingly recommended as standard Pflegeversicherung covers only part of care costs.