What is covered by state health insurance in Germany. M-Y

Last Updated on October 13, 2022

We continue the list of medical services that will (or will not) be paid for by state health insurance in Germany – Krankenkasse (KK).

Part 1. GKV. How payments are formed
Part 2. GKV. Everything that I (not) will be paid from – A-L
Pregnancy in Germany. Part 3. Mutterpass and Hebamme
Pregnancy in Germany. Part 4. Giving birth, anestesia, stimulation
Asperger’s syndrome without outdated clichés. 1

What is covered by health insurance in Germany

Navigation:
Massage
Medical transport
Medicines
Naturopath (Heilpraktiker)
Online-consulations, telemedicine
Osteopath
Physiotherapy
Psychotherapist
Pregnancy, childbirth and infertility
Preventive examinations of adults
Preventive examinations of children
Rooming-in – being in the hospital with a sick child
Sanatorium (Kur)
Sport medicine
Sterilization
Vaccination

Massage

10 percent of the cost of therapy multiplied by the number of visits, plus € 10 per recipe.

Medical transport

The ambulance is called very rarely, usually you have to go yourselves. The usual causes are injuries, when you are afraid to touch a person so as not to damage unnecessary, bleedings. It is not uncommon to see that the ambulance picks up from the therapeutic praxis.

After that, a paper will be sent, where it will be necessary to describe in detail what led you to use the transport.

Surcharge of 10 euros for the use of transport, regardless of its type – for an medical airplane and a helicopter as well.

Medicines

Read about how medicines are paid for and what is written on the prescription here.

In addition, the KK can pay for homeopathy, medicines based on natural ingredients – a list of what KK and how much. Homeopathy usually requires a prescription from a recognized homeopathic specialist.

Naturopath (Heilpraktiker)

Usually there is a charge, but some KK pay a certain amount if the treatment is carried out by a doctor from their list of doctors.

Online consultations, telemedicine

This area is actively developing. For example, we sometimes do it online with a speech therapist. There are almost no restrictions now, with the exception of doctors who must work with devices – radiologists, for example. The doctor himself decides whether he will accept this particular patient online or not. At the same time, the doctor is not obliged to see anyone online.

If the patient makes an appointment online, he receives a link to a dedicated website that provides a secure connection.

Osteopath

The patient pays himself, but some health insurance companies pay in part. Standard – 3 visits per year for 40 euros.

How to make a visit to an osteopath and what he is all about, see here

Physiotherapy

10 percent of the cost of therapy multiplied by the number of visits, plus € 10 for recipe.

Psychotherapist

The KK pays for a psychotherapist who is on the list of approved by KK. It is usually not about all possible psychotherapeutic methods (usually analytical psychology, behavioral psychology, depth psychology (Freud)). When choosing a psychotherapist, it also helps to study their pages on the Internet.

Now the waiting time for a psychotherapist is up to one and a half years. If you cannot wait, contact the KK, it will find a psychotherapist nearby.

Pregnancy, childbirth and infertility

All free and possible paid examinations during pregnancy are described in detail here.

A special issue is infertility treatment. Krankenkassen participate only partially. So, the examination is free of charge. But some tests may come from your wallet in some part (for example, blood sampling services).

Stimulation of ovulation – paid two or three times, but you will have to pay for the medicine (the price is different depending on which medicine). The following procedures will cost even more. Insemination – from 200 (without hormones) to 1000 euros (with hormones), artificial fertilization – 3000 euros. Up to half of the cost is paid as standard, but some KK attract customers by paying the larger part.

It also makes sense to look for a specific KK if you do not want to give birth in the hospital, but in the Geburthaus (the family home served by the midwives (Hebamme)) or at home. Some KK are ready to compensate for the cost of the Rufbereitschaft of Hebamme (she is ready to come to give birth at any time, so she refuses other calls).

Additional services for pregnancy can be included in the bonus account. For example, additional tests or ultrasounds, courses for preparing fathers, collecting Stammzellen (they must not only be collected, but then paid for storage!), etc. Before you happily switch to insurance that promises a long list of additional procedures, first find out their cost. Chances are that you can only do one of them and still have to pay extra. And then compare that with how much you are losing on the difference in individual percentages of KK (see first part).

Preventive examinations of adults

  1. Early diagnosis of cancer:
  • from 20 years old women annual check for cervical cancer
  • from the age of 30 women an annual breast examination (palpation). Ultrasound is usually paid by patients (about 60 euros) – some KK take over if there were cases in the family
  • from 50 years of age women every two years mammography
  • from 45 years old men annual examination of the prostate
  • after 35 years of age, skin cancer screening every two years
  • from 50 years old several tests for bowel cancer

2. Health check-up (Check-up) from 35 years old every three years: examination with pressure measurement, blood and urine tests and a conversation with a doctor.

3. Women under 25 years old – annual examination for chlamydia.

4. Men over 65 – ultrasound to prevent abdominal aortic aneurysm.

Preventive examinations of children

1. Regular examinations of children. From U1 to U9, as well as J1 – paid by all Krankenkassen, U10, U11, J2 – not by all.

Read more about routine examinations of children here.

  • U1, immediately after birth
  • U2, 3.-10. day of life: external standard examination – listen, see reflexes
  • U3, 4.-5. weeks of life: reflexes, motor skills, reactions, hips, parent interviews
  • U4, 3.-4. month: development, motor skills, nervous system, reflexes
  • U5, 6.-7. month: development, motor skills, reflexes
  • U6, 10.-12. month:motor skills, vision, speech
  • U7, end of 2. year: vision, speech, fine motor skills, gross motor skills
  • U7a, end of 3. year: vision, speech

Read more about speech development problems in Germany and what can you do

  • U8, end of 4. year: motor skills, speech, pronunciation, reflexes
  • U9, end of 5. year: preparation for school – motor skills, hearing, vision, speech
  • U10, between 7 and 8 years, additional inspection, not paid by every KK
  • U11, between 9 and 10 years: additional inspection, not paid by everyone. School problems, socialization, jaw abnormalities, sports, media consumption
  • J1, 13-14 years: general health, height, vaccinations, puberty, mental health problems, alcohol consumption or smoking
  • J2, 16-17 years: additional inspection. Puberty, sexual development, socialization, career choice

2. Additional paid examinations:

  • vision by babies
  • Kidney ultrasound (€ 30) for babies

Rooming-in – being in the hospital with a sick child

Paid by someK. Most often we are talking about the age of 9 years. If the child is older, then there must be additional reasons: he cannot be understood without his parents, he has psychological problems, etc. If the child is younger, then staying with him is included in the standard services

Sanatorium (Kur)

It’s easy enough to get the Mutter-Kind Sanatorium. Therapists are eager to see mothers burn-out, especially if the child is not alone. After pandemia it is really true and good for every mother.

In adults, it depends on the disease. The main trend: sanatorium services can also be provided in the nearest sanatoriums on an outpatient basis. Therefore, the KK will not rush to pay for accommodation in a sanatorium on the other side of the country.

Sports medicine

A sports medical examination is recommended for anyone who starts a new sport, wants to increase the load or returns to sports after a break. A regular examination of the choice of a sport costs 120-150 euros, an in-depth one – up to 200 euros. Many KK take over part of the cost. For example, TK KK pays 120 euros every two years.

Torn ligaments and heart attacks are a frequent companion of non-professional sports, when a person is overworked or engaged after a long break, so such an examination makes sense, especially if the KK takes over.


Do you have any more questions? Use comments ⇓ or private communication form

Sterilization

Not paid

Vaccinations

Children:

  • small children:
    Hepatitis B, Diphtherie, Tetanus, Poliomyelitis, Haemophilus influenzae Typ B (Hib.) infektion, Pertussis (Keuchhusten) – whooping cough, Masern – measles, Mumps, Röteln – rubella, Varizellen – chickenpox, rotavirus, meningococcus – free of charge

    Paid – meningococcus of the second type (up to 400 euros in the amount of 3 vaccinations), is taken over by some Krankenkassen
  • girls (now also boys) between 12 and 17 years old – Humane Papillomaviren (papilloma virus)

Adult patients (regulated by KK):

  • flu – from 60 years old standard plus risk groups
  • tetanus – every 10 years to everyone
  • diphtheria – every 10 years for everyone
  • pneumococcus – from 60 years old standard plus risk groups
  • shingles – from 60 years old is standard, people with poor health – from 50 years old
  • FSME – tick-borne encephalitis – free for people living in risk areas (map, for example, here), travelers are not paid
  • Haemophilus influenza Typ B (Hib.) infektion – risk groups
  • Hepatitis A – people at risk (e.g., taking blood, working with refugees, etc.)
  • Hepatitis B – adults at risk
  • Tollwut – hydrophobia, after being bitten by an animal and prophylactically for business travelers and students traveling abroad to risk areas
  • Meningokokken – people at risk, especially business travelers and students abroad
  • Poliomyelitis (Kinderlähmung) – for adults – at risk groups, especially overseas
  • Varizellen – chickenpox, adults at risk (working with children and with severe neurodermatitis)
  • Röteln – rubella, for adults at risk (working with children)
  • Pertussis (Keuchhusten, whooping cough) – for adults at risk (working with children), pregnant women
  • tuberculosis – not done

A note about hydrophobia (Tollwut): If you are bitten by an wild animal or unknown dog, you should go to the doctor and get these vaccinations!

Exotic vaccinations for adults

  • cholera – paid for in case of a business trip to a country where vaccination is mandatory
  • yellow fever – a business trip to a country where vaccination is compulsory
  • typhoid – business trips or student trips to risk areas

All posts about medicine – #medicine.

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