Health services in private health insurance: what the term means

Health services can be divided into several categories, and each follows its own reimbursement rules.

The common thread through all categories is medically necessary treatment under § 1 (2) MB/KK. It is the ticket to core reimbursement. Prevention and health promotion are separately regulated extra promises of the plan, and anything with no link to health remains a private matter.

Self-pay health services (IGeL) started as a term in statutory care. They are offers that the benefits catalog of the statutory health insurance funds does not include and that patients there pay for themselves, for example measuring eye pressure for glaucoma screening or additional ultrasound examinations. Privately insured people still come across the term in the doctor's practice, often with the remark that this is an IGeL service and therefore a private matter.

For private health insurance, this logic does not hold. There is no IGeL catalog, only the question of whether the service is medically justified and covered by the plan. This is exactly why many plans reimburse checkups that people with statutory health insurance pay for out of their own pocket. We recommend that you do not pay for supposed IGeL offers yourself out of habit, but submit the bill as usual or ask the insurer in advance.

Prevention includes vaccinations, preventive checkups and, depending on the plan, courses on exercise, nutrition or stress management. It also includes cancer screening, which many plans reimburse beyond the statutory programs. Most plans reimburse vaccinations according to the general recommendations in full, and travel vaccinations are a quality feature of good plans. Plans handle prevention courses differently. Here it is worth checking the clause before you book the course.

In our advice work, we see that prevention benefits are submitted less often than any other category, probably because the single amounts seem small. Over the years they add up. We recommend that you treat prevention receipts like all others: collect them, check them and submit them.

Not quite. Health services is the medical umbrella term for all services related to health. The benefits of private health insurance mean the part of them that your own plan reimburses. The plan decides how large this part is.

First the treating doctor with their justification. In a dispute, the insurer with its own review, and if necessary a court in the end. Under the terms, it is enough if the treatment was justifiable as necessary based on objective medical findings.

Increasingly. Many plans reimburse prescribed digital health applications, but not voluntary fitness and wellness apps. Here too, the link to an illness separates the categories.

No. Confirmations for an employer, a daycare center or a sports club are not medical treatment, and you pay for them yourself. The practice sets the fee according to the fee schedule for doctors.