Preventive checkups in private health insurance: what is covered and how often

The preventive catalog of a good plan covers all stages of life. It starts with the U checkups for children, continues with prenatal care and includes the screenings at an older age. The overview shows typical components and the usual interval. Your own plan is what counts.

Like any outpatient service, billing follows the medical fee schedule, and you do not need approval before the appointment. For cancer screening in detail, for example extended methods and intervals, a separate standard applies. The general check-up usually includes your medical history, a physical examination, a blood count with sugar and fat levels and a urine test. Depending on the plan, a resting ECG, a lung function test or an ultrasound can be added. How far the scope goes is set by the plan, not by the practice's price list.

Whether prevention in private health insurance depends on age limits is decided by a single wording. Plans with the clause prevention according to statutory programs mirror the rules of the statutory health insurance fund. There, the check-up under § 25 SGB V is planned from age 35 every three years, and skin cancer screening from age 35 every two years. Plans with the addition also beyond the statutory programs reimburse the same checkups every year and regardless of age.

Comfort plans extend the catalog further, for example with extended lab profiles or additional imaging. You cannot conclude from this that private health insurance is always ahead. An entry-level plan can be weaker on prevention than a statutory health insurance fund with a bonus program. The difference comes from the plan, not from the system.

Vaccinations are also part of prevention. Common plans reimburse the recommended vaccinations, including tetanus, diphtheria, whooping cough, measles, pneumococcus, flu and shingles. Many plans pay for the TBE vaccination for people who live in risk areas. Good plans also include travel vaccinations, which statutory health insurance funds only subsidize on a voluntary basis.

For privately insured children, the early detection checkups are standard. In the first six years of life, ten U checkups are due, and between twelve and fifteen years the youth checkup follows. Many plans add extended screenings for newborns, for example hearing and hip examinations or the extended metabolic screening. Because every child in private health insurance has their own contract, it is worth checking whether the plan for children offers the same preventive scope as the parents' plan. Prenatal care is a separate area of benefits with its own rules.

From more than 5,000 applications with health questions, we see a connection that is rarely spoken about. Complete, documented prevention without abnormal findings is the best argument in any later risk assessment. If you go to your check-up regularly and are healthy, you can prove it, for example when you switch to a plan with stronger benefits.

We recommend that you treat the preventive scope as a separate criterion in the plan comparison and look closely at the wording on the statutory programs. Submit bills from prevention together. In many plans they reduce neither the deductible nor the no-claims refund. Which checkup makes medical sense in your case belongs in the conversation with your doctor, not in an insurance guide.

In many plans they are not, but this is not a given. The clause usually says that preventive benefits are not taken into account for the deductible. If it is missing, you effectively pay for the check-up yourself until the deductible is used up.

Often not. Many insurers explicitly exclude preventive checkups when they decide whether a year was claim-free. If the plan does not say so, a submitted preventive bill can cost you the no-claims refund. It is worth checking the clause before you submit.

In part, yes. Checkups such as glaucoma screening or an ovarian ultrasound are not standard benefits of the statutory health insurance fund. In private health insurance, reimbursement depends on the plan and on the medical reason, not on a fixed catalog.

No. Preventive checkups go through the normal billing route like any doctor's visit. Prior approval only makes sense for large, plannable treatments, not for a check-up.

After the general waiting period of three months, you can use preventive benefits without restriction. Many insurers waive waiting periods completely after a medical examination or when you switch from statutory health insurance. If you have just taken out the contract, check the waiting period clause briefly and plan your first check-up after it.