Pregnancy in private health insurance: benefits and prenatal care

Private health insurance reimburses prenatal care under the maternity guidelines and, beyond that, every medically justified additional examination. The check-ups take place every four weeks, and from the 32nd week of pregnancy every two weeks. They include ultrasound, blood tests, CTG monitoring and toxoplasmosis screening.

Beyond the mandatory benefits, people with private health insurance use extended check-ups such as 3D and 4D ultrasound or specialized prenatal centers. Billing follows the fee schedule for doctors with the specialist and the fee schedule for midwives with the midwife. There is no exemption from contributions like the one during maternity benefit in statutory insurance, and the plan premium continues.

Midwife services are fully reimbursable in private health insurance. Reimbursement covers prenatal care, preparation for the birth, support from an attending midwife at the birth and postnatal care up to the twelfth week after the birth. A home visit costs €60 to €120.

Billing follows the reimbursement principle. The midwife bills you, and you submit the bill to the insurer. Some insurers also offer direct billing. Clarify this in advance with the midwife and the insurer.

The biggest difference between plans lies in prenatal diagnostics. If there is a medical indication, the non-invasive prenatal test and the detailed anomaly scan are fully reimbursed as medical services. Without a clear indication, reimbursement counts as a self-pay health service and depends on the plan.

The following overview classifies the most important benefits. The euro amounts are guide values from the market and do not replace a confirmation from your plan.

In a documented high-risk pregnancy, the scope of prenatal care expands automatically with a medical justification. The insurer then also reimburses examinations that would not be included as standard. In a multiple pregnancy, the frequency of check-ups also increases, in most plans without problems with benefit limits.

If you spend a longer period abroad during the pregnancy, you should check the plan's clause on stays abroad. The reimbursement of prenatal care abroad is often regulated differently. Antenatal classes go through the prevention module, and some plans specify certain types of course or a fixed amount.

From over 5,000 applications with health questions, we know that the most common point of dispute is the reimbursement of prenatal diagnostics without a documented indication. If you get a written confirmation of cover here, you avoid unpleasant surprises.

The time at which you join private health insurance also matters. An existing pregnancy must be disclosed in the application and can make taking out the contract more difficult or delay it, because it is part of the health questions. We recommend that couples planning a family clarify their insurance cover before the pregnancy begins, because switching during the pregnancy is hardly possible.

All medically necessary check-ups under the maternity guidelines, plus midwife care and, with an indication, prenatal diagnostics. Purely optional services without an indication can be refused.

A home visit costs €60 to €120. Midwives bill under their fee schedule, and private health insurance reimburses these services in full under the reimbursement principle.

If there is a medical reason, yes, as a medical service. Without an indication, reimbursement depends on the plan, and the test then costs €150 to €400.

Yes. Unlike statutory health insurance, there is no free cover through another person's policy, and the plan premium continues unchanged.