Where statutory health insurance falls short in outpatient care
Germany's GKV covers essential outpatient treatment. But in several practical areas, coverage is limited or absent entirely:
- Preventive screening: The large health check (großer Gesundheits-Check) is available only once between ages 18–34, then every 3 years from 35. Glaucoma screening, extended cancer prevention, and organ ultrasound are not standard GKV benefits.
- Glasses and contact lenses: GKV covers frames and lenses only for severe visual impairment (≥6 diopters or specific conditions). Most adults pay the full cost themselves.
- Alternative medicine and Heilpraktiker: GKV generally does not reimburse naturopathy, homeopathy, traditional Chinese medicine, or Heilpraktiker treatment.
- Co-payments: GKV requires co-payments for physiotherapy, massage, prescribed medication, and therapeutic aids. These accumulate over time.
- Children's extra checks: Beyond standard U-examinations, additional screenings (strabismus testing, speech development, expanded hearing checks) are not fully covered.
What outpatient supplementary insurance is for
Outpatient add-ons do not replace GKV. They close specific, targeted gaps — each addressing a different slice of outpatient care. These are structured through distinct product categories:
Prevention (V100)
Extended screenings and diagnostics beyond GKV: health checks, cancer prevention, glaucoma, ultrasound, immunizations — including children's extra checks.
Outpatient supplement (Basis / Komfort / Premium)
Broader ambulatory coverage: glasses, Heilpraktiker, physiotherapy co-pays, medication co-pays, alternative medicine, travel health, and LASIK.
Cost reimbursement (Kostenerstattung)
Privatpatient status for outpatient visits: your GKV pays the statutory share, the add-on covers the private portion. Enables access to private-practice specialists.
Prevention tariff: V100
The V100 prevention tariff covers screenings and diagnostics that GKV limits or excludes. Key features:
| Screening area | GKV standard | With V100 |
|---|---|---|
| Health check (großer Gesundheits-Check) | Once (18–34), then every 3 years | ✓ Covered |
| Glaucoma screening | — | ✓ Covered |
| Osteoporosis prevention | — | ✓ Covered |
| Extended cancer screening | Basic only | ✓ Expanded |
| Mammography (all ages) | From age 50 | ✓ No age limit |
| PSA test (prostate screening) | — | ✓ Covered |
| Organ ultrasound (up to 4 organs) | — | ✓ Covered |
| Children: strabismus, eye, hearing checks | Partial | ✓ Expanded |
| Travel immunizations (FSME, Hepatitis, etc.) | Partial / risk-only | ✓ Covered |
| Pregnancy: additional ultrasound + triple test | — | ✓ One per pregnancy |
V100 provides up to €1,000 across two consecutive calendar years for covered prevention services, plus up to €200 for immunizations. No health assessment required. Monthly premiums from approximately €3.60 (children) to €11.45 (age 35). Premiums as of June 2025.
Outpatient supplement: ambulant add-on tariffs
Three tiers of broader outpatient supplementary cover are available. These are not prevention-specific — they cover Heilpraktiker access, glasses, co-pay elimination, and more:
| Benefit area | Basis | Komfort | Premium |
|---|---|---|---|
| Glasses / contact lenses | 80%, up to €155 every 36mo or at ≥0.5 dpt change | 100%, up to €175/24mo | 100%, up to €330/36mo |
| Heilpraktiker / alternative medicine | 50%, up to €260/yr | 60% | 90%, up to €2,500/2yr incl. Hufeland methods |
| Physiotherapy co-pays (massage, Krankengymnastik) | 100% | 100% | 100% |
| Medication co-pays | — | 100% | 100% |
| Travel health insurance | 100%, up to 42 days | 100%, up to 42 days | 100%, up to 56 days |
| LASIK eye surgery | — | — | €1,000 (once, 36mo wait) |
| PKV switch option when GKV obligation ends | Up to age 40 within 10yr of contract | — | Up to age 50 within 10yr of contract |
Monthly premiums range from approximately €4.87 (Basis, age 25) to €40.55 (Premium, age 35). All tiers include a per-calendar-year deductible (€25 for under-20s, €50 for adults). Does not apply to travel health benefits. Premiums as of June 2025.
Cost reimbursement model (Kostenerstattung)
A structurally different approach: with a cost reimbursement tariff, you agree with your GKV to receive treatment as a private patient. Your GKV pays the statutory share, the supplementary tariff covers the private remainder.
This is not a supplement on top of GKV benefits — it replaces the standard GKV billing process with private-patient billing. The result:
- Access to private-practice specialists, including those who do not accept GKV patients
- Potentially shorter waiting times
- Broader diagnostic and therapeutic options
- Physician billing at private fee schedule rates
Because Kostenerstattung covers full private-patient outpatient billing, premiums are substantially higher than the ambulant add-on tiers above — representative examples range from approximately €96–€146 per month depending on tariff variant and entry age. This reflects the fundamentally different scope of cover.
Cost reimbursement tariffs (Kostenerstattung) are not for everyone. They require agreeing to the cost-reimbursement principle with your GKV (minimum 3-month commitment) and involve receiving private invoices yourself. A consultation helps assess whether this model fits your situation.
Frequently asked questions
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