Preventive care in private health insurance

The benefits of private health insurance briefly

In private health insurance, insured persons receive comprehensive benefits that exceed the basic benefits in public health insurance benefits catalog.

Depending on the chosen tariff, insured persons in private health insurance can adapt the benefits to their individual needs and place an emphasis, e.g. on preventive examinations or alternative practitioners.

The most important benefits in private health insurance include:

• Reimbursement for more treatment methods compared to Public Health Insurance including 100% reimbursement for outpatient physician treatment, direct specialist treatment, access to private practices and clinics.
• Reimbursement for alternative treatment methods
• Reimbursement of medicines (also medicines without prescription)
• 100% reimbursement of remedies (massages, physiotherapy, physiotherapy, …) and aids (hearing aids, prostheses, wheelchairs, ...) as well as partial reimbursement of visual aids (glasses, contact lenses, ...)
• Coverage of dental treatment, professional teeth cleaning, dentures, misaligned teeth, and orthodontics for children
• Reimbursement of services during pregnancy
• Insurance coverage also abroad

What benefits does ottonova's private health insurance include? All information about our private health insurance and our different tariffs - find out now!

Public vs. privately insured: Here's how preventive checkups differ

Although every insured person has a right to certain free preventive services from their health insurer, over 40% of Germans in public health insurance going to the doctor for checkups. This was the finding of a 2018 survey by the market research institute GfK. The preventive examinations perceived so sparsely differ by gender, by different age groups and by whether the patient has public or private insurance.

Public care preventive checkups: these services are part of the program

The costs for many examinations are borne by the public health insurance funds. But other than private health insurances they have age restrictions. These services are:

• Cancer screening, such as examinations to prevent various types of cancer, such as cervical cancer, breast cancer, prostate cancer, skin cancer or colon cancer
• Cardiovascular checks, such as measuring blood pressure or checking cholesterol levels
• Preventive dental care, such as plaque and tartar removal
• Preventive care during pregnancy, such as ultrasound diagnostics, blood tests for infections and HIV, or the detection and monitoring of high-risk pregnancies
• Vaccinations, such as protective and regular vaccinations, basic vaccinations for children and booster vaccinations
• Preventive examinations for children and adolescents, such as the so-called U and J examinations of posture and motor skills, heart and lungs, hip ultrasounds

Preventive medical checkup in private health insurance: What privately insured persons can expect

Private health insurers are also guided by the above-mentioned framework program. Their range of preventive and treatment services depends on the chosen tariff but is usually much broader.

These examinations are often additionally reimbursed by private health insurers:

• Early detection of cancer: PSA test for early detection of prostate cancer; HPV test for early detection of cervical cancer.
• Cardiovascular checks: Blood tests for early detection of high blood pressure, circulatory diseases, and metabolic disorders; Ultrasonography of the great vessels (head, neck, abdomen, legs); echocardiography
• Dental care: professional teeth cleaning
• Other private preventive services: Glaucoma screening (glaucoma); test of hormone levels/testosterone levels; breath test to detect Helicobacter infections in digestive disorders.

Private patients also have advantages in terms of flexibility: they can often have their health checked regardless of their age and have the option of including alternative treatment methods in the range of services covered by their tariff - such as naturopathic treatments.

The situation is different for patients with public health insurance: If they want to take advantage of special additional treatments for preventive care, things can get pretty unpleasant. As soon as so-called "IGeL" services are involved, patients with public health insurance are asked to pay.

Preventive care: What is an IGeL service?

We are not dealing with a prickly insectivore here. Individual health services - IGeL for short - are treatments that are not covered by public health insurance. As a result, people with public health insurance must pay for them out-of-pocket. And they pay a lot for the comprehensive preventive examinations: Every year, people with public health insurance pay around 1 billion euros for IGeL. Experts have been arguing vociferously for years about the benefits of these examinations - they could lead to unnecessary interventions; the consumer groups complain. The IGeL services are a sensible addition to the range of services offered by public health insurers, countered the German doctors' associations.

For privately insured patients, many benefits, and services that legally insured patients must pay for themselves are a matter of course anyway. However, the reimbursement and scope of preventive services depends on the individual insurance contract.

Our IGeL tips for privately insured persons:

Before you choose a private health insurance plan, consider which preventive examinations make sense for you. Have you had any previous illnesses? Does your family tend to have certain medical conditions, such as diabetes or colon cancer? Voilà, you should include these preliminary examinations with the corresponding services in your private health insurance tariff.

Checklist: Which checkups you need at which age

You may not have to worry about glaucoma or diabetes when you're 20, and no one is likely to recommend a rubella vaccination when you're 40. Check-ups for early detection of diseases are related to the age at which the probability of certain diseases statistically increases.

Find out when which check-ups is recommended and what exactly is examined in our checklist.

Preventive medical checkups

0 to 18 years

• Regular vaccinations for children (e.g. against diphtheria, poliomyelitis, hepatitis B, tetanus, measles, rubella)
• Vaccinations of the service catalog as well as booster vaccinations
• Preventive dental check-ups for children between the ages of 6 and 18 three times a year, and twice a year from the age of 18. For adults, plaque and tartar is removed, and the dentition is checked for periodontitis.

35 to 45 years

Prevention from 35

• From the age of 35, publicly insured patients are entitled to the so-called “Check-up 35”. This examination checks for precursors of cardiovascular diseases such as elevated cholesterol or blood pressure levels. Patients are also tested for autoimmune diseases (rheumatism, Crohn's disease) and metabolic disorders (diabetes, thyroid problems). As a private patient you can have that check too but even earlier.
• To detect the first signs of skin cancer, skin screening is recommended for men and women over 35.
• Public health insurance doesn’t cover prostate checks that early (from 45) but private health insurance does. Do not wait until 45!

Prevention from 40

• With the help of glaucoma screening, the first signs of glaucoma can be identified. This involves measuring intraocular pressure and performing an ophthalmoscopy (private screening service).
• If required, men can now have their hormone levels and testosterone levels determined with a blood test (private preventive service).

Prevention from 50

• Between the ages of 50 and 54, physicians recommend a colon and rectal examination for the early detection of colorectal cancer.
• From 55, the doctor should perform a colonoscopy in men and women.
• Women ages 50 to 69 can screen for breast cancer with a mammogram every two years for early detection.
• Every two years, women can also take advantage of an ultrasound for early detection of breast cancer (private preventive service).

Prostate examinations and colonoscopies don't seem particularly pleasant at first glance, but they are the fountain of youth for your health. After all, in ten years' time you'll still want to be running dynamically past young joggers in the park - just like today. So, what are you waiting for? Go for a check-up and prevent diseases.