The GKV benefits catalogue: entitlements vs extras

When you join Germany's public health insurance (Gesetzliche Krankenversicherung, or GKV), you're entitled to a set of core medical benefits defined in law. But between what the law guarantees and what you might need lies a grey area: some services doctors offer are optional add-ons you pay for privately, while your chosen Krankenkasse might offer unique perks others don't. Understanding this landscape helps you avoid bill shock and choose the right insurance for your needs.

What the law actually covers: the GKV benefits framework

Germany's health insurance law, the Sozialgesetzbuch Fünftes Buch (SGB V), does not provide a definitive, line-by-line catalogue of covered services. Instead, it sets a legal framework: GKV must cover medical treatment that is adequate, economically justified, and meets the current standard of medical science. The detailed list of what qualifies is established by the Gemeinsamer Bundesausschuss, or G-BA (Joint Federal Committee), an independent body representing GKV funds, physicians, and hospitals.

What this means for you: GKV broadly covers doctor visits (both general practitioners and specialists), hospital treatment, prescribed medication, basic dental care, preventive screening, and medically necessary therapy. All Krankenkassen must provide at minimum this same core package—no insurer is allowed to offer less or refuse anyone membership based on health or income.

Doctor and specialist visits

Primary care (Hausarzt) and specialist consultations are fully covered once you've chosen a doctor. There is no direct cost to you at the point of care. Specialists typically require a referral from your GP, and your insurance covers the visit in full.

Hospital treatment

Emergency and necessary inpatient care is covered entirely by GKV. If you stay in a public or contracted hospital ward (a shared room), there is no out-of-pocket cost for the treatment itself. Your only Zuzahlung (co-payment) is a flat 10 Euro per day for hospital stays, and only for a maximum of 28 days per calendar year.

Prescribed medication

Medications your doctor prescribes are covered by GKV, but you pay a Zuzahlung per prescription. As of 2026, this ranges from around 5 to 10 Euro per item, depending on the medication's price and your Krankenkasse's specific rules. However, note that starting in 2027, the German government has planned to raise these co-payments to between 7.50 and 15 Euro as part of broader GKV reform. Medications available over-the-counter without prescription are not covered.

Basic dental and medically necessary therapy

GKV covers preventive dental care, treatment of tooth disease, and basic repair. Dental cleaning that is medically necessary as part of disease treatment is covered; cosmetic cleaning is not. GKV also covers physical therapy (Physiotherapie), speech therapy (Logopädie), occupational therapy (Ergotherapie), and other prescribed rehabilitative care when medically necessary. Like all services, therapy carries a small co-payment.

The grey zone: IGeL (Individuelle Gesundheitsleistungen)

IGeL are the private services your doctor offers outside the GKV catalogue. They are not covered by your insurance, and you must pay the full cost yourself, in cash, right away. The term stands for Individuelle Gesundheitsleistungen—individual health services. IGeL are entirely optional; no doctor can force you to pay for one, and you have the absolute right to decline.

Doctors offering IGeL must inform you in writing before they provide the service, explain what it is and why they recommend it, and quote the price upfront. They must also tell you that the service is not covered by insurance. Common examples include extra ultrasound scans during pregnancy beyond the standard screening, PSA tests for prostate cancer, eye pressure tests (tonometry), professional tooth cleaning for cosmetic reasons, travel vaccines not required by law, and premium treatments or diagnostic methods.

Why doctors offer IGeL

The core reason: GKV reimburses doctors less than they would earn from private patients. IGeL allow practitioners to offer services they believe are valuable but which either lack sufficient scientific evidence to justify public funding, or fall outside the GKV scope. IGeL pricing is regulated by a fee schedule (Gebührenordnung für Ärzte, or GOÄ), which is public and varies by complexity; however, costs can still add up quickly.

How to evaluate an IGeL offer

Before you pay, check the IGeL-Monitor (www.igel-monitor.de), a free, independent platform operated by the medical service (Medizinischer Dienst). It rates hundreds of IGeL services based on scientific evidence: some have tentatively positive ratings, many have unclear evidence, and some are rated negative or even harmful. The platform is designed specifically to help you decide whether a service is worth your money or likely not effective. You can always ask your doctor why they recommend a particular IGeL, request a written quote (Kostenvoranschlag), and decline without penalty.

Satzungsleistungen: voluntary extras that differ between insurers

While all Krankenkassen must offer the same core GKV benefits, they may also offer additional voluntary services called Satzungsleistungen (literally, statutory additions). These are perks each insurer chooses to offer, and they vary widely. Satzungsleistungen are one of the main ways Krankenkassen compete for members; comparing them can be one of the best reasons to switch insurers.

Common Satzungsleistungen

• Professional dental cleaning (Professionelle Zahnreinigung): some funds cover this partially or fully, though it is not legally required
• Travel vaccines and preventive inoculations beyond those mandatory by law
• Wellness and fitness programmes (gym subsidies, yoga courses, back pain classes)
• Osteopathy or naturopathic treatment
• Fertility support or acupuncture for specific conditions
• Bonus programmes that reward preventive care visits with vouchers or contributions to fitness memberships
• Subsidised health apps or digital consultations

The scope and generosity of these extras change year to year, and German health policy has increasingly questioned whether Satzungsleistungen can be justified when core GKV funds are strained. When choosing a Krankenkasse or considering a switch, it is worth checking the insurer's website or calling their customer service to see exactly which voluntary services they offer and whether they align with your needs.

Zusatzversicherung: private top-up insurance for known gaps

GKV does not cover everything you might expect a doctor to pay for. The two biggest gaps are dental restorations and spectacles. This is where private supplementary insurance, called Zusatzversicherung, fills in. These are inexpensive add-on policies you buy in addition to your GKV; they are not a replacement for public insurance.

Dental top-up (Zahnzusatzversicherung)

GKV covers tooth disease and prevention, but not dental restoration. If you need a crown, implant, bridge, or denture, GKV pays only a fixed subsidy (usually 50 to 70 percent of the cost of a basic solution); you pay the rest. A private dental top-up insurance reimburses anywhere from 50 to 100 percent of restoration costs, depending on the plan. These policies typically cost between 10 and 30 Euro per month.

Most dental top-up policies include a waiting period of six to eight months before they cover major work (such as implants or crowns), and many stage the reimbursement over the first few years: you might get only 20 percent in year one, increasing to full coverage by year five. This is intentional—insurers want to prevent people from signing up just before costly work they already know they need.

Glasses and contact lenses (Brillenzusatzversicherung)

GKV covers glasses only for children and young adults up to age 18, and even then only partially (usually lenses, not frames). For adults, spectacles and contact lenses are not covered at all. A private glasses top-up typically reimburses 100 to 200 Euro toward a new pair of glasses or contact lenses every two years. Combined dental and glasses policies are increasingly popular and often cost only a few Euros more per month than dental coverage alone. These plans usually have short or no waiting periods.

How to choose a top-up plan

Private top-up insurers are for-profit companies entirely separate from your Krankenkasse. The most popular names include DKV, Allianz, R+V, and Universa, but dozens of options exist. When comparing, note the monthly premium, the maximum annual or biennial payout per service, the waiting period before coverage begins, and any co-insurance (the percentage you still pay after reimbursement). Many insurers offer online calculators to show you the net cost over several years. Since most policies do not require a health questionnaire to enrol, it usually makes sense to buy one early if you know you'll need it.

Comparing and switching insurers: what to look for

All 100 or so Krankenkassen in Germany are legally required to accept you and charge the same base contribution rate (currently around 15.5 percent of income, split equally with your employer). However, some add a small surcharge called Zusatzbeitrag (additional contribution). Meanwhile, the Satzungsleistungen they offer can differ significantly.

Switching insurers takes about a month and is free. You can do it once per calendar year, or more frequently if your insurer raises its surcharge. When comparing Krankenkassen, look at: the base and additional contribution rates, the specific Satzungsleistungen offered (especially dental cleaning and wellness programmes), how they manage IGeL complaints, and customer service reputation. Most large insurers have English-language websites, and websites like krankenkassenvergleich.de (independent comparison portals) list and compare specific services by fund.

Expats and students in Germany often have more flexibility than German citizens to choose an insurer. If you have Privatversicherung (private insurance) because you are self-employed or earn above the income threshold, the rules and benefits are quite different; this guide applies only to those in the GKV (Gesetzliche Krankenversicherung) system.

A practical checklist

1. Confirm that your Krankenkasse covers all doctor visits, hospital stays, and prescribed medication before you assume it is not your responsibility
2. Always ask your doctor explicitly: is this service covered by GKV, or is it an IGeL I must pay for separately?
3. Request a written quote and treatment plan for any IGeL before agreeing to it
4. Check the IGeL-Monitor online before paying for an individual health service
5. Review your Krankenkasse's Satzungsleistungen annually and consider switching if another insurer offers better perks for your lifestyle
6. If you know you'll need dental work, glasses, or both, price a private top-up policy early; the waiting period may make it worthwhile to buy now rather than later
7. Keep receipts for all Zuzahlungen; if you reach the annual out-of-pocket cap (currently 2% of gross income, or 1% for chronic patients), further services are free for that year
8. When comparing insurers, check both the base rate and the Zusatzbeitrag, as well as the voluntary extras offered