What your insurance covers
From January 2027 the German statutory health insurance austerity act takes effect — changing the margins of outpatient care. We believe you have a right to know what you are entitled to. This page lists it — completely and without ulterior motive.
What you are entitled to
- Cancer screening: yearly genital examination from 20, Pap/HPV by age scheme, breast palpation from 30, mammography screening 50–75 (invitation), from 45 actively possible
- Pregnancy: complete antenatal care incl. three basic ultrasounds and all guideline labs
- Contraception: prescription methods until your 22nd birthday; counselling always
- With symptoms: every medically indicated diagnostic and treatment — ultrasound, labs, clarification. "Statutory patient" does not mean waiting-list medicine
- Vaccinations: HPV to 17 (catch-up partly to 26, insurer-dependent), influenza, others per STIKO
- Chronic conditions: endometriosis, PCOS, menopausal symptoms with disease value — diagnostics and guideline therapy are covered
What changes in 2027 — and what does not
The austerity act tightens budgets and intensifies efficiency audits — but it does not cut the benefits catalogue above. What changes for practices: tighter quarterly budgets, more documentation duties, less scheduling leeway. What we make of it you can follow on our reality-check page: digitalising routine so medicine keeps its time.
What this means for us (as of October 2026): Our budget for statutory services is exhausted for routine screening. We currently cannot offer new statutory screening appointments – not even on request. A waiting list would be dishonestly long. We are sorry, especially towards patients who have trusted us for many years.
Who has priority now:
- Acute symptoms: severe pain, bleeding (no older than 3 days) or a newly felt lump. You can request an appointment in our emergency consultation online, up to three days in advance. We allocate these appointments by medical urgency.
- Follow-up after findings: existing patients with a positive HPV test, an abnormal smear or a cancer diagnosis continue to be cared for. We will contact you.
- Pregnant patients continue to be reliably accompanied through prenatal care.
Your entitlement to statutory screening remains: if we cannot offer you an appointment, the appointment service (116 117) arranges appointments at other practices. Self-pay services are not subject to the statutory budget, which is why appointments are still available for them. This is not a decision against statutory patients. More on screening →
Our promise is simple: we will never sell you a covered service as a private one. If you are entitled to something, we tell you — even if the practice budget gains nothing. And where a service truly is not covered, we tell you beforehand in writing, with the price, so you decide freely.
Your rights as a patient
- Second opinion: before plannable procedures you are entitled to an independent second view — we actively support it
- Access: your findings belong to you; you receive copies of your file on request
- Appointment service (116 117): arranges specialist appointments within deadlines for statutory patients
- No service against your will: screening too is an offer, not a duty — informed decision also means: no is a valid answer
Frequent questions about insured services
Do I have to buy extras to be well cared for?
No. Statutory medicine covers what is medically necessary — that is its legal mandate, and 2027 does not change that. Extras can offer comfort or extended diagnostics; necessary for good care they are not.
Why do I get some examinations only once a year?
Because the catalogue intervals rest on studies, not thrift — more frequent examinations without cause demonstrably do not improve outcomes. With any indication, the interval does not apply anyway.
What if the insurer rejects a service?
You can appeal — and we support you with reports and justifications. Many rejections fail on formalities, not on the medicine.
Will you treat statutory patients worse because of the act?
No. For acute symptoms and abnormal findings, we treat statutory patients with the same care as everyone else. What the reduced budget limits is the number of screening appointments without a specific reason – not the quality of care.
Your question not here?Write to us — directly and securely via the online reception.
Ask your questionUnsure what you are entitled to?
Ask us — with us, the answer to "does insurance pay?" comes before the service, not on the invoice.
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