Statutory health insurance plans cover all necessary treatments for their insured members. The situation is different for Individual Health Services (IGeL): These must be paid for out of pocket. These are medical examinations or treatments that are not included in the statutory health insurance coverage catalog. These include, for example, certain ultrasound exams at the gynecologist’s office, intraocular pressure measurements, or PSA tests for men. Many patients are unsure whether they really need these services. According to the Consumer Advice Center, the majority of IGeL offerings are novel treatment methods whose medical benefits and risks have not yet been clarified.
The “Federal Medical Service” evaluates each year whether the services offered are appropriate. According to the IGeL Report 2024, those with public health insurance spend approximately 2.4 billion euros annually on out-of-pocket services. The IGeL Monitor currently evaluates 68 commonly offered services. Only a few are classified as “generally positive,” while many are rated as “unclear,” “generally negative,” or “negative.”
Patient organizations and consumer advocates criticize the fact that many insured individuals are not adequately informed by doctors about the benefits, risks, and costs. They are calling for greater transparency and stricter rules regarding patient education. According to the AOK health insurance provider, the federal government acknowledges these information gaps but currently sees no need for legislative changes and points to existing information requirements.
The IGeL-Monitor, for example, advises against accepting offers too hastily and recommends gathering information in advance whenever possible. Experts, such as those from the Consumer Advice Center, advise taking sufficient time to consider the decision, requesting a written cost estimate, and consulting independent sources of information—such as the IGeL-Monitor, the National Health Portal gesund.bund.de, or the Consumer Advice Center—before deciding on a self-pay service.
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