"Your insurance doesn't cover this, I'm afraid – but I would recommend it." Many people with statutory health insurance in Germany have heard this sentence in a doctor's practice. It refers to IGeL (Individuelle Gesundheitsleistungen, "individual health services"): tests and treatments you pay for out of your own pocket. Some make sense for particular people, many are scientifically unproven, and a few demonstrably do more harm than good. This article is meant to help you tell them apart, and to know your rights.

What IGeL are, and why they exist

Germany's statutory health insurance (GKV) pays for services that, in the words of § 12 of the Social Code Book V, are "sufficient, appropriate and economical" and do not exceed "what is necessary". Which tests qualify is decided by the Federal Joint Committee (G-BA), the top self-governing body of doctors, hospitals and insurers. Anything not in that catalogue can be offered privately. That includes services whose benefit is unproven, services that are not medically necessary (travel vaccinations, certificates) and services that were simply never assessed.

That does not automatically make IGeL useless. It does mean that nobody has independently confirmed that the benefit outweighs the harm, or that such an assessment came out negative. And the practice making the offer earns money from it.

How common they are

The Medizinischer Dienst Bund (MD Bund), the national umbrella organisation of the statutory insurers' medical review boards, regularly surveys insured people. The most recent IGeL-Report was published in December 2024 (forsa, 2,013 statutorily insured people aged 18–80, surveyed July–August 2024):

31%of insured people used at least one IGeL in 12 months (women 41%, men 22%)
≥ €2.4 bnspent per year, by the report's own account a conservative estimate
3.3 mtransvaginal ultrasound scans of the womb and/or ovaries, the most frequent IGeL
> €500 mper year on IGeL that the IGeL-Monitor rates "unclear" or "(tending) negative"

Second place goes to eye-pressure measurement for glaucoma screening (2.4 million); among men, the PSA test comes first (1.2 million). Ophthalmology (€544 million) and gynaecology (€543 million) take the most money. More than two-thirds of respondents said they knew too little, or only partly enough, to decide in an informed way. About one in five feared their further care might suffer if they declined an offer.

The IGeL-Monitor: an independent rating

Since 2012 the MD Bund has rated frequently offered IGeL on igel-monitor.de, using the methods of evidence-based medicine. The overall verdict has five levels:

  • positive: benefit clearly outweighs harm
  • tending positive: benefit slightly outweighs harm
  • unclear: benefit and harm are unknown or roughly equal
  • tending negative: harm slightly outweighs benefit
  • negative: harm clearly outweighs benefit

In February 2025 there were 58 ratings: none positive, 3 tending positive, 23 unclear, 28 tending negative, 4 negative. The Monitor itself acknowledges that "subjective value judgements" enter the weighing, and some ratings are several years old. They are well-argued guidance, not a verdict on your case.

How common IGeL are rated (as of October 2026)

  • Ovarian ultrasound for cancer screening: "negative". In the large British UKCTOCS trial, screening did not reduce deaths from ovarian cancer, even after 16 years. By contrast, about 3 in 100 screened women had healthy ovaries removed, and about 3 in 20 of those operations led to complications. Gynaecological societies point out that the scan can reveal other findings; a benefit for cancer screening in women without symptoms has not been shown. Cost: about €25–53.
  • Eye examination with eye-pressure measurement for glaucoma screening: "tending negative". There are no studies of benefit; possible harms include false alarms, missed glaucoma and unnecessary eye drops. Only about one in ten people with raised eye pressure actually has glaucoma. If you have symptoms or glaucoma is suspected, insurance pays. Cost: usually €20–40.
  • PSA test for prostate cancer screening: "tending negative" (last updated 2017). If 1,000 men aged 55–69 are tested every four years, about one is spared death from prostate cancer and around 30 receive an additional cancer diagnosis. Germany's revised S3 guideline now favours a risk-adapted PSA test over the rectal examination; it is not yet a statutory benefit. More in our article on PSA screening.
  • Vitamin D test without symptoms: "unclear". No study shows that testing healthy adults benefits them. If a deficiency is reasonably suspected, insurance pays. Cost: around €30. See vitamin D deficiency and supplements.
  • Thyroid ultrasound and thyroid blood tests for screening: both "tending negative" (2024). No studies of benefit, but a risk of false alarms and overdiagnosis.
  • Dermatoscopy for skin cancer screening: not rated, because since April 2020 it has been part of statutory skin cancer screening (every two years from age 35). It remains an IGeL only for younger people or at shorter intervals. See dermatoscopy.
  • Bone density measurement currently has no IGeL-Monitor rating. Insurance pays for a DXA scan when osteoporosis is known or when concrete findings make drug treatment a possibility; a purely precautionary scan without such grounds is an IGeL.

The IGeL-Monitor has no separate rating for tumour markers as a screening test in healthy people. At the top of the price range are whole-body examinations, discussed in our article on whole-body MRI.

Your rights

What applies when you are offered an IGeL

In writing, and beforehand: Under the federal contract between doctors and statutory insurers (Bundesmantelvertrag-Ärzte, § 3(1) and § 18(8)), a practice may charge a statutorily insured patient only if the patient expressly asked for the service and gave written consent before treatment, having been told they must pay the costs. Without a written agreement, the doctor may lose the right to a fee. In addition, § 630c(3) of the Civil Code (BGB) requires information on the expected costs in text form before treatment begins.

Billing under the GOÄ: The invoice must follow the official fee schedule for doctors (GOÄ) and itemise each service; flat fees and success fees are not permitted.

No pressure: According to the guide from the German Medical Association and the National Association of Statutory Health Insurance Physicians, doctors must not push IGeL, and there is no reason to decide on the spot. A medically necessary insured service must never be made conditional on your decision about an IGeL.

Saying no is your right: You do not have to sign a form declining an IGeL. The doctor, not the practice staff, must explain benefits and risks.

Five questions before you agree

  1. What specific problem is this supposed to solve for me? If you have symptoms or an increased risk, insurance often pays.
  2. What is the proven benefit, and for how many people in 1,000? And what does the IGeL-Monitor say?
  3. What happens if the result is abnormal? Follow-up tests, procedures and their risks are part of the bill.
  4. What will it cost in total, under which GOÄ items and with which multiplier?
  5. Can I think it over or get a second opinion?

If your rights are ignored, you can contact your health insurer, a patient advice service or a consumer advice centre (Verbraucherzentrale).

Bottom line

IGeL are neither rip-offs by definition nor sensible by definition. For an individual, a service can be reasonable, for example when it answers a real question and you understand the costs and consequences. As a routine check in people without symptoms, however, the benefit of the most common IGeL is unproven, and ovarian ultrasound for cancer screening does more harm than good on balance. Decide informed, in writing and without time pressure.

Evidence: — Not recommended as a routine test without symptoms or increased risk (ovarian ultrasound: IGeL-Monitor "negative"; glaucoma and thyroid checks: "tending negative"; vitamin D test: "unclear").

References

  1. Medizinischer Dienst Bund. IGeL-Report 2024: Versichertenbefragung (forsa), Kurzfassung und ausführlicher Bericht. Essen: MD Bund; 2024 (Pressekonferenz 3.12.2024).
  2. Medizinischer Dienst Bund. IGeL-Monitor: Bewertungsgrundsätze und IGeL A–Z. igel-monitor.de (abgerufen 27.10.2026).
  3. Medizinischer Dienst Bund. IGeL-Monitor: Dünnschichtzytologie – Kassenleistung oft zusätzlich als IGeL verkauft. Pressemitteilung, 13.02.2025.
  4. IGeL-Monitor. Ultraschall der Eierstöcke zur Krebsfrüherkennung (Bewertung „negativ“; aktualisiert 18.11.2020).
  5. Menon U, Gentry-Maharaj A, Burnell M, et al. Ovarian cancer population screening and mortality after long-term follow-up in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial. Lancet. 2021;397(10290):2182-2193. doi:10.1016/S0140-6736(21)00731-5 Open article (DOI) ↗
  6. IGeL-Monitor. Augenspiegelung mit Augeninnendruckmessung zur Glaukom-Früherkennung (aktualisiert 12.12.2019); PSA-Test zur Früherkennung von Prostatakrebs (aktualisiert 06.04.2017); Früherkennungsuntersuchung auf Vitamin-D-Mangel (2022); Dermatoskopie zur Früherkennung von Hautkrebs (2020).
  7. Deutsches Ärzteblatt. Zwei Schilddrüsen-Vorsorgeuntersuchungen als tendenziell negativ bewertet. 05.08.2024.
  8. Bundesärztekammer, Kassenärztliche Bundesvereinigung. Selbst zahlen? Ein Ratgeber zu Individuellen Gesundheitsleistungen (IGeL) für Patientinnen und Patienten sowie Ärztinnen und Ärzte. 2. Aufl. Berlin; 2012 (geändert 2015).
  9. Bundesärztekammer (GOÄ-Ratgeber). IGeL: Ohne Vertrag kein Honoraranspruch. Dtsch Arztebl. 2009;106(38). § 630c Abs. 3 BGB; § 12 Abs. 1 SGB V. Find on PubMed ↗
  10. Verbraucherzentrale Bundesverband. IGeL: 10 Tipps für Patient:innen. Stand 15.07.2025.
Prof. Dr. med. Markus Guba

Head of Liver Surgery and Transplantation at LMU University Hospital Munich. Edits this independent blog in a private capacity; views are his own. About →

This article is general information and not individual medical advice. Decisions about tests and treatment belong in a conversation with your own physician.