For preventive check-ups in private health insurance, your tariff decides what is paid. Unlike statutory health insurance, there is no catalogue that applies to everyone in the same way. Some tariffs cover the early detection that the GKV also knows. Others include further check-ups or limit them through maximum amounts, age limits or a deductible.
You can see whether an examination is reimbursed in the tariff terms, ideally before you book the appointment. How the doctor’s bill is calculated also helps determine what the tariff finally reimburses.
The key points at a glance
- The PKV tariff determines which preventive check-ups are reimbursed. A uniform benefit catalogue as in the GKV does not exist.
- Check the scope, age limits, intervals, maximum amounts and deductible in the terms.
- You pay the bill first and submit it to the insurer, within three years after the end of the billing year.
- Doctors’ bills follow the GOAE (scale of fees for doctors). Above the threshold of 2.3, the practice must justify the multiplier.
- Health questions in the application must be answered truthfully. Findings from preventive check-ups can play a role here.
What counts as preventive care, and what does PKV pay?
Preventive care includes examinations that aim to detect diseases early, before symptoms appear. Which examination belongs to the standard statutory benefits at which age and at which intervals is set by their guidelines. Your health insurer or the practice will tell you the current position. An overview of all PKV benefits is available in a separate article.
In PKV, by contrast, the tariff counts. The table shows what you should clarify for the most common examinations.
| Examination | Statutory health insurance | Private health insurance |
|---|---|---|
| Check-up (health examination) | Standard benefit if age and interval match the guidelines | Per tariff. Check interval and age limit |
| Skin cancer screening | Standard benefit under the guidelines | Per tariff. Check whether an age limit applies |
| Colorectal cancer screening | Standard benefit under the guidelines | Per tariff. Check age and interval |
| Gynaecological and urological screening | Standard benefit under the guidelines | Per tariff |
| Dental check-ups | Regular check-ups (bonus booklet) increase the fixed subsidy for dentures | Per tariff, including for prophylaxis |
| Additional blood tests or measurements at your own request | Often paid privately | Only if the tariff includes optional services |
Which preventive check-ups matter for students?
For students, the basics come first. These include the health check-up with the family doctor, the dental check-up, skin cancer screening and, depending on your sex, gynaecological or urological screening. Which examination is due for you depends on age, sex and family risk. Your family doctor can help you classify this.
Vaccination status is also part of prevention. The article on vaccinations in PKV explains how PKV handles this.
Dental check-ups in PKV: what depends on the tariff?
Dental check-ups consist of regular examinations and, if you wish, prophylaxis such as a professional teeth cleaning. In the GKV, regular check-ups recorded in the bonus booklet affect the fixed subsidy for dentures. In PKV, the tariff sets whether and how much prophylaxis is reimbursed, and whether dental treatment and dentures are regulated separately.
You will find calculation examples and reimbursement cases in the article on dental costs in PKV.
Cancer screening in PKV: what do you check in the tariff?
For cancer screening, tariffs differ mainly in four points:
- Scope: Does the tariff reimburse the examinations that the GKV also covers, or does it include more?
- Age limits: Is reimbursement tied to a minimum age, or does it apply from the start of the contract?
- Intervals: How often can you claim the same examination?
- Maximum amount and deductible: Is there an annual budget, and does the invoice count towards your deductible?
The answers are in the tariff terms or the benefits overview. When in doubt, ask your insurer before the appointment.
How does the practice bill, and how much does the tariff reimburse?
If you have private insurance, you pay the doctor’s bill first and submit it to the insurer. There is no direct contractual relationship between the practice and the insurer. The principle is explained in the article on cost reimbursement in PKV, and how to read your bill is covered in benefit statements in PKV.
You can submit within three years after the end of the year in which the invoice was issued. An invoice from March 2026 is therefore valid until 31 December 2029.
What do the factors on the invoice mean?
Private medical services are calculated under the scale of fees for doctors (GOAE). The single rate results from the number of points for the service multiplied by the point value of 5.82873 cents. The practice sets the multiplier within the range at its reasonable discretion. For personal medical services the threshold is 2.3 and the maximum rate is 3.5. Up to the threshold the practice does not need to give reasons. Above it, it must justify each service on the invoice with reference to the patient, the illness or the circumstances. Generic justifications are not enough. More on this from the Federal Agency for Civic Education.
Example with freely chosen points: a service has 100 points. The amounts are calculation figures and not a price for a specific examination.
| Factor | Calculation | Amount |
|---|---|---|
| Single rate (1.0) | 100 points times 5.82873 cents | 5.83 € |
| Threshold (2.3) | 5.82873 € times 2.3 | 13.41 € |
| Maximum rate (3.5) | 5.82873 € times 3.5 | 20.40 € |
Whether your tariff also reimburses rates above the threshold is set out in the terms. Above the maximum rate, a written fee agreement under section 2 GOAE is required in advance. For emergencies and acute pain treatment, such an agreement is excluded. A reform of the GOAE is planned, but no date has been set. Until then, the current scale of fees applies.
Submit the invoice or keep the premium refund?
Some tariffs pay back part of the premiums if you submit no invoices for a year. This refund is usually conditional on the absence of claims. For a single preventive invoice, it is worth weighing the two sides: what does the reimbursement bring, and what premium refund would you lose? Also check whether preventive benefits count towards your deductible.
What do preventive check-ups have to do with the health questions in the application?
The PKV application contains health questions that you must answer truthfully. You must disclose known circumstances about which the insurer asked in text form before you make the contract declaration. If you breach this duty, the insurer may in some cases withdraw from the contract or terminate it. Its rights lapse five years after the contract is concluded, or after ten years in cases of intent or fraudulent deception (sections 19 and 21 VVG). Findings from earlier preventive check-ups can therefore be important for the application.
Go to your check-ups when they are due, and answer the questions in the application honestly. If you are unsure which details are needed, an anonymous risk enquiry before the application can help.
Are preventive benefits a reason for PKV during studies?
Preventive benefits are one tariff detail among many. The consequences of the decision carry more weight. Exemption from compulsory insurance normally applies for the whole course of study and cannot be revoked, and a return to the GKV is usually possible only after the end of studies. The Verbraucherzentrale describes this as well. In addition there are health questions in the application and premiums that can rise over time.
Which further insurance cover makes sense during your studies is shown in the insurance overview for students.
Frequently asked questions
Does PKV pay for preventive check-ups?
That depends on the tariff. A tariff may reimburse early detection examinations, but the exact conditions vary. Check the scope, age limits, intervals, maximum amounts and deductible. You pay the bill first and submit it to the insurer.
Are there special preventive check-ups for students?
Ask your health insurer or university whether they offer special services for students. In general, the examinations that suit your age and sex apply to you, such as the health check-up, the dental check-up and skin cancer screening. Your family doctor can tell you what makes sense for you.
Is the youth check-up J2 still available during studies?
The youth check-up is aimed at young people. As a rule, you are past it once you start your studies. Adults are offered other services, such as the health check-up. Your tariff or health insurer will tell you which of these it pays for.
Who pays for a check-up?
In the GKV, the health check-up is a standard benefit if age and interval match the guidelines. In PKV, reimbursement depends on the tariff. Additional blood tests or measurements at your own request are often paid privately, unless the tariff includes optional services.
What to do now
- Search the tariff terms for “preventive care” or “early detection” and note the scope, age limits, intervals, maximum amount and deductible.
- Ask your insurer before an appointment whether the examination is reimbursed.
- Keep the paid invoice and submit it promptly, within the three-year deadline.
- Weigh up whether your tariff pays a premium refund for claim-free years.
If you want to talk through your situation, you will find the way to advice on the Academycon homepage.
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Status: October 2026. This article provides general information and does not replace individual advice.
