A second opinion before surgery is set to become a condition for payment for certain planned procedures under the GKV Contribution Rate Stabilisation Act (GKV-Beitragssatzstabilisierungsgesetz) from 2028. The Bundestag passed the law on 10 July 2026. According to the Federal Ministry of Health (BMG), it also passes the Bundesrat. The Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA) will decide in a directive which procedures are covered.
Short answer: Under the GKV Contribution Rate Stabilisation Act, a second opinion becomes a condition for payment for selected planned procedures. According to the BMG, two planned procedures are to be set each year from 2028, starting with hip replacement and spinal procedures. The G-BA sets the details. Last updated: November 2026.
Key points in brief
- The second opinion applies to planned procedures, not to emergencies.
- The G-BA decides which procedures are covered and sets the process in a directive.
- According to the BMG, two planned procedures are to be set each year from 2028.
- Without a prior second opinion, the procedure may not be reimbursed under the law.
- The G-BA directive is still pending, so many details remain open.
Why a second medical opinion exists
Many operations are planned well in advance. Between diagnosis and surgery there is time to weigh alternatives, add findings or seek a second assessment. This is where the second opinion comes in. A second doctor who was not involved in the original treatment reviews the findings and describes whether the planned procedure appears necessary from that perspective and which alternatives could be considered.
A second opinion does not replace treatment or the decision itself. It gives you another basis for the conversation with your treating team. Going into an appointment with a clear list of questions helps you weigh the benefits and risks of a procedure against each other.
Which procedures are planned?
The law does not work with a fixed list. Instead, it requires the G-BA to set the covered procedures each year. The stages that the BMG describes look like this:
| From | Procedures according to the BMG |
|---|---|
| 2028 | Hip replacement and spinal procedures |
| 2029 | Surgical removal of the gallbladder or the uterus |
| 2030 | (Partial) removal of the tonsils and arthroscopic shoulder procedures |
The list becomes binding only with the G-BA decision. If you are planning one of these procedures, ask the treating practice or clinic which directive and which documents apply.
What the second opinion means for insured people
The second opinion is linked to how the treatment is paid for. Under the law, it is meant to be a condition for payment of the procedure. For the practice or clinic, this creates a strong incentive to secure the second opinion in advance. How this works for you in practice, meaning whether you arrange the appointment yourself, which body issues the assessment and whether deadlines apply, will be set out in the G-BA directive.
Until that directive exists, much remains unclear. You can prepare now by gathering the documents that belong to your case and writing down the questions you want answered.
Which documents belong in a second opinion?
An assessment is only as good as the findings it rests on. The second doctor needs the full picture to place your situation correctly. Ask the treating office for copies of the most important records before you book the appointment. This saves time and prevents key findings from being missing.
- Imaging results such as X-ray, MRI or CT, ideally as image files plus the report.
- Discharge letters and reports from recent treatment for the same complaint.
- A current list of your medication and known intolerances.
- Your own notes on symptoms, progression and questions for the treating team.
Sort the documents by date. If you obtain a second opinion, it also helps to know exactly which question should be answered. A question such as “Is the operation necessary, and are there alternatives?” leads to a clearer answer than a general request for an assessment.
What to keep in mind about the second opinion
A second opinion is a snapshot. It rests on the documents available and on the state of medical knowledge at the time. If your health changes, a new assessment can make sense. Ask for the results in writing and discuss them with the team that plans the procedure, so you keep track of which recommendations exist and how they relate to each other.
Equally important is who pays for the second opinion and what that means for you. A clear statement from your health insurer before the appointment avoids unpleasant surprises.
What is still open?
- The G-BA directive with the binding list of procedures and the process.
- Cost coverage for the second opinion itself. Ask your health insurer before the appointment.
- The exact implementation in practices and clinics from 2028.
Frequently asked questions
Does the second opinion already apply in 2027?
According to the BMG, the list starts in 2028. What is prepared already in 2027 is set by the G-BA directive. As long as that directive is not in place, no binding statement can be made about individual dates. Check the current status with the G-BA and your health insurer.
Do I need a second opinion for every operation?
No. The rule only covers the procedures that the G-BA determines. Emergencies and other unplanned treatments are not covered, because the law speaks of planned procedures. Whether your procedure is included will be shown by the directive.
Who pays for the second opinion?
The directive and your health insurer settle this question. Ask your health insurer which services it covers for a second opinion before you book an appointment.
Can a second opinion prevent an operation?
A second opinion is an assessment, not a decision. If it reaches a different conclusion, you are still free to decide with your treating team. It can, however, show alternatives you had not discussed before.
What to do now
- Write down the planned procedure and ask the practice or clinic whether it is planned.
- Check the G-BA directive once it is published and compare it with your procedure.
- Ask your health insurer whether, and to what extent, a second opinion is covered.
- Have the diagnosis explained to you in writing before you decide.
Related reading
- Health insurance 2027: what changes for insured people and students
- GKV reform 2026: what the contribution rate stabilisation act regulates
- Spouse family insurance from 2028: what the contribution costs
- Additional contribution of health insurers 2027: why the range is so wide
Sources: BMG: Bundestag passes GKV Contribution Rate Stabilisation Act, press release of 10.07.2026, BMG: FAQ on the GKV Contribution Rate Stabilisation Act, accessed November 2026.
Last updated: November 2026. This guide is general information, not individual advice.
