Embracing Preventive Healthcare and Wellness in Germany

Germany gives you a list of medical services that your health insurer must pay for in full, before anything is wrong with you, with no Zuzahlung and no referral. Most foreign residents claim almost none of them, because every one of these entitlements is written in German, buried in a section number, and advertised on a leaflet in a waiting room you have not visited yet. This chapter is a plain list of what preventive healthcare in Germany actually consists of: which check-ups and screenings you can claim, the exact age each one starts, what your Krankenkasse (statutory health insurance fund) owes you beyond that, and where the system will happily sell you something instead. It is not medical advice, and it does not tell you what to have done. It tells you what is already yours, so that the decision is yours to make with a doctor rather than one you never knew existed.

What Preventive Healthcare Means in German Law

The German word you will see everywhere is Vorsorge, literally “provision in advance”, used for anything done to catch a problem early. The related word is Früherkennung, “early detection”, which is what the law calls screening. These are not marketing terms. They are legal categories, and the entitlements attached to them sit in the Sozialgesetzbuch V (SGB V), the fifth book of the German social code, which is the statute that governs statutory health insurance.

Two sections do most of the work. Paragraph 25 SGB V gives every insured person over 18 the right to a general health examination and to cancer screening. Paragraph 26 does the same for children and adolescents up to 18. What those two sections deliberately do not do is set any ages or intervals. Paragraph 25 subsection 4 hands that job to the Gemeinsame Bundesausschuss, the Federal Joint Committee, usually shortened to G-BA. This is the body that decides what statutory insurance pays for, and it publishes its decisions as Richtlinien, binding directives. Every age and every interval in this chapter comes from those Richtlinien, because that is the only place they exist. If a website gives you a screening age without naming the Richtlinie, it is copying another website.

This matters more than it sounds, because the Richtlinien change. The general check-up cadence changed in 2019 and most English-language guides never noticed. The cancer screening directive was last amended in December 2025. So the practical rule is: the ages below are what the directives say now, and your Kasse and your doctor work from the same documents. If something here does not match what a practice tells you, the directive is the thing to ask about by name.

The Gesundheitsuntersuchung: One Check-Up Before 35, Then Every Three Years

The general check-up is the allgemeine Gesundheitsuntersuchung, still universally called the “Check-up 35” out of habit, and the habit is now misleading. The Gesundheitsuntersuchungs-Richtlinie sets it out in two sentences. From the age of 18 until you turn 35, you have the right to exactly one general health examination. Once. Not annually, not every three years, but a single one across seventeen years. From the age of 35, you then have the right to one every three years, and after you have had one, you cannot have another in the two calendar years that follow.

The single check-up available to people under 35 is the entitlement almost nobody in that age band claims, largely because the old name says 35 and everyone assumes it does not apply to them. It does. If you are 29 and have never had one in Germany, you have one waiting. Ask your Hausarzt (family doctor) for a Gesundheitsuntersuchung and say you have not had one before.

What it contains is fixed by the directive, not by the practice. There is a history-taking covering your own, your family’s and your social history to establish a risk profile; a full physical examination the directive calls a Ganzkörperstatus; a check of your vaccination status; and a discussion of the results. From 35, blood work is standard and covers a lipid profile (total, LDL and HDL cholesterol, and triglycerides) and fasting plasma glucose, plus a urine dipstick test for protein, glucose, red and white blood cells and nitrite. Under 35, the blood work is only done where your risk profile calls for it, and the directive gives its own examples: a positive family history, obesity, or high blood pressure. If any of those apply to you, say so, because it is what unlocks the blood test.

Two extras ride along with the check-up and are easy to miss. From 35, you can have a one-off screening for hepatitis B and a one-off screening for hepatitis C, each once in your life, taken as part of a Gesundheitsuntersuchung. And men from the age of 65 have a one-off entitlement to an ultrasound screening of the abdominal aorta, looking for an aneurysm. Neither is offered automatically in every practice. Both are in the directive.

The check-up also produces a piece of paper worth knowing about: the Präventionsempfehlung, a prevention recommendation issued as a formal medical certificate where the doctor thinks it is warranted. It is the formal bridge to the prevention courses described further down, and it is one of the things your Kasse is required to take into account when deciding on them.

Krebsfrüherkennung: The Screenings and the Age Each One Starts

Cancer screening is the part of German prevention with the most money behind it and the least English-language explanation. The ages come from the Krebsfrüherkennungs-Richtlinie, in its current version in force since 12 March 2026, and from the Richtlinie für organisierte Krebsfrüherkennungsprogramme, which governs the three programmes run as organised schemes with written invitations. Taking part is expressly voluntary. Nothing here is a recommendation to have any of it done, and screening genuinely has trade-offs in both directions, which is why the G-BA is required to send you its own Versicherteninformation explaining the benefits and the risks before you decide. That decision belongs to you and a doctor. What follows is only the answer to “am I allowed, and from when”.

For women, screening for cancers of the genital organs starts at 20. Clinical breast examination, meaning examination by hand, is added from 30. Both run annually once you have started. Alongside these, the organised cervical screening programme works in two phases: from 20 to 34 you can have a cytology-based smear test, the Pap test, once a year; from 35, you switch to a combined test every three years, the Ko-Testung, which is cytology plus an HPV test together, and you cannot repeat it as a primary screen in the two calendar years after one.

Mammography screening is separate and is the one whose upper age changed. Under the directive as it stands, women have the entitlement roughly every 24 months, starting from the age of 50, at the earliest 22 months after the previous round, and up to the age of 75. The upper limit used to be 69 and moved to 75, so if you are between those ages and were once told you had aged out, you have not. This programme runs by invitation: an Einladungsstelle, usually your Kasse, writes to you. If you have moved recently, moved between Kassen, or your Anmeldung data is stale, the letter is exactly the sort of thing that fails to arrive. You do not have to wait for it.

For men, screening for cancers of the prostate and the external genitals starts at 45 and is annual thereafter. The directive lists precisely what the examination is: a targeted history, inspection and palpation of the external genitals and the surrounding skin, palpation of the prostate through the rectum, and palpation of the regional lymph nodes. Note what is not in that list: a PSA blood test is not part of the statutory screening entitlement, which is why it is routinely offered as a paid extra. That is dealt with in the IGeL section below.

Two screenings apply to everyone. Skin cancer screening, the Hautkrebs-Screening, starts at 35 and is available every second year, looking for malignant melanoma, basal cell carcinoma and squamous cell carcinoma; the directive says it should be done together with the general check-up where possible, which is a useful thing to request in one appointment. And lung cancer screening is new: from your 50th birthday until your 76th, if you are a current or former heavy cigarette smoker as defined in the Lungenkrebs-Früherkennungs-Verordnung, you can have a low-dose CT scan roughly every 12 months. This entitlement did not exist in the version of this chapter you may have read before, and it is the single most recent addition to the list.

Bowel Cancer Screening from 50, and a Correction Worth Knowing

Bowel cancer screening deserves its own section because the rule most sources still print is out of date. For years the entitlement started at 50 for men and 55 for women. Under the current organised programme directive there is no distinction by sex at all: everyone insured has the entitlement from the age of 50.

From 50 you choose between two methods. One is a stool test for hidden blood, the Test auf occultes Blut im Stuhl, commonly called the FIT or iFOBT, done every two years. The other is a Koloskopie, a colonoscopy. If you have a colonoscopy, no other screening method is used for the nine calendar years that follow, after which the choice opens again. You get at most two screening colonoscopies in your life, and a colonoscopy from the age of 65 counts as the second one. Invitations go out at 50, 55, 60 and 65.

The practical value here is knowing the choice exists. A stool test is posted to you and takes a minute; a colonoscopy needs a specialist appointment and a day. Both are covered. Which is appropriate for you depends on your history and is a conversation for a doctor, not for a guide.

Children: U1 to U9, the J1, and the Yellow Booklet

If you have children, this is the section with the most immediate consequences, because the childhood examinations run to a timetable with tolerance windows, and missing a window can mean losing the appointment entirely rather than just being late for it.

The Kinder-Richtlinie provides ten examinations in the first six years of life, numbered U1 to U9 with a U7a inserted in the sequence. U1 comes immediately after birth. U2 falls between the 3rd and 10th day of life, tolerated to the 14th. U3 is in the 4th to 5th week, tolerated from the 3rd to the 8th. U4 is the 3rd to 4th month, U5 the 6th to 7th, U6 the 10th to 12th. Then they spread out: U7 at 21 to 24 months, U7a at 34 to 36 months, U8 at 46 to 48 months, and U9 at 60 to 64 months. Each has a tolerance window a little wider than the target period, and the directive is explicit that the periods apply to premature babies too, with prematurity taken into account when the results are judged. The J1, the adolescent examination, sits in its own separate directive and is a single examination between your child’s 13th and 14th birthdays, with a twelve-month tolerance on either side.

Be careful with what you read elsewhere about U10, U11 and J2. Those are not in any G-BA directive and are not statutory entitlements. Many Kassen pay for them anyway as a Satzungsleistung, a benefit the fund adds voluntarily in its own statute. So they are often free, but whether you get them depends on which Kasse you are with, which makes them one of the small real differences between funds for families.

All of this is recorded in the gelbes Heft, the yellow booklet handed to you at birth, formally the Untersuchungsheft. Keep it. It is not a souvenir. It is the document that proves attendance, and, as the next section explains, it is designed to do double duty at the Kita door.

Vaccinations, the Measles Rule and Getting into a Kita

Vaccination is a Kassenleistung. Paragraph 20i SGB V gives you an entitlement to protective vaccinations, with the G-BA setting the detail on the basis of the recommendations of the Ständige Impfkommission, the standing vaccination committee at the Robert Koch-Institut, universally called the STIKO. The statute goes so far as to say that any departure from a STIKO recommendation must be specially justified. In practice: if the STIKO recommends it for someone in your situation, it is covered.

There is one limit worth knowing before you book a holiday. Travel vaccinations are only covered under paragraph 20i where the trip abroad is for work or training, or where there is a particular public health interest in preventing a disease being brought into Germany. A vaccination for your own holiday is not covered by that entitlement. However, paragraph 20i subsection 2 lets a Kasse add further vaccinations in its own statute, and many do pay for travel jabs on exactly that basis. It is a genuine and easily checked difference between funds.

Now the part that catches families out. Measles protection is not optional if your child is going to a Kita or a school. Paragraph 20 subsection 8 of the Infektionsschutzgesetz (IfSG), the infection protection act, requires anyone born after 31 December 1970 who is cared for in, or works in, a Gemeinschaftseinrichtung to show adequate measles protection or immunity. Paragraph 33 IfSG defines those institutions, and the list is broad: Kitas and after-school clubs, licensed childminders, schools and other training institutions, homes, and holiday camps. Adequate protection is defined precisely: at least one vaccination from the first birthday, and at least two from the second birthday. It does not apply where there is a medical contraindication. Paragraph 20 subsection 9 is the separate proof duty: the evidence has to be given to the head of the institution before the child starts or you start work, and it can be an Impfdokumentation, a doctor’s certificate, or a confirmation that proof was already shown elsewhere.

There is a second, separate Kita duty that is missed even more often, and it is not about measles. Paragraph 34 subsection 10a IfSG says that on first admission to a Kita, the parents must provide written proof that a medical consultation about the child’s complete, age-appropriate vaccination status took place shortly beforehand. Note what this is and is not: it is proof that you had the conversation, not proof that the child is vaccinated. If you do not provide it, the Kita notifies the Gesundheitsamt, the public health office, which may summon you to a consultation. The same provision ends by saying that further rules under Land law remain unaffected, which is why individual Bundesländer run their own invitation and reminder systems around the U-examinations and why the requirements at your Kita may go further than the federal minimum. Ask the Kita what it wants to see, in writing, before the start date.

This is where the yellow booklet earns its keep. Paragraph 26 subsection 2 SGB V requires the doctor’s documentation of the U-examinations to note measles vaccination status and the fact that vaccination counselling took place, expressly so that it can serve as the proof required by both of the IfSG provisions above. In other words, if you attend the U-examinations and the booklet is filled in properly, the booklet is already the document the Kita is asking for. Bring it.

Präventionskurse: The Money Most Newcomers Never Claim

This is the entitlement with the clearest cash value and the lowest uptake among foreign residents. Your Kasse subsidises certified prevention courses: Rückenschule (back training), yoga, Ernährungsberatung (nutrition counselling), Entspannung (relaxation), Raucherentwöhnung (smoking cessation), Bewegungskurse (exercise courses). People pay for these privately, in full, every day, without ever asking.

Be precise about what the law actually says, because it is weaker than the internet claims and the difference matters. Paragraph 20 subsection 5 SGB V says the Kasse may provide a behavioural prevention service if that service has been certified. Not must: may, and only if certified. This is not a hard entitlement in the way the paragraph 25 screenings are. What the statute does require, in subsection 1, is that every Kasse provide for prevention benefits in its own statute, and in subsection 6 it earmarks a per-member sum for prevention work. So the money is there and every fund has a scheme, but the terms are the fund’s.

The mechanism that makes it work is certification. Paragraph 20 subsection 2 requires the GKV-Spitzenverband, the national association of statutory health insurance funds, to set uniform requirements and a single certification procedure. In practice most funds delegate this to the Zentrale Prüfstelle Prävention, the ZPP, which certifies courses on their behalf. The practical rule follows directly: check that a course is certified before you pay for it, not after. An uncertified yoga class at the studio around the corner is not reimbursable no matter how good it is, and a certified one at the Volkshochschule (adult education centre) usually is. Course providers who are certified advertise it, and the ZPP maintains its own directory.

You will see confident claims that you get two courses a year at 80 percent. Do not rely on that. No number, no percentage and no annual limit appears anywhere in paragraph 20. Those figures are each Kasse’s own policy, set in its Satzung, and they differ between funds and change. Look up your own fund’s terms, or ring them and ask three questions: how many courses per calendar year, what share of the fee, and up to what cap. If your check-up produced a Präventionsempfehlung, mention it, because subsection 5 requires the Kasse to take it into account.

One thing this chapter is not doing is telling you which activity to take up. If you want the wider picture on staying well here rather than the reimbursement mechanics, the chapters on fitness centers and gyms and on yoga and wellness retreats cover the ground properly, and wellness and spas covers the Kur and sauna tradition that Germans take a good deal more seriously than most newcomers expect.

Bonusprogramme: Being Paid for What You Already Did

Paragraph 65a SGB V is the provision worth reading twice, because it is stronger than most summaries suggest. It does not say a Kasse may run a bonus scheme. It says the Kasse determines in its statute the conditions under which insured people who take up the screening entitlements under paragraphs 25, 25a and 26, or the vaccinations under paragraph 20i, have a claim to a bonus. Every statutory fund must have such a scheme. Only the conditions are its own.

Read that against the rest of this chapter and the point becomes obvious: the things you are now going to claim for free are the same things your fund will additionally pay you for having claimed. The check-up, the cancer screening, your children’s U-examinations, your vaccinations. Subsection 1a extends the same idea to regular participation in prevention courses, and subsection 2 provides for bonuses where your employer runs workplace health promotion, in which case both the employer and the participating employee get one.

Two honest caveats. First, the form of the bonus is the fund’s choice: some pay cash, some pay vouchers, some reduce contributions, some fund a health account you draw on. Second, subsection 3 is a real constraint: bonuses for the prevention-course measures under subsection 1a must be financed in the medium term from the savings they generate, the funds must account for those savings to their supervisory authority at least every three years, and where no savings are achieved, no bonuses may be granted for those measures. So a scheme can shrink. Check the current terms rather than a blog post.

Because the schemes differ so much, this is also one of the few places where switching Kasse is a rational decision rather than a chore, and where prevention connects directly to money. Comparing funds on contribution rate alone misses the point: the extras are where they actually differ. If you want to compare statutory funds on contribution and on the extras together, including their bonus schemes, the Krankenkassen-Wert-Check does that in the browser; it is a Plus tool, so it sits behind a paid tier, and you can see the current tiers on the Werkzeu.ge pricing page. Werkzeu.ge is built by Cryon UG, the company behind WeLiveIn.de, and it is in beta, so treat its output as a starting point rather than an answer, and not as financial advice. The mechanics of actually switching, and the question of whether you can or should leave the statutory system at all, belong to Insurance Essentials in Germany, which covers the income threshold and the age rules that make leaving close to permanent.

The Dentist, the Bonusheft and Children’s Teeth

Dental prevention is where turning up once a year is worth the most money per hour of anything in German life. The Bonusheft is a small booklet your dentist stamps at each annual check-up. The statute never uses the word: what paragraph 55 SGB V rewards is your own efforts to keep your teeth healthy, and the booklet is simply how you prove it. The subsidy for dentures, crowns and bridges starts at 60 percent of the set amount for the standard treatment, rises to 70 percent for those efforts, and rises to 75 percent where your teeth have been regularly cared for and you took the examinations in each of the last ten calendar years without a break. The five-year and ten-year tests are what the booklet records. Sibling chapter The German Healthcare System works through what that is worth on a real crown and how the booklet fits into using the system generally, so it is not repeated here.

What is worth adding here is the children’s half, because it is the same paragraph 55 test seen from the other end. Paragraph 22 SGB V lets insured children from their sixth birthday until their eighteenth have a dental examination once in every calendar half-year, twice a year, aimed at preventing disease rather than treating it: examination of the gums, explanation of causes, assessment of caries risk, instruction in oral hygiene, and treatment to harden the enamel. The same age group is entitled to Fissurenversiegelung der Molaren, fissure sealing of the molars. And under paragraph 26 SGB V, dental early-detection for the under-sixes includes inspection of the mouth, caries risk assessment, nutrition and hygiene counselling and enamel hardening.

The connection is this: paragraph 55 only lets your adult subsidy rise if, over the relevant five or ten years, the childhood examinations were taken in every calendar half-year and, after 18, at least one dental examination was taken in every calendar year. Attendance as a child is part of the same unbroken chain. For a family newly arrived, the chain starts the year you start it, so the sooner the booklet exists, the sooner the ten-year clock runs.

IGeL: The Things You Are Offered and Pay For Yourself

Sooner or later a receptionist or a doctor will offer you something that is not on any of the lists above, at your own expense. These are individuelle Gesundheitsleistungen, individual health services, known as IGeL. Typical offers are a PSA blood test, an ultrasound of the ovaries, glaucoma screening, a professionelle Zahnreinigung (professional dental cleaning), or extra imaging. They are not covered by statutory insurance, and that is precisely why they are being offered to you as a private service.

Foreign patients get upsold here more than anyone, for a simple structural reason: the offer arrives in German, at a moment when you are already anxious, from someone in a white coat, and you have no way of knowing which side of the line the thing sits on. So learn the line. If it is in this chapter, it is free. If someone is asking you to pay at the desk, it is an IGeL, and it is optional by definition.

You have a statutory protection here, and it is worth knowing by name. Paragraph 630c subsection 3 of the Bürgerliches Gesetzbuch (BGB), the civil code, says that where the treating doctor knows that a third party will not fully cover the costs, or has sufficient grounds to think so, they must inform you of the expected costs before treatment begins, in Textform, meaning in a durable written form. That is not a courtesy. It is a condition. If nobody put the cost in writing before starting, that duty was not met. The practical version: never agree to anything at a reception desk on the spot. Ask for it in writing, take it home, and decide there.

On whether any of it is worth buying, there is an independent German source that exists for exactly this question: the IGeL-Monitor, run by the medical service of the statutory funds, which reviews the evidence for each service and grades it. Its scale runs positiv, tendenziell positiv, unklar, tendenziell negativ, negativ. The distribution is the thing to know. Of the 71 services currently listed in its A to Z index, 27 are rated unclear, 25 tending negative, 6 negative, 10 carry no assessment, and 3 are tending positive. Not one is rated positive. That is 58 of 71 sitting somewhere between unclear and negative.

Which does not mean refuse everything. It means the base rate is poor, the burden of explanation sits with whoever is selling, and an IGeL can still be entirely reasonable for a specific person with a specific history. Look the service up on the IGeL-Monitor by name, ask the doctor why it applies to you rather than to people in general, and ask what changes depending on the result. If nothing changes, you are buying information you will not act on. This chapter cannot and does not tell you whether any particular service is right for you; only a doctor who knows your history can, and the point of knowing the line is that you get to have that conversation as an informed customer rather than a surprised one.

If You Are Privately Insured

Everything above describes statutory insurance. If you are privately insured, under private Krankenversicherung (PKV), none of paragraph 25, paragraph 26 or paragraph 65a applies to you as a statutory entitlement. This is the single most common misunderstanding among higher-earning foreign residents, who assume that paying more buys at least the same list.

Private prevention is contractual. What you get is what your policy says you get, no more and no less, and it varies enormously between insurers and between tariffs with the same insurer. Some private policies are more generous than the statutory list, covering screenings earlier or more often. Some are narrower, or apply an excess to exactly the things that are free in the statutory system, or require pre-approval. There is no G-BA directive standing behind any of it, so there is no external document you can point a practice to.

The practical consequence is that you have to read your Tarif, the specific tariff document, and find the section on Vorsorge. Do it before you need it, not in the waiting room. If your German is not up to that, this is a legitimate use of an hour of a broker’s or a translator’s time, because the answer is stable for years. The broader question of who should be in which system, and why leaving the statutory system is close to irreversible, is covered in Insurance Essentials in Germany.

Claiming Preventive Healthcare Without Fluent German

None of these entitlements requires you to speak German. Every one of them is advertised only in German. That gap is the whole problem, and it is worth being blunt that your Kasse is not obliged to solve it for you: your fund does not have to pay for an interpreter for a medical appointment, a point covered in The German Healthcare System along with the rest of getting treated here.

What works in practice is short and specific. Book the appointment by naming the thing: “Ich möchte einen Termin zur Gesundheitsuntersuchung” for the general check-up, “zur Krebsfrüherkennung” for cancer screening, “zum Hautkrebs-Screening” for skin screening. Reception staff recognise these words instantly because they are the billing categories. You do not need a sentence around them.

Second, use your Kasse’s written channels rather than the phone. Most funds have an online Geschäftsstelle or an app, and written German is far easier to handle with a translator than a phone call under time pressure. Ask about the Bonusprogramm and the Präventionskurse in writing, in your own words, and you will get a written answer you can read at your own speed.

Third, when you go, bring the paper. The eGK, your health card, is the thing that proves entitlement, and the yellow booklet or Bonusheft is what proves attendance. German prevention runs on stamps in booklets to a degree that surprises people from digital-first systems, and a lost booklet costs real money years later. Anything you are prescribed as a result is dealt with at the Apotheke, and what you pay there is covered in Pharmacies and Prescriptions in Germany. If you are here caring for an older relative, prevention shades into a different system entirely, and Care Services for the Elderly covers Pflege.

What to Do Next

Start with the one that expires. If you are under 35 and have never had a Gesundheitsuntersuchung in Germany, that single check-up is sitting unclaimed and the window closes on your 35th birthday. Book it. If you are over 35, work out when your last one was: if it was three or more years ago, or never, you are due.

Then check your age against the list once, on paper, and note the ones you have reached: 20 for cervical screening, 30 for clinical breast examination, 35 for skin cancer screening and for the hepatitis B and C one-offs, 45 for prostate screening, 50 for bowel cancer screening and for lung screening if you are or were a heavy smoker, 50 to 75 for mammography, 65 for the abdominal aorta ultrasound in men. You do not need to act on all of them. You need to know which ones exist so that a doctor can tell you which ones make sense for you.

Then do the two administrative things that pay for themselves. Ring or write to your Kasse and ask, in writing, for the terms of its Bonusprogramm and its Präventionskurs subsidy: how many courses a year, what share, what cap, and what counts. Ask your dentist for a Bonusheft at your next visit and get it stamped every year without fail. Neither takes an hour. Both are worth hundreds of euros over a decade, and the dental one compounds.

If you have children, put the U-examination windows in a calendar today, because those are the entitlements with hard edges, and check the yellow booklet is being filled in at every visit. Before a Kita start date, ask the Kita in writing what proof it needs and when, so the measles evidence and the vaccination-counselling certificate are ready rather than urgent.

And keep one sentence for the reception desk: if it is free, it is on this list; if someone is asking you to pay, it is an IGeL and it can wait until you have it in writing. None of this is medical advice, and this chapter has deliberately not told you what to have done. Prevention in Germany is a set of doors that are already open and unmarked in your language. Knowing they are there is the whole job. Walking through any particular one is a decision for you and your doctor.