What Does Private Health Insurance Cover in Pregnancy and Birth?

Which check-ups does private health insurance cover during pregnancy?

The standard check-ups are set out in the maternity guidelines of the Federal Joint Committee (G-BA), the body that defines public health benefits.[1] Private health insurance pays for them as part of the insured event of pregnancy.[2] The guidelines include:

• Three basic ultrasound scans, around weeks 9 to 12, 19 to 22 and 29 to 32.
• Lab tests for blood group, antibodies, rubella immunity and infections such as syphilis, hepatitis B and chlamydia.
• A screening for gestational diabetes between weeks 24 and 28.
• Urine and blood pressure checks at every appointment.
• Closer monitoring such as CTG in a high-risk pregnancy.

Does private health insurance cover NIPT and extra scans?

Whether private health insurance pays for NIPT, the prenatal blood test for trisomies, and for extra scans such as organ or 3D scans depends on the tariff and a medical reason, for example your age, a family history or an earlier miscarriage. Some family tariffs include additional scans. Public insurance covers NIPT only in justified individual cases.[1]

Does private health insurance pay for a midwife and antenatal classes?

Private health insurance pays for a midwife's care before, during and after the birth, including home visits.[2] Midwives bill privately insured women under the fee rules of their federal state. Antenatal and postnatal courses are paid if the tariff includes them. Public insurance covers the courses, and midwife care after the birth for up to 12 weeks.[3]

What does private health insurance pay for a hospital birth?

Private health insurance pays for the hospital stay, the doctors and the midwife at the birth through your contract.[2] Your tariff can include a single room, treatment by the senior consultant (Chefarzt) and a family room, so your partner can stay with you and the baby. If your contract includes a daily hospital allowance (Krankenhaustagegeld), it also pays for the days in hospital for the birth.

Treatment the baby needs is paid by the baby's own contract; depending on the insurer, routine care of a healthy newborn may run through the mother's contract. Through Kindernachversicherung, the insurer of a parent has to take on the baby, backdated to the birth and without risk surcharges or waiting periods, if you register the baby within two months.[4] The insurer may require that parent to have been insured with it for up to three months, and the baby's cover may not be better than the parent's.[4] How newborn enrolment works sets out the details, and family health insurance in Germany the costs.

Does private health insurance pay for a home birth or a birth centre?

Private health insurance pays for a birth at home or in a birth centre either by refunding the costs or with a fixed lump sum (Entbindungspauschale), depending on the tariff. Some daily sickness allowance tariffs pay a lump sum too. The tariff conditions say whether a birth centre counts, whether the lump sum still applies after a move to hospital, and whether your deductible applies. Public insurance covers both.[5]

How does private health insurance compare with public insurance for pregnancy and birth?

Both systems pay for the check-ups, the midwife and the birth. Private tariffs can add comfort and extras that public insurance does not pay. A new contract can have a waiting period of up to eight months, and your baby gets its own contract.

Whether private cover suits your plans for a family is the subject of our PKV decision guide.

Is there a waiting period for the birth in private health insurance?

A new private contract can have a waiting period of up to eight months for the birth, counted from the start of cover.[6] The waiting period does not apply if you switch directly from public or private full cover in Germany and apply within two months, because the time insured there counts.[6] If the tariff provides for it, the insurer can also waive the waiting period against a medical certificate about your health.[7]

If you move to Germany from abroad, whether your previous cover counts is up to the insurer. Insurers handle prior cover from another European country differently, and whether you are employed or self-employed can make a difference. We clarify this with the insurer before you apply.

Can you take out private health insurance while pregnant?

You can apply while pregnant. If the application asks about a pregnancy, you have to state it, under the same duty to disclose as every other health question.[8] The waiting period for the birth applies unless it is credited or waived.

How an insurer handles an application during pregnancy depends on your situation and the insurer. We clarify how insurers would decide before anything is filed: book a free 30-minute call, and we also check what the tariffs that fit you pay for the birth.

What money do you receive during maternity leave and parental leave?

Privately insured employees receive a one-off maternity payment of up to €210 from the federal social insurance office.[9] The employer pays the difference between €13 a day and the net pay.[10] A daily sickness allowance in the contract pays during the protection period (Mutterschutz) and can close the gap to full net pay.[11] The private premium keeps running during maternity leave. Maternity pay with private health insurance sets out the amounts and what changes during parental leave (Elternzeit).