IGeL – overview of self-payer services
IGeL stands for “individual health services”. The cost of these services is not normally covered by statutory health insurance providers and has to be paid for privately. Often, the benefit of these services is not completely clear – and in some cases is even disputed.
At a glance
- “Individual health services” (IGeL) are not included in the catalog of benefits offered by statutory insurance providers.
- The costs of IGeL normally have to be paid for by patients themselves.
- Some health insurance providers also voluntarily cover the costs of certain IGeL or offer supplementary/add-on insurance to cover these services.
- It is often the case that the benefits of IGeL have not been sufficiently proven.
- Providers of IGeL must provide patients with detailed information about the scope of the service and the costs involved in advance.
- If there is a medical need for a specific test, the costs may be covered by the statutory health insurance fund on a case-by-case basis.
What are individual health services, or IGeL for short?
People with statutory health insurance do not usually have to pay for medical services – in principle, the statutory health insurance fund pays for any medical treatments required. Exceptions are possible additional payments, for example, for medicines or a stay in hospital, or personal contributions, for example towards dentures.
Services in this context refers to health or medical services, such as tests and treatments. The statutory health insurance scheme has a catalog of services that specifies which services are paid for by the health insurance provider. But doctors, hospitals, therapists and other medical service providers may also offer services that are not included in the statutory health insurance scheme catalog. In outpatient settings, these services are called “individual health services”, or IGeL for short (abbreviated from their German name “Individuelle Gesundheitsleistungen”). In inpatient settings (in hospital), services that have to be paid for privately by patients are known as optional or elective services (“Wahlleistungen”).
The statutory insurance providers do not normally cover the cost of IGeL offerings. This means that people with statutory health insurance usually have to pay for these services out of their own pocket. For this reason, they are also referred to as self-payer services (“Selbstzahler-Leistungen”).
Important: Some statutory health insurance providers cover the cost of certain individual health services. For this reason, it can be worth checking with the insurance provider in advance whether they will cover the cost or whether there are any alternative options to consider. Some IGeL are also covered under private add-on insurances.
Why do statutory health insurance funds not normally pay for IGeL?
The Joint Federal Committee (Gemeinsamer Bundesausschuss – G-BA) decides which medical services the statutory health insurance scheme will pay for. In performing its role, it comes under the legal supervision of the Federal Ministry of Health and, within a framework prescribed by legislators, it specifies which of the medical services in the statutory health insurance scheme catalog will be paid for. In compliance with the Fifth Book of the Social Security Code (SGB V), services that the statutory health insurance scheme pay for must “be sufficient, purposeful and economical; they may not exceed the scope required”.
Many IGeL offerings are services for which there is no proven additional benefit, or the effectiveness of which has not been demonstrated. As a result, the G-BA did not approve them or has not yet made a decision on them. Studies are required to demonstrate the benefit or effectiveness of a medical test or treatment method. The G-BA does not conduct its own studies, but contracts third parties to carry out independent assessments that examine the data from studies. In making its decisions, the G-BA also takes account of costs in order to satisfy the requirement of economical efficiency.
Important: The reason why a particular medical service or medication is not included in the statutory health insurance scheme catalog of services is not always that its effectiveness has not been demonstrated. It may also be rejected, for example, if the benefit of the medical service or medication is not, in the opinion of the Joint Federal Committee, in proportion to the cost and that alternative options are available.
There are also IGeL which, in the opinion of experts, contradict medical advice and may cause harm. For example, some experts advise against ultrasound scans of ovaries as part of cancer screening because studies have been unable to demonstrate any benefit and the scans could even cause harm due to unclear findings that require verification. For instance, unclear findings can cause undue distress and require patients to undergo further testing for clarification.
Although there is no clear evidence of the benefit of many IGeL offerings, or they may even cause problems, the individual health services are certainly not useless or ineffective in general. There are also IGeL offerings which are certainly useful and important. These may include, for example, certain medical certifications, sport-related examinations, travel inoculations, and medical cosmetic services. IGeL in the area of psychotherapy may also be beneficial, for example, couples and family therapies, which are not normally covered by statutory health insurance.
Due to the wide range of IGeL offerings, a generalized assessment of all is not possible. It is therefore advisable for patients to ask about any specific IGeL service that they want to use and try to find independent information about them as far as possible. They should never allow themselves to feel pressurized into agreeing to an IGeL.
What rights do patients have in relation to IGeL offerings?
Doctors, dentists and psychotherapists can independently offer a very wide range of individual health services (IGeL). For these particular services, they are not required to adhere to the calculation of the basis fee rates found in the Scale of Fees. The 2.3 times higher rate, or even the 3.5 times maximum rate, may be charged for a service if the difficulty and time required for that specific service justify it. This means that IGeL services are often more profitable for doctors than services covered by statutory health insurance. However, doctors are legally obliged to give the patient detailed, written information about the examination or treatment method concerned, including the costs. If in any doubt, ask very directly for evidence of the benefits to you personally of availing of the service on offer and about the costs that will be incurred.
Once the explanation has been given, time to think it over should be granted, and then a clear decision should be possible. If this is not the case, it may be worth putting off the decision and getting information about the service from a different source. In any case, individual health services (IGeL) may only be delivered with the patient’s explicit consent.
Which IGEL services are frequently offered by doctors?
According to estimates, there are several hundred individual health services.
A study by the “IGeL-Monitor” showed that the following IGeL are frequently offered:
- ultrasound scans of the ovaries or breast for early detection of cancer
- specific tests to diagnose cervical cancer (thin-layer cytology)
- measurement of intraocular pressure and ophthalmoscopy for early detection of glaucoma
- PSA test as an indication of prostate cancer
- acupuncture for lower back pain
- a full blood count for preventive health care
The cost of these tests, which are frequently offered as IGeL, may be covered by statutory health insurance funds – if, for example, they are considered to be medically necessary.
Where can I find information about IGeL?
Doctors and other providers of individual health services (IGeL) must give their patients detailed information about the service concerned, and its costs, in advance. Patients can also find additional information from other sources. For example, they might get a second specialist opinion or consult their health insurance provider.
There are websites that provide detailed information about IGeL. One that is particularly informative is the “IGeL-Monitor”, operated by the Medical Review Board of the National Associations of Social Health Insurers (“Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen e. V.”, MDS). To evaluate individual health services, the expert team behind this service carries out research in medical databases that contain specialist literature on the subject.
- Bundesärztekammer, Kassenärztliche Bundesvereinigung und Deutsches Netzwerk Evidenzbasierte Medizin e.V. Selbst zahlen? Ein Ratgeber zu Individuellen Gesundheitsleistungen (IGeL) für Patientinnen und Patienten sowie Ärztinnen und Ärzte. 2. Auflage. November 2012 [zuletzt geändert Juni 2015].
- Bundesministerium für Gesundheit (BMG). IGeL. Aufgerufen am 20.10.2021.
- Bundesministerium für Gesundheit (BMG). Kostenerstattung in der GVK. Aufgerufen am 20.10.2021.
- Bundesministerium für Gesundheit (BMG). Leistungskatalog der Krankenversicherung. Aufgerufen am 20.10.2021.
- Bundesministerium für Gesundheit (BMG). Zuzahlung. Aufgerufen am 20.10.2021.
- Gemeinsamer Bundesausschuss (G-BA). Bewertungsgrundlagen. Aufgerufen am 20.10.2021.
- Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen e.V. (MDS). IGeL Monitor - IGeL-Report 2018: Häufig angebotene IGeL widersprechen medizinischen Empfehlungen und können schaden. Aufgerufen am 20.10.2021.
- Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen e.V. (MDS). IGeL Monitor – IGeL-Report 2020. Kurzbericht.
- Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen e.V. (MDS). IGeL Monitor – Ultraschall der Eierstöcke zur Krebsfrüherkennung. Aufgerufen am 20.10.2021.
- Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen e.V. (MDS). Von der IGeL zur Kassenleistung: Dermatoskopie zur Früherkennung von Hautkrebs. Aufgerufen am 20.10.2021.
- Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen e.V. (MDS). IGeL Monitor – Kurz & bündig. Aufgerufen am 20.10.2021.
- Patientenbeauftragte der Bundesregierung. Individuelle Gesundheitsleistungen (IGeL). August 2019.
- Unabhängige Patientenberatung Deutschland (UPD). Wie finde ich heraus, ob eine angebotene IGeL sinnvoll für mich ist? Aufgerufen am 20.10.2021.
- Verbraucherzentrale. Was sind individuelle Gesundheitsleistungen (IGeL)? Aufgerufen am 20.10.2021.