Will your insurer reimburse YEARS?

No. Statutory health insurance covers treatment in case of illness and preventive care to the extent set out in the statutory catalogue of benefits — for example the check-up from age 35 every three years. Preventive diagnostics at the depth of a YEARS programme, with an extended biomarker profile, imaging and medical interpretation, are not included. That does not mean you have to pay for the check-up entirely out of pocket for good. Via outpatient supplementary insurance, occupational health insurance through your employer, or a switch to private health insurance, YEARS becomes reimbursable depending on the policy. Which of these routes fits your situation is quickest to establish in a short consultation.

Occupational health insurance, bKV for short, is private supplementary cover that your employer takes out and pays for on behalf of the workforce. It gives you an annual health budget that you use for services the statutory fund does not cover, or covers only in part: dental treatment, glasses, osteopathy, non-medical practitioners and preventive care. Budgets are usually between 600 and 1,500 euros per person per year. Up to the budget amount, 100 percent is reimbursed. You sign nothing and contribute nothing. Unlike a privately arranged supplementary policy, the group contract usually does away with the health assessment.

As a rule, no. Because the employer insures an entire group, insurers typically waive health questions, waiting periods and exclusions in the group contract. Ongoing treatments are covered too. That is the decisive difference from a supplementary policy you take out yourself: there you are asked about your state of health, and existing diagnoses can lead to exclusions of individual benefits or to a rejection. So if you are already in treatment, the route via your employer is usually the only one still open to you. The specific terms depend on the insurer and the group contract.

YEARS bills according to the German medical fee schedule (GOÄ). You receive an invoice showing your name, the services rendered with their GOÄ codes and the date: exactly the details insurers need for a reimbursement. You submit this invoice via your insurer’s app, or by email or post. You have until the end of the statutory three-year limitation period to do so. With occupational health insurance, 100 percent is reimbursed up to the amount of your annual budget, provided the service is included in your policy’s catalogue of benefits. We do not recommend submitting a request in advance, because in practice it often reduces the reimbursement.

Cover from occupational health insurance ends in principle with the employment relationship, because the contract exists between your employer and the insurer. Many policies do, however, offer continuation: you take the contract over privately and then pay the premium yourself, usually without a further health assessment. That is precisely what makes occupational cover interesting in the long run if you have a pre-existing condition. You keep access that you might no longer obtain privately. Whether your policy provides for continuation, and on what terms, is set out in the contract conditions and should be clarified before you move.

That depends heavily on the policy. There are outpatient supplementary policies that reimburse private preventive services and private outpatient treatment, and there are ones that essentially mirror the statutory catalogue and contribute little towards a check-up of this depth. You pay the premiums yourself, and you are asked about your state of health when you sign up. The advantage over the occupational route: the cover belongs to you and stays with you when you change jobs. In practice the two complement each other well, because the employer-funded budget reduces the own share that the supplementary policy leaves open. What adds up for you can be worked through in a short conversation.