Pregnancy: Which examinations are paid for by the health insurance fund?Pregnant women are entitled to a variety of preventive examinations and consultations with the goal of continuously monitoring the health of the mother and child. In high-risk cases, health insurers will cover the costs of further necessary measures.
– Three ultrasound examinations are covered by health insurance during pregnancy. – All important tests for diseases such as rubella, hepatitis B, HIV or gestational diabetes are also free of charge for those with statutory health insurance. – Many health insurance companies pay their members for additional examinations as a voluntary benefit ("statutory benefits"). – IGeL services are therefore not mandatory for better preventive care.
– Special examinations, such as an organ ultrasound, must be paid for by the patient as an IGeL, but are covered by the health insurance system if a certain developmental disorder is suspected, if the findings are unclear, or if the pregnancy is at risk. – If you want more than is legally required, you should ask your health insurance company in advance which additional services will be covered. – Important to know: Ultrasound examinations do not provide 100% certainty that the child is healthy.
What health insurance benefits are available for pregnant women?
The maternity guidelines regulate which services are paid for by the statutory health insurers. Oral health education. Nutritional recommendations (z.B.B. increased iodine intake and information on the relationship between diet caries risk).
Blood test to determine the fetal rhesus factor: new benefits
Until now, all rhesus-negative pregnant women have been treated with anti-D immunoglobulins. This is medically unnecessary, because the risk of sensitization of the mother exists only with a rhesus-positive child. The background: If women with a negative Rhesus factor are expecting a Rhesus-positive child, the maternal blood can form antibodies against the child's Rhesus factor.
Since July 2021, there is a new blood test for pregnant women. This determines whether they need precautionary treatment with anti-D prophylaxis. The new test is used in the laboratory to analyze the child's DNA in the mother's blood. How the rhesus factor of the unborn child is determined. The aim is to find pregnant women who will really benefit from the treatment. If the child is rhesus positive, the mother receives the anti-D immunoglobulins. Testing is allowed from 12 weeks of pregnancy at the earliest. Week of pregnancy. Unnecessary medication is thus avoided.
As this is a prenatal genetic test, the medical information and consultation obligations apply in accordance with the provisions of the Genetic Diagnostics Act.
In principle, the prescribed specialized genetic counseling may only be performed by human geneticists and gynecologists who have the appropriate qualifications according to the Gene Diagnostics Act (GenDG) and the guidelines of the Gene Diagnostics Commission.
Trisomy test for high-risk pregnancies to be covered by the health insurance system
With a special blood test, pregnant women from the 10. The pregnant woman can have the blood of her child tested at the first week of pregnancy to determine whether it has a trisomy. Until now, the so-called prenatal test (NIPT) had to be paid privately. These are not to be a standard or routine examination during pregnancy.
The prenatal test is expected to become part of the prenatal examinations covered by the health insurance system in spring 2022. According to a decision of the Joint Federal Committee, the test is to be carried out in justified individual cases with special risks and after medical consultation.
During the examination, hereditary components of the child are examined from the blood of the pregnant woman for genetic defects or. for trisomies 13, 18 or 21. Unlike amniocentesis, there is no risk of miscarriage with trisomy blood testing.
Trisomy 21 is the so-called Down syndrome, in which people have one more chromosome than others in every cell of their body. Chromosome 21 is present in triplicate. In addition to Down syndrome, the test can also detect the rarer and more serious trisomies 13 and 18.
Consequences of trisomy are mental and physical disabilities and delayed development. However, the characteristics are very different.
Trisomy cannot be treated. Therefore, if possible, psychosocial and medical counseling should be considered before and after the examination. After a conspicuous finding, expectant parents can contact pregnancy counseling centers, self-help groups or disability associations.
Further information and contact details can be found on the website of the Federal Joint Committee.
Which ultrasound examinations are covered by health insurance?
The three basic ultrasound examinations provided for by law, also known as sonography, take place around the 10th week of pregnancy., the 20. and the 30. week of pregnancy instead of. They serve as a regular check whether the pregnancy is proceeding normally and whether the child is developing according to its age without malformations and dysfunctions.
Since 2013, pregnant women have been able to choose between the normal or the extended ultrasound during the second basic ultrasound examination. In addition, important parts of the child's body (head, neck, back, chest and torso) are examined in more detail. Guidelines stipulate that doctors must have special qualifications and equipment for this purpose. Otherwise, they must refer to trained colleagues.
Which additional services do doctors offer??
Since 1. As of January 2021, ultrasound examinations during pregnancy that are not medically necessary are prohibited. Three ultrasound examinations are scheduled as part of the prenatal care. You can read more about this in the section "Which ultrasound examinations are paid for by the health insurance fund??"
The IGeL Monitor already came to the conclusion in 2016 that the additional ultrasound examinations have no medical benefit.
Scientific studies provided no evidence on whether additional ultrasound examinations reduce the risk of infant mortality. Whether malformations, growth disorders or even birth risks can be better detected and whether the parental bond with the child becomes stronger.
Under the new Radiation Protection Ordinance, so-called "baby television" is no longer permitted since 1. Prohibited from January 2021.
Baby TV Gynecologists perform 3D and 4D ultrasound examinations for the sole purpose of taking pictures or films of the unborn child. Such medically unnecessary ultrasound examinations may no longer be performed to protect the fetus, because with the onset of bone formation, considerably more sound energy is absorbed at the bones. The tests carried out as part of normal prenatal care. 2D examinations paid for by the health insurance funds remain.
If doctors detect abnormalities in the child's development, they may continue to perform a 3D or 4D ultrasound. This can be done, for example, if there is a suspicion of a certain developmental disorder, an unclear finding or a high-risk pregnancy as a health insurance service. Pregnant women usually have to visit a specialized practice for this purpose.