Regelleistungen

Regelleistungen are the standard benefits of the German statutory health insurance (GKV). They comprise the baseline medical services that all insured persons receive and that are reimbursed to providers when medically necessary. The scope and conditions of Regelleistungen are defined in the benefits catalog maintained by the Gemeinsamer Bundesausschuss (G-BA) on behalf of the statutory health insurance system and are designed to ensure nationwide access to essential care.

The catalogue covers a broad range of services, including outpatient and inpatient medical treatment, prescribed medications, rehabilitation measures, and the use of medically required devices and aids. It also encompasses preventive and early-detection services, vaccinations, and various therapies such as physiotherapy, occupational therapy, and speech therapy. In dentistry, Regelleistungen include standard preventive care and essential dental treatments that are medically necessary. Mental health services and other recognized therapeutic interventions may also fall under Regelleistungen when they meet medical necessity and guideline-based criteria.

Financing and cost-sharing: Regelleistungen are financed by the statutory health insurers. Insured persons may owe co-payments (Zuzahlungen) for certain Regelleistungen, with exemptions or reductions for particular groups (for example, children or low-income individuals) and for chronic conditions or long-term care circumstances. The exact amounts and exemptions are governed by statutory rules and may vary.

Difference from private or voluntary services: Regelleistungen contrast with Wahlleistungen or private Zusatzleistungen, which are not covered by the GKV and may require additional private insurance or out-of-pocket payment. The list of Regelleistungen and its updates are periodically reviewed and adjusted by the G-BA based on medical evidence and cost-effectiveness.