Gynaecology

Direct access without referral

Gynaecologists (Gynäkologen, gynécologues) can be accessed directly by women without a GP referral, regardless of the insurance model. Whether you are on Standard, Hausarzt, HMO, Telmed, or Network, you do not need to go through your GP first for gynaecological consultations. This exception is universal and recognised by all KVG insurers.

To see a gynaecologist, simply call their practice directly and book an appointment. Bring your insurance card and, if relevant, any previous gynaecological records or reports.

What KVG covers in gynaecology

KVG covers medically necessary gynaecological consultations and treatments, including:

• Annual preventive check-up (Vorsorgeuntersuchung), including Pap smear — once every three years for women over 21 without symptoms (age 21–70). The preventive check-up itself is covered without franchise for women in the eligible age range.
• Investigation and treatment of gynaecological symptoms (bleeding abnormalities, pain, infections, etc.)
• Prescription of the contraceptive pill (the pill itself is not always covered — see below)
• STI screening when clinically indicated
• Colposcopy, biopsy, and minor in-office procedures
• Referrals to reproductive medicine or oncology

Contraception and KVG

Contraception is generally not covered by KVG. The consultation to prescribe contraception is covered, but the contraceptive medication (pill, ring, patch, IUD insertion) is typically not reimbursed by basic insurance. IUD insertion is covered by KVG when medically indicated for non-contraceptive purposes (e.g. endometriosis management).

Exceptions exist for hormonal contraception prescribed for medical reasons (e.g. polycystic ovary syndrome, endometriosis, severe dysmenorrhoea). Discuss with your gynaecologist whether your specific situation qualifies.

Maternity and pregnancy

Pregnancy care is well-supported under KVG:

• Pre-natal check-ups (typically 7–10 visits) are covered without applying to the franchise
• Routine pre-natal ultrasounds are covered
• Hospital birth (in the general ward) is covered after the franchise
• Post-natal check-up (typically 6 weeks after birth) is covered
• Breastfeeding support from a midwife is covered (a set number of hours)

Midwife care (Hebamme) is directly covered by KVG — you can see a midwife during and after pregnancy without a GP referral. Midwife-led births in birthing centres (Geburtshaus) are also covered.

Reproductive medicine

Fertility treatments (IVF, ICSI, egg freezing) are largely not covered by KVG. The diagnostic work-up for infertility (hormone tests, semen analysis, fallopian tube assessment) is covered as a medically necessary investigation — it is only the treatment phase (IVF cycles) that falls outside coverage.