April 30, 2026, 8:17 am | Read time: 6 minutes
Most parents are familiar with the so-called “U-examinations.” These are preventive check-ups that monitor the healthy development of children and are covered by statutory health insurance. However, the preventive care catalog of statutory health insurance for children and adolescents is much more extensive. In some areas, there is a gap in coverage. FITBOOK and pediatrician Dr. Ronny Jung explain what the insurance covers and which examinations you should check with your own health insurance.
U and J: What does statutory health insurance cover?
The so-called U-examinations (U1 to U9) and the youth examination J1 are standard services of statutory health insurance.
- U-examinations (U1 to U9): from birth to age 6
- Youth examination J1: ages 12 to 14.
This means: The costs are always covered. It’s different for U10, U11, and J2. These are not standard services of statutory health insurance.
- U10: ages 7 to 8
- U11: ages 9 to 10
- J2: ages 16 to 17
However, many health insurance companies (such as TK, AOK, KKH) cover these examinations as additional services outside of standard care.1 The billing for these examinations does not automatically go through every insurance company, and not every pediatric practice offers the examination. Therefore, it is advisable to check with your own health insurance and pediatric practice beforehand to see if these examinations can be performed and if the insurance covers them.
Also covered: Blood tests and screenings for newborns
In addition to the U-examinations, statutory health insurance also covers other important screenings in the first days of life. This includes the expanded newborn screening via blood test. These are used to detect congenital metabolic defects, hormonal disorders, and defects of the blood, immune, and neuromuscular systems as early as possible. A screening for cystic fibrosis is also included. Also covered by insurance are screenings for severe congenital heart defects using pulse oximetry and the newborn hearing screening.2
According to Dr. Ronny Jung, pediatrician and board member of the German Society for Pediatric and Adolescent Medicine (DGKJ), these examinations are extremely important. “If abnormalities are detected earlier and interventions are made earlier, it can help prevent some disorders from developing and better ensure healthy development,” the expert explains to FITBOOK.
Often forgotten: It’s not over after U9
The participation rates in U-examinations in Germany are very high, at over 95 to 99 percent. This is according to a report by the Robert Koch Institute.3 However, many parents are not aware of the J-examinations. At least the numbers suggest so. “That’s where it falls apart,” complains pediatrician Jung. “J1, we’re at about 30 percent, and J2, only 6 percent,” he says. “Many parents may feel that the child is now out of the woods. But that’s not the case. There are other developmental issues. These include physical development during puberty, but also the psychological side: media, bullying, school performance, addiction.”
Dr. Jung sees a problem in the current system of insurance benefits for children in the time gap between U9 and J1, that is, between ages six and twelve. “A lot happens during this time,” the doctor emphasizes. U10 and U11, which fall into this period, are only additional services outside of standard care. The Joint Federal Committee and professional politics have been discussing and debating for several years how best to close this preventive care gap.4
Preventive care is not just diagnostics
Preventive care in the examinations classified under U and J is not just about weighing, measuring, and taking blood, Dr. Jung emphasizes. “The U-examinations are also important for parents because they can address questions they have according to the different developmental phases of the child.” It’s about closely monitoring the child’s development, advising on all areas of preventive care, and properly steering preventive care, such as through early intervention and therapy.
Missed a standard examination? Don’t worry, just catch up
If you missed or skipped one of the standard examinations, you don’t have to worry about getting into trouble for a late visit to the practice. “We don’t make anyone feel guilty,” promises Dr. Jung. Statutory health insurance usually covers the U-examination even if the official period is slightly exceeded. For most U-examinations, there are set “tolerance periods” (often several weeks to months). Within this time frame, you can catch up on the examination, and the insurance will cover it.5 But even if an examination can no longer be billed as a regular preventive service at the expense of the insurance, it is still medically sensible. “Then the examination is conducted as a preventive measure, with the same content,” says Dr. Jung. His tip: To make it easier to reliably keep appointments, many practices offer reminder systems for parents via special apps or SMS.
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Dental examinations as an important part of preventive care
Not only the pediatric practice plays a role in preventive care. Dental care is also part of the service catalog, and it starts very early. Between the 6th and 34th month of life, statutory health insurance covers three dental early detection examinations for dental, oral, and jaw diseases. This includes examining the child, but also advising the parents and providing guidance on daily tooth brushing. Additionally, during this period, there is an entitlement to fluoride varnish for enamel hardening twice per calendar half-year.6
From the 34th month of life to the sixth year, three more dental early detection examinations follow, as well as an entitlement to fluoridation. And even after that, preventive care doesn’t end: Between ages six and 18, there are annual measures of dental individual prophylaxis to prevent dental diseases. From age 12, these appointments are also documented in the bonus booklet, which is important later for higher subsidies for dental prostheses.7
Pediatrician Dr. Anne Heinz explains in the FITBOOK video what is behind chalk teeth:
Vaccinations: “Life festival” thanks to immunization
Vaccination is also a topic during the various U and J examinations: The pediatrician informs about the vaccinations covered by statutory health insurance and records the administered vaccinations in the child’s vaccination card.
The standard vaccinations recommended by the Standing Committee on Vaccination (STIKO) for children and adolescents include vaccinations against rotaviruses, diphtheria, tetanus, whooping cough (pertussis), polio (poliomyelitis), Haemophilus influenzae type b (Hib), hepatitis B, meningococcal B, meningococcal ACWY, pneumococci, measles, mumps, rubella, chickenpox (varicella), and human papillomaviruses (HPV). In infancy, there is also preventive care against RSV infections.8 For some of these vaccinations, there are combination vaccines. This means that doctors can vaccinate against several diseases with one injection. The exact timing can change due to updated recommendations. Therefore, the current vaccination schedule is the best guide for planning the appointments precisely.