Germany's Check-up 35: what statutory insurance tests – and what it doesn't

From their 35th birthday, everyone with German statutory health insurance is entitled to a health check every three years. Known as the "Check-up 35" (officially the Gesundheitsuntersuchung), it is regulated in detail: what the family doctor asks, measures and sends to the lab is set by a directive of the Federal Joint Committee (G-BA), the body that decides what statutory health insurance (GKV) pays for. Here is what it contains, what it leaves out, how it fits the evidence, and why its future is now under review.

Who is eligible

Between their 18th and 35th birthdays, insured adults may have the check-up once; from 35 onwards, every three years. After a check-up, no further one is due in the following two calendar years. It costs you nothing.

What is included

• History: personal, family and social history, aimed at a risk profile, including cancers in the family. Where medically indicated, cardiovascular risk should be estimated with a risk chart; which one is not specified.
• Physical examination ("full status"): including heart, lungs, neck arteries, abdomen, foot pulses, skin, musculoskeletal and nervous system, height, weight and blood pressure.
• Vaccination status check, with advice to catch up on missing vaccines.
• Blood (routinely from 35; between 18 and 34 only with a risk profile such as obesity, high blood pressure or a relevant family history): a lipid profile of total, LDL and HDL cholesterol and triglycerides, plus fasting glucose.
• Urine dipstick (from 35 only): protein, glucose, red and white blood cells, nitrite.
• One-time screening for hepatitis B and C from 35: a test for hepatitis B surface antigen and for hepatitis C antibodies. If either is positive, the same sample is tested for viral genetic material. People vaccinated against hepatitis B do not need the B test.
• Counselling: results, motivational counselling on smoking, exercise and diet, a pointer to cancer screening and, where useful, a written prevention recommendation.

What is not included

Neither the directive nor the information sheet of the National Association of Statutory Health Insurance Physicians (KBV) provides for ApoB or lipoprotein(a), HbA1c (long-term blood sugar), creatinine and eGFR (estimated kidney function), the urine albumin-to-creatinine ratio (a sensitive marker of kidney damage; the dipstick only picks up larger amounts of protein), an ECG, ultrasound, thyroid tests or a blood count. The check-up is a population-wide net, not a personal work-up.

What the evidence says

The best evidence on general health checks is sobering. A Cochrane review pooled 17 randomised trials, 15 of which reported outcomes for 251,891 adults. General checks did not change total mortality (risk ratio 1.00; 95% confidence interval 0.97–1.03), cancer mortality (1.01) or cardiovascular mortality (1.05). The authors concluded that general health checks are unlikely to be beneficial. See The annual physical is dead and Why Cochrane says standard check-ups don't work.

That does not make the German check-up worthless. Its core parts (blood pressure, lipids, glucose, smoking, vaccination) target risks that are easy to treat. The value appears only when an abnormal result leads to action, and a single surgery reading is often not enough; see Blood pressure: the most important number you can measure at home.

The hepatitis test has its own rationale: chronic hepatitis B and C often cause no symptoms for years and can lead to cirrhosis, liver cancer and, in the worst case, liver transplantation; early antiviral treatment can prevent this.

The US Preventive Services Task Force (USPSTF, US) advises against a screening ECG in symptom-free low-risk adults and finds the evidence insufficient for higher-risk adults, so its absence is reasonable.

What you can ask your GP to add

The real line runs not between "in the check-up" and "private extras" but between screening without a reason and investigation with a reason. Under German social law (§ 27 SGB V), insured people are entitled to care needed to detect a disease, so tests with a medical reason are normal GKV care. Without one, they are an IGeL ("individual health service"), which you pay yourself, under a written contract and billed according to the official fee schedule for doctors (GOÄ).

The check-up within German screening

Cancer screening is governed by separate directives. The statutory offer as of October 2026:

• From 18: one check-up up to 34; from 35 every three years, plus hepatitis B and C once.
• Women from 20: annual genital examination; ages 20–34 an annual cervical smear (Pap test), from 35 a combined smear and HPV test every three years.
• Women from 30: additionally, an annual breast examination by hand.
• From 35: skin cancer screening every two years (dermatoscopy).
• Men from 45: annual examination of prostate and external genitals by touch.
• From 50: bowel cancer screening for women and men: a stool test every two years or colonoscopy, with at most two screening colonoscopies (colonoscopy).
• Women 50–75: the mammography screening programme every two years; extension to 45–49 decided, expected from August 2027.
• Ages 50–75: annual low-dose lung CT for heavy current and former smokers meeting set criteria (since April 2026).
• Men from 65: a one-time ultrasound for abdominal aortic aneurysm.

The check-up under review

German law (§ 25 SGB V) now requires the G-BA to review the check-up against current evidence and decide on changes by 31 December 2027. On 15 October 2026 the G-BA opened that review: age limits, target groups, frequency, content, differences between the sexes and target diseases, with a possible focus on cardiovascular disease. It has asked the independent institute IQWiG to assess a risk-adapted check-up, the urine dipstick and a one-time HIV test. The outcome is open.

What this means for you

• Use the appointment, but as a conversation about your risks, not a full service.
• Bring: your vaccination record, a list of medications, home blood pressure readings and your family history (early heart attacks or strokes, cancer, kidney disease).
• Ask: "What is my cardiovascular risk over the next ten years?" "Do I have a reason for kidney tests or Lp(a)?" "Which cancer screening am I due for now?"
• When offered paid extras: take time to decide, and ask how an abnormal result would change your care.

This article is general information and not individual medical advice. Decisions about tests and treatment belong in a conversation with your own physician.