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BSG: No coverage of costs for pre-implantation genetic diagnosis (PGD)

In its ruling of 27 August 2025 (B 1 KR 59/23 B) confirms that statutory health insurance is a Pre-implantation genetic diagnosis (PGD) as part of artificial insemination not must assume – even if one parent has a significant genetic risk (in this case: Robertsonian translocation).

Background

A married couple applied for artificial insemination in accordance with Section 27a of the German Social Code, Book V (SGB V), including PGD. The health insurance fund refused. The treatment was carried out privately, after which the couple sought reimbursement of costs in accordance with Section 13(4) SGB V. The Social Court and the Regional Social Court dismissed the action; the Federal Social Court did not allow an appeal.

Key messages from the BSG

  • PID is not a fertility treatment service.
    Section 27a of SGB V covers only measures to induce pregnancy in cases of infertility. PGD, on the other hand, serves to select genetically suitable embryos.
  • No entitlement under Section 27 of the German Social Code, Book V (SGB V).
    Genetic conditions such as Robertsonian translocation are not treatable diseases. PGD cannot treat them.
  • Access to Section 27a SGB V only in cases of actual infertility.
    As the couple was fundamentally capable of conceiving naturally, there was no entitlement to benefits.

The Senate considers a broader interpretation of Section 27a SGB V to be conceivable in principle, but did not need to examine this in depth for formal reasons.

practical relevance

PID and polar body diagnosis remain unchanged. self-pay services.
Although there is a right to funding for IVF/ICSI in cases of proven infertility, further diagnostic steps to minimise risk are not covered. As a result, many couples resort to treatment abroad, where PGD is regularly part of the medical standard.

assessment

The decision confirms the restrictive case law of the Federal Social Court and highlights a continuing regulatory gap between medical necessity and legal service limitations. Against this background, legislative clarification or reassessment by the courts appears necessary.

BSG: No coverage of PGD costs by statutory health insurance

The Federal Social Court (BSG) has 27 August 2025 (B 1 KR 59/23 B) decided that statutory health insurance must provide Pre-implantation genetic diagnosis (PGD) does not have to pay even if the parents have a significant genetic risk – such as Robertson translocation. PID therefore remains exclusively a self-pay service or must be used abroad.

The case in brief

A married couple applied for artificial insemination in accordance with Section 27a of the German Social Code, Book V (SGB V), including PGD. The health insurance fund refused, but the couple had the treatment carried out anyway and demanded reimbursement of the costs. All instances – up to the Federal Social Court (BSG) – rejected the application.

Why the BSG rejects PGD

  • Section 27a of SGB V applies only in cases of infertility.
    However, the couple were medically capable of conceiving a child naturally.
  • PID is not used to induce pregnancy., but rather the selection of genetically suitable embryos. It is therefore not covered by statutory health insurance.
  • Section 27 SGB V also does not apply., as genetic predispositions such as a Robertsonian translocation do not constitute a treatable disease – and PGD cannot treat them either.

Although the BSG suggests that a broader interpretation of Section 27a SGB V would be possible, it does not address this issue further.

Practical consequences

  • IVF/ICSI will continue to be covered in cases of infertility.
  • PID and polar body diagnosis remain excluded – even in cases of high risk of severe genetic damage.
  • Many couples therefore resort to foreign treatments where PID is considered a regular part of IVF.

need for reform

The decision highlights a continuing regulatory gap:
The statutory health insurance system finances artificial insemination, but not the diagnostics required for this purpose if genetic risks are known. A constitutional extension of Section 27a of the German Social Code, Book V (SGB V) or a legislative clarification would therefore be urgently needed.

Dr Marko Oldenburger

Dr Oldenburger advises and represents individuals, different and same-sex couples on the path to fertility fulfilment, including surrogacy and international adoptions. Send him an e-mail at (oldenburger@schneiderstein.de) or use our Contact form.
By the way: We offer country-specific package prices for surrogacy and international adoption procedures from A-Z (fixed prices) or modular fees depending on your service requirements. This means that your expenses can be calculated from the outset. Further information on the desire to have children here.