No reduction for subsidies from a bonus programme
Statutory health insurance funds often offer their customers bonus programmes for health-conscious behaviour under section 65a SGB V and pay cash bonuses for this. The health insurance funds can decide for themselves which services are rewarded, e.g. preventive medical check-ups, vaccinations, healthy eating or sporting activities. Such bonus payments to promote health-conscious behaviour are not a refund of contributions. Therefore, the health insurance contributions deductible as special expenses are not reduced (BFH ruling of 1.6.2016, X R 17/15; BFH ruling of 6.5.2020, X R 16/18). However, there are still services provided by statutory health insurance funds that are considered "genuine" refunds of contributions and therefore reduce the deduction for special expenses.
The Federal Ministry of Finance has recently commented again on the distinction between bonus payments and refunds of contributions (BMF letter of 16.12.2021, BStBl 2022 I p. 155). According to this, the following applies, among other things:
Refunds of contributions that reduce the deduction for special expenses also include premium payments under section 53 SGB V. These are, for example, premiums for insured persons who participate in general practitioner-centred care. If the benefit is granted in the form of bonus points, these must be converted into euros and reported as a refund of contributions. Bonuses for family-insured participants in bonus programmes are to be attributed to the main insured person.
A refund of contributions also occurs if a bonus from the statutory health insurance relates to a measure covered by basic health insurance (in particular health prevention or protection measures, e.g. for the early detection of certain diseases) or is paid for behaviour that does not incur costs (e.g. non-smoking status, healthy body weight).
If the statutory health insurance reimburses or rewards costs for health measures under a bonus programme according to section 65a SGB V that are not included in the regular insurance coverage of basic health insurance (e.g. osteopathy treatment) or serve to promote health-conscious behaviour (e.g. membership in a sports club or gym) and have been or are privately financed by the insured, this is not a refund of contributions. The health insurance contributions deductible as special expenses are therefore not to be reduced by the amount of the cost reimbursement or the bonus attributable to it. A flat-rate bonus does not have to exactly cover the actual costs incurred or to be incurred.
For the sake of simplicity, it may be assumed that bonus payments made on the basis of section 65a SGB V do not reduce the deduction for special expenses up to an amount of 150 EUR per insured person. If the bonus payments exceed this amount, the excess amount is considered a refund of contributions, which reduces the deduction for special expenses. The taxpayer is free to provide evidence that no refund of contributions has been made if bonus payments exceed 150 EUR. This means they must demonstrate that the bonus payments under section 65a SGB V were made to promote health-conscious behaviour. This regulation applies in all open cases and for payments made up to 31 December 2023.
In fact, statutory health insurance funds are required to check whether a payment that is neutral or reduces special expenses has been granted. They must inform the tax authorities electronically, and the corresponding data is then automatically included in the respective tax assessment. However, experience shows that the programme-controlled notifications are not always correct. And the current non-objection limit of 150 Euro is likely to have been ignored in many cases. Therefore, check whether the correct values have been applied in your tax assessment.
Note: At the end of 2020, the Federal Fiscal Court ruled that bonus payments from private health insurance "to promote cost-conscious behaviour" are to be regarded as a refund of contributions and therefore reduce the deductible special expenses if the bonuses are paid regardless of whether the policyholder has incurred financial health expenses (BFH ruling of 16.12.2020, X R 31/19).
(2023): No reduction for subsidies from a bonus programme
Which health and nursing insurance contributions can I claim?
You can enter your full health and nursing insurance contributions for basic cover as special expenses in your tax return. The tax office deducts a flat rate of four per cent for sickness benefit from the contributions paid to statutory health insurance.
For those privately insured: Costs for health and nursing insurance are only recognised up to the basic contribution of the private health insurance. Optional benefits, such as treatment by the head physician or a two-bed room in hospital, are considered under "other insurance contributions" if there is still room within the deductible maximum amount.
If you have a more comprehensive contract, the private health insurance will determine the exact proportion of basic cover. If your health insurance contributions do not exceed the maximum amount of 1.900 Euro (2.800 Euro for self-employed), you can claim contributions for other insurances. Favourable contributions include those for unemployment insurance, additional health or nursing insurance, private disability insurance, accident or liability insurance, or term life insurance. Endowment and pension insurance policies can be considered as special expenses if the policies were taken out before 2005.
A married couple pays a total of 4.600 Euro in contributions for health and nursing insurance in a year without sickness benefit. This means the contributions exceed the joint maximum amount of 3.800 Euro (twice 1.900 Euro). Nevertheless, they are deductible as special expenses to this extent, but further insurance contributions, such as accident or motor vehicle liability insurance, can no longer be deducted.
Since the general contribution rate for those with statutory insurance covers sickness benefit, contributions are reduced by 4% on a flat-rate basis. The reduction only applies if there is an entitlement to sickness benefit in the event of illness. The reduction is made by the tax office. Until 2014, the reduction did not apply to the income-independent additional contribution. Since 2015, the following legal situation applies: The newly designed fund-specific income-dependent additional contribution is now considered an integral part of the health insurance contribution and is therefore included in the assessment basis for calculating the four per cent reduction amount. The contribution is no longer differentiated into a basic contribution and the additional contribution.
(2023): Which health and nursing insurance contributions can I claim?
