(2022)
No reduction due to 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 examinations, 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 policyholders 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 policyholder.
A refund of contributions also exists 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 scope 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 simplification purposes, it can 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 for bonus payments of more than 150 EUR that no refund of contributions has taken place. 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 not to have been observed 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).
