No reduction for subsidies from a bonus programme
Many statutory health insurance companies offer bonus programmes under § 65a SGB V to promote health-conscious behaviour – for example, for vaccinations, preventive check-ups or sporting activities.
Such bonus payments are not genuine premium refunds and therefore do not reduce the amount of your health insurance contributions deductible as special expenses. The Federal Fiscal Court has confirmed this several times (e.g. rulings of 01.06.2016 and 06.05.2020).
What counts as health-conscious behaviour?
Examples of measures promoted by health insurance companies as part of a bonus programme:
- Preventive check-ups (e.g. cancer screening)
- Vaccinations
- Health courses or sports programmes
- Nutritional advice
Such payments are not taken into account for the deduction of special expenses – they do not lead to a reduction.
Difference between bonus payments and premium refunds
The Federal Ministry of Finance (BMF) clarified in the BMF letter of 16.12.2021 which payments from the health insurance company do reduce the deduction of special expenses. These include:
- Premiums under § 53 SGB V: Payments for programmes such as general practitioner-centred care are considered premium refunds.
- Bonus points: If bonus points are converted into cash, they are also considered refunds.
- Family members: Bonus payments for family members are attributed to the main insured person.
- Basic health insurance: Payments for measures covered by basic protection (e.g. simple preventive check-ups) are considered refunds.
- Privately funded health measures: For self-paid services (e.g. osteopathy or sports club), bonus payments are not refunds and do not reduce the deduction.
Simplification rule: Up to 150 Euro tax-free
Bonus payments of up to 150 Euro per year and insured person are generally not considered premium refunds. You do not need to prove what the payment was for.
Important: If the 150 Euro limit is exceeded, you must prove that it is not a refund – otherwise the excess amount will be deducted from the special expenses.
This rule was originally valid until the end of 2023, then extended to 2024 (see BMF letter of 28.12.2023) and is permanently regulated by law from 01.01.2025 (§ 10 para. 2b EStG).
What applies from 2025?
Since 01.01.2025, the 150 Euro simplification rule has been anchored in the Income Tax Act. This means:
- Bonus payments up to 150 Euro per year remain tax-free.
- Only the amount exceeding this is considered a premium refund.
- You can prove that the excess amount is also not a refund.
This regulation was adopted with the Annual Tax Act 2024 and is now permanently valid.
Check your tax assessments!
The health insurance companies electronically transmit to the tax authorities whether a payment reduces the deduction of special expenses. This data is not always correct. Therefore, you should check whether an unjustified reduction has been made in your tax assessment.
What applies to private health insurance?
For private health insurance companies, bonus payments are usually considered premium refunds – especially if you had no specific costs. The Federal Fiscal Court decided this in 2020.
No reduction for subsidies from a bonus programme
Which health and nursing care insurance contributions are deductible?
Contributions to health and nursing care insurance can be deducted as special expenses in the tax return – but only for the so-called basic cover.
For those with statutory insurance, the tax office reduces the contribution by 4% as this portion covers sickness benefit. The reduction is applied only if there is an entitlement to sickness benefit.
Privately insured individuals can also only deduct the basic contribution. Optional benefits (e.g. treatment by a head physician, two-bed room) are not included. They are only deductible as other pension expenses if the maximum amount has not been exhausted.
Maximum amounts for other pension expenses:
- 1.900 Euro per year for employees and pensioners
- 2.800 Euro per year for self-employed
As long as these amounts are not exceeded, other insurances can also be claimed – e.g. unemployment, liability, accident or disability insurance.
Example: A married couple pays a total of 4.600 Euro in contributions to health and nursing care insurance. As this is basic cover, the full contributions are deductible – even if they exceed the joint maximum amount of 3.800 Euro (2 × 1.900 Euro). Further insurances can then no longer be considered.
Which health and nursing care insurance contributions are deductible?
