Frankfurt Nine euros for a corona vaccination, blood pressure and weight in the normal range plus membership in the fitness studio are 30 euros. These are examples from the Barmer bonus program.
Most statutory health insurances offer their members a financial incentive for health-conscious behavior. In some cases, the most ardent insured can reap more than 300 euros in bonus payments.
In addition, some health insurance funds pay their members a dividend in good years in which they have generated a premium surplus. But be careful – the tax office is also interested in all of these payments. They may have to be taxed.
In principle, taxpayers can state their health insurance contributions – whether statutory or private – in their tax return as special expenses. This reduces the taxable income and thus the tax burden. However, a premium refund must be deducted from the special expenses, which reduces the tax burden accordingly.
Crucial difference: premium reimbursement or reimbursement of costs
The Federal Fiscal Court had already decided in 2020 (XR 16/18 and XR 30/18) that from a tax perspective, it depends on whether the insured person had a financial outlay to receive the bonus.
This means that if the insured person did not have to spend any money in order to receive the premium, this is a premium refund. The special expenses must therefore be reduced by the premium.
If, on the other hand, the insured has incurred an expense beforehand, the costs will be reimbursed. This does not reduce the special expenses.
Since then, taxpayers have been able to invoke these rulings and object to their tax assessment if the tax offices had not yet made the distinction. With the BMF letter, the tax offices are now instructed to implement the BFH ruling in exactly the same way.
For tax purposes, dividends are considered to be the amount paid back
A so-called premium refund exists if the health insurance company grants a premium for the insured person to take advantage of health measures within the basic health insurance cover. This could be cancer screening, vaccinations or dental check-ups. Health-conscious behavior such as a healthy body weight or the non-smoking status are also included.
All of these cases have in common that the insured person has no financial expense. This means that a granted bonus must be deducted from the health insurance contributions paid for special expenses.
The same applies if the health insurance company has made a profit at the end of the year and pays a dividend to its members. “In terms of tax law, the dividend is considered to be a paid back contribution,” emphasizes the United Wage Tax Aid (VLH).
150 euros allowance
The first 150 euros of the bonus payments are classified as benefits of the statutory health insurance for reasons of simplification, so that there is no reduction in the special expenses deduction in this amount, the BMF has now announced. “Only if the bonus payments exceed this amount is there a premium refund in the amount of the excess amount, which reduces the deduction of special expenses,” explains Jana Bauer from the Federal Association of Wage Tax Assistance Associations (BVL).
In contrast, it is a reimbursement of costs when the health insurance pays out a bonus for the fact that the insured person takes health measures outside of the basic health insurance coverage.
This can be, for example, a glaucoma examination, a PSA test, an osteopathy treatment or a professional teeth cleaning. Health-promoting measures such as membership in the fitness studio or sports club can also be rewarded.
The insured person has his own financial expense, which the health insurance company cushions with the bonus. In the tax return, the special expenses do not have to be reduced by this bonus. Good to know: “A flat-rate bonus does not have to exactly cover the costs actually incurred,” writes the BMF.
The health insurances must show their bonus payments for a premium reimbursement and a reimbursement of costs separately. The Techniker Krankenkasse, for example, writes on its website that it sends the tax-relevant premium refund directly to the tax office. This means that taxpayers must also correctly state the special expenses in their tax return, otherwise they risk proceedings for tax evasion.
Treatment costs as an exceptional burden
Most of the time, the health insurance bonus does not cover the expenses incurred. Then the tax authorities can help. While the health insurance contributions are part of the special expenses in the tax return, many other self-borne health costs can be recognized there as an extraordinary burden. Exceptional expenses also reduce the taxable income and thus the tax burden – provided that a reasonable personal contribution has been exceeded.
Costs for osteopathy, physiotherapy or medical massages, for example, are recognized as extraordinary burdens. Taxpayers can therefore offset these costs against tax.
It is only important that you deduct any reimbursement of costs by the health insurance company from the amount in the tax return and only state the expenses you actually incurred.
Expressed in numbers
An example: a taxpayer pays 900 euros in health insurance contributions per year. She receives a bonus of 100 euros for vaccinations and regular check-ups. She also goes to the osteopath three times. Your cash register will reimburse 120 euros of the invoice amounting to 270 euros.
In the tax return, she must deduct the premium reimbursement from her health insurance company from the contributions. As a result, she spends 900 euros minus 100 euros. 800 euros are therefore incurred as a special expense. In addition, it can claim 270 less EUR 120, i.e. EUR 150, as an extraordinary burden.
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