Health bonus in private health insurance: who gets it and how it works

The health bonus is a component of some private health insurance plans. The insurer pays an annual bonus if the insured person proves defined prevention criteria. The logic behind it is actuarial. People who go to check-ups regularly, exercise and do not smoke cause lower treatment costs on statistical average. The insurer passes part of these savings back as a bonus.

There is no legal entitlement, and far from every plan has this component. Whether a bonus is paid, and how much, is set out only in the plan conditions. The bonus programs of the statutory health insurance funds work in a similar way, but they are a separate system with their own rules and are not meant here.

The bonus and health programs work with similar components (values from experience, with no claim for any single plan):

You usually have to provide proof every year, often with a deadline at the end of the insurance year. If you miss the deadline, you lose the bonus for the whole year.

From experience, the range is €50 to €500 per year. Many plans scale the bonus by the number of criteria you meet. If you only prove the check-up, you receive the base amount. If you meet all components, you receive the maximum. Payment is usually made in the following year, after the insurer has checked the proof you submitted.

If you stay with all components consistently over the years, you can collect a four-digit amount over a decade, with documented prevention as a side effect. To be honest about its place, measured against an annual premium of several thousand euros, the bonus is a bonus, not a premium lever. The big levers for the premium are the choice of plan and the deductible.

Both components pay money back, but for different behavior. The no-claims refund rewards you for submitting no bills during the year, regardless of your lifestyle. The health bonus rewards documented prevention, regardless of whether you used benefits.

This makes the combination interesting. In well-designed plans, the check-up does not put the no-claims refund at risk, because preventive services are expressly excluded there. If you have both components, check exactly this exception in the conditions. Otherwise the check-up appointment ends up costing you the higher refund.

In our advice work, we see two extremes with this component. Some prospective clients overestimate the bonus and almost choose the wrong plan because of it. Others give it away for years because the way to provide proof is too much effort for them.

We recommend that you do not count the health bonus as a premium reduction, but as a bonus for the prevention you actually do. Then your expectations fit, and the administrative effort does not feel like lost time. As a criterion for choosing a plan, it belongs at the end of the list, behind the scope of benefits, premium stability and the chances of acceptance.

Only the name. In the reform debate, the German term for health bonus describes a uniform contribution to the statutory fund that does not depend on income. Supporters hope for more competition and lower non-wage labor costs. Critics see low earners at a disadvantage. With the Zusatzbeitrag, which does not depend on income, one element of this idea already exists. The plan component of private health insurance has nothing to do with it.

It can reduce the premiums you can deduct as provision expenses, similar to a no-claims refund. The exact treatment depends on the individual case. This does not replace tax advice. A tax advisor is responsible for the individual assessment.

In many plans it does not, because preventive services are excluded from the claim-free rule. But this is not written in every set of conditions. Check the clause before you submit the bill.

Yes, if the component is designed as a voluntary extra benefit. Bonuses that are firmly part of the plan, on the other hand, cannot be ended by the insurer on its own. The difference is set out in the conditions and is a good criterion to check before you sign.