No-claims refund in private health insurance: requirements, amount and claim-free years

The no-claims refund is a plan component of private health insurance. If the insured person makes no claims for a full calendar year, the insurer pays back part of the premium in the following year. The reference point is usually the main health insurance premium. Premium relief plans and the Pflegepflichtversicherung (i)PflegepflichtversicherungCompulsory long-term care insurance. Everyone with health insurance in Germany must have it, privately insured people through their private insurer. are excluded.

Economically, the bonus is financed from two sources: from the guarantee in the plan and from the insurer's surpluses, which flow back to the insured through the reserve for no-claims refunds. This is why both forms exist: scales with a firm promise and performance-based payments decided anew each year.

The no-claims refund usually follows a scale. The more claim-free years in a row, the higher the bonus (values from experience):

Across all plans, the range is one to six monthly premiums. Payment is usually made in the third quarter of the following year. In most plans, a single submitted bill resets the scale to zero, and the build-up starts again from the beginning. This is exactly what makes the decision on small bills so valuable.

Every reimbursed service puts the bonus for claim-free years at risk: the doctor's bill, the submitted prescription, the treatment by a non-medical practitioner. Many plans, however, exclude exactly the services that are in everyone's health interest. Check-ups and vaccinations do not count as a claim there.

This exception is not written in every set of conditions. If your plan has it, you can go for check-ups without risking the bonus. If it does not, you pay for early detection indirectly through the refund. So look at the plan conditions before your first doctor's appointment of the year, not at the end of the year.

The rule of thumb is simple. If the total of all bills of the year is below the expected bonus, paying yourself is worth it. If it is above, you submit. If your plan has a deductible, you calculate in two steps. First weigh the total of the bills against the deductible, because up to its amount there would be no reimbursement anyway. Then weigh the rest above it against the bonus. If you expect a bonus of three monthly premiums, you can pay bills up to just below this amount yourself and be better off than if you submitted them.

One note on tax belongs here, without replacing tax advice. The refund reduces the premiums you can deduct as special expenses in the year it is paid out. With a high tax rate, the net advantage is therefore smaller than the gross bonus.

In our advice work, we see the most confusion among insured people who have both a deductible and a bonus rule in their plan and look at the two thresholds separately.

For plans with a deductible and a bonus rule, we recommend that you calculate the threshold as one combined figure. The deductible applies first, the bonus only after it. If you do not calculate this properly, you give away part of the benefit. Worked through once a year, it is a quarter of an hour of work that is often worth several hundred euros.

Only if you submit the bill. You can also pay for emergency treatment yourself if the total is below the bonus. The doctor does not report the treatment itself to the insurer. All that matters is whether you submit it.

Yes. The refund belongs to the policyholder, so to you, not to the employer. Two things are still worth considering. It reduces the premiums of the payout year that you can deduct as provision expenses. And you pay bills you hold back on your own, while the employer only contributes to the ongoing premium.

Not the guaranteed part, because it is part of the contract. The insurer, on the other hand, decides on performance-based refunds anew each year. In years with poor business results, they can fall or be dropped.