Employer certificate: what it is for

The certificate has two functions. It proves that the duty to have health insurance is met through a private contract, and it confirms the amount of the premium. Together, both are the condition for the employer contribution under § 257 SGB V. The employer pays half of the premium, but no more than the amount it would also have to pay for an employee with statutory health insurance.

Since the turn of the year, the proof has in principle been digital. The private health insurer sends the relevant premium data electronically to the Federal Central Tax Office. From there, it is made available to the employer for retrieval as part of the ELStAM procedure. As a rule, employees therefore no longer have to request a paper certificate from the insurer every year and hand it in to the employer. Premium changes are also in principle reported electronically.

One thing still matters: after the start of the contract, premium adjustments, plan changes or changes in the Pflegepflichtversicherung (i)PflegepflichtversicherungCompulsory long-term care insurance. Everyone with health insurance in Germany must have it, privately insured people through their private insurer., you should check your next payslip. If the employer contribution is missing or too low, you should inform the payroll department early so that the stored ELStAM data can be checked.

The ELStAM procedure transmits the data that is relevant for tax purposes and for calculating the employer contribution. This includes in particular the type of insurance and the amount of the premiums for private health insurance and private Pflegepflichtversicherung (i). The data covers both the ongoing premiums and changes such as premium adjustments, plan changes, start of cover or end of cover.

It is important that no health data, diagnoses or information about submitted bills are transmitted. Plan details or benefits are not the focus either. The only thing that matters for the employer is which premium amount may be taken into account for payroll. With the transmitted premium data, you can easily check on your payslip whether the full employer contribution has been taken into account.

Since the turn of the year, the central link between private health insurance and payroll is no longer the paper certificate but the electronic data transmission through ELStAM. In principle, the employer pays half of the actual premium for private health insurance and Pflegepflichtversicherung (i), but no more than the statutory maximum employer contribution. If the private premium is higher, the employee pays the share above it personally.

Premiums for privately insured family members can also be included in the calculation of the employer contribution, as long as these family members would in principle be eligible for family insurance in statutory insurance. This can be especially important for spouses without relevant income of their own or for children. Overall, however, the employer contribution remains limited to the statutory maximum amount.

If the data was transmitted incorrectly, the employee asks the insurer directly to correct the data and send it again. If the data arrives late, the employer can only grant the employer contribution once it is available. If the data is missing completely, the employer contribution is not paid at all until it is provided. This can cause noticeable financial disadvantages, which is why it always pays to clarify things in good time.