Act to Strengthen Competition in Statutory Health Insurance: background and effects

The Act to Strengthen Competition in Statutory Health Insurance came into force on April 1, 2007 and fundamentally reformed statutory health insurance. Until then, each fund had its own contribution rate, and the rates differed widely from fund to fund.

The act set a uniform general contribution rate for all of Germany and moved competition to the Zusatzbeitrag (i). Its core part, the Health Fund together with the uniform contribution rate, took effect on January 1, 2009. As a side effect, the act introduced compulsory health insurance for everyone resident in Germany, which had not existed before.

At its core are four changes:

• Since then, the Health Fund has pooled all contributions of insured people and distributes the money to the statutory health insurance funds according to a fixed procedure.
• The uniform general contribution rate, today 14.6 percent under § 243 SGB V, replaced the rates that used to differ.
• The Zusatzbeitrag (i) under § 242 SGB V became the element of competition specific to each fund, and it is where the funds differ today.
• Since then, compulsory health insurance has covered everyone resident in Germany, whether they have statutory or private insurance.

The Health Fund created a central body that collects all contributions of people with statutory health insurance. The money is not distributed to the individual funds according to the number of their members, but according to the morbidity-based risk structure compensation scheme. Funds with older or sicker insured people receive higher allocations.

This procedure is meant to prevent a fund from gaining an advantage by selecting healthier members. For insured people, it means that their contribution depends on the Zusatzbeitrag (i) of their fund and not on the burden of illness of the other members.

Although the act concerned statutory insurance, it also changed private health insurance. In 2009, the Basistarif replaced the former Standardtarif (i)StandardtarifA statutory social plan for people who have been privately insured for many years. Its benefits are close to statutory health insurance, and its premium is capped.. Since then, it has offered privately insured people benefits at the level of statutory insurance, and its premium is capped at the statutory maximum contribution.

At the same time, the transfer of ageing reserves was regulated. Since then, anyone who changes private insurer can take with them the part of their reserves calculated in the Basistarif (i)BasistarifA statutory social plan that every private insurer must offer. Its benefits are comparable to statutory health insurance, and its premium is capped at the statutory maximum contribution.More about Basistarif →. Both changes noticeably strengthened the position of privately insured people.

In 2026, the average additional contribution charged is around 2.9 percent, and the range among large funds runs from 2.18 to 4.39 percent. What this means on an income at the Beitragsbemessungsgrenze of €5,812.50:

• cheapest large fund: lowest Zusatzbeitrag (i)
• most expensive large fund: over €120 more per month

The act made exactly this lever possible. You can change fund with notice to the end of the month after next, and after a contribution increase even through the special right of termination.

We have supported more than 5,000 applications with health questions. The act rarely plays an explicit role in direct advice, but its effect shows every day. If you understand the rules of the additional contribution, you can actively use competition within statutory insurance.

We recommend that you do not see the reform of 2007 as a historical footnote, but as a current rule of the game. It determines how much competition is possible in statutory insurance and how much room remains for optimization within your statutory health insurance fund.

No. It made contribution rates uniform and allowed competition through the Zusatzbeitrag (i), but it did not bring a cost reduction. On the contrary, the maximum contribution in statutory health insurance has risen considerably:

Yes. Since the act, everyone resident in Germany must have health insurance, whichever system they are in. If you can no longer pay your private premium, you are placed in the Notlagentarif and are not automatically taken over by a statutory health insurance fund.