HR-Glossar
Zusatzbeitrag zur Krankenversicherung (supplementary health insurance contribution)
How the fund-specific supplementary contribution is levied and borne, what the average rate is for and when a special right to leave arises.
1. What is Zusatzbeitrag zur Krankenversicherung (supplementary health insurance contribution)?
The supplementary contribution is the part of the health insurance contribution that each health insurance fund sets itself. It comes alongside the general contribution rate, which is uniform nationwide, and is levied as a percentage of income subject to contributions. The legal basis is Section 242 SGB V.
It is the only element of price in which health insurance funds differ – and therefore what carries competition between them at all. A fund operating economically can charge a lower rate; one with higher expenditure has to raise it.
Under Section 249 SGB V it is borne half by the employer and half by the employee – like the general contribution rate. That was not always so: for several years employees bore the supplementary contribution alone, which made it a figure of considerable political attention. The return to equal funding changed that.
For payroll, one feature follows: this is a rate that differs per employee, according to the fund they have chosen, and that can change during the year.
2. Origin and development
Until 2009 every health insurance fund set its entire contribution rate itself. With the introduction of the health fund the contribution rate became uniform nationwide, and the funds have since received their money from that fund – allocated under an adjustment scheme taking account of the age, sex and morbidity of their members.
That abolished price competition at its core. The supplementary contribution restored it at a narrow point: where the allocations from the fund are not enough, the fund levies a rate of its own in addition. It is therefore at once a funding instrument and a competitive signal.
Its design has changed fundamentally twice. At first it was a fixed euro amount borne by employees alone – with the consequence that in absolute terms it burdened everyone equally, regardless of income. It was later converted to an income-related percentage, and finally equal funding was restored.
3. Core principles and how it works
Set by each fund
Every health insurance fund determines its own supplementary rate, based on its financial needs. It applies equally to all its members.
Borne half and half
Under Section 249 SGB V employer and employee each bear half of the supplementary contribution. For payroll that means the rate of the respective fund must be held correctly for each employee.
The average rate has a function of its own
Section 242a SGB V governs the average supplementary rate, published annually. It is not a contribution rate for employees but a reference figure – for contribution subsidies and for assessing contributions of particular groups, for instance.
A special right to leave on introduction or increase
Where a fund levies a supplementary contribution for the first time or raises its rate, membership can be terminated under Section 175(4) SGB V up to the end of the month for which the increased contribution is first levied.
Twelve months' commitment as the rule
Without that trigger, members are bound to their chosen fund for at least twelve months. After that, notice can be given to the end of the month after next.
The contribution ceiling applies here too
The supplementary contribution is levied only on income subject to contributions up to the health insurance contribution ceiling.
4. Who is Zusatzbeitrag zur Krankenversicherung (supplementary health insurance contribution) relevant for?
- Everyone with statutory health insurance – the supplementary contribution affects every membership. - Employers – they bear half and have to reflect the rate for each fund. - Payroll teams – maintaining the fund-specific rates sits with them; an out-of-date rate produces wrong contributions for everyone affected. - Employees intending to switch – the special right to leave is the occasion that makes a change practically possible. - Voluntarily insured people and pensioners – separate rules on bearing the cost apply to them.
5. How it differs from related terms
- Supplementary contribution and general contribution rate – the general rate is set uniformly by statute nationwide, the supplementary one by each fund. Only the latter distinguishes the funds. - Fund-specific and average supplementary rate – one is actually levied, the other is a reference figure under Section 242a SGB V. They are constantly confused. - Supplementary contribution and long-term care contribution – long-term care insurance has its own rates and its own surcharges and reductions; it has nothing to do with the supplementary contribution. - Supplementary contribution and the contribution ceiling – the ceiling caps the assessment, the supplementary contribution sets the rate. Two different levers. - Supplementary contribution and supplementary private cover – private supplementary insurance is a separate contract with no connection to statutory contribution law.
6. Variants and adaptations
How it is borne differs by group of people:
- Employees – half by the employer and half by the employee. - Voluntarily insured people without an employer – they bear the supplementary contribution in full themselves. - Pensioners – the pension insurance institution contributes; how it is borne follows its own rules. - Marginal employees – in marginal employment flat-rate contributions apply; no fund-specific supplementary contribution is levied there. - Employees in the transitional band – the supplementary contribution is calculated from the reduced income subject to contributions like the other contributions.
7. Advantages and challenges
Advantages
- Preserves price competition between funds, which the health fund would otherwise have removed
- Levied in relation to income and therefore socially more balanced than a fixed euro amount
- Since the return to parity, borne half and half — the burden is shared
- The special right to leave gives members an effective means of response
- The contribution ceiling limits the burden at the top
Challenges
- An out-of-date rate in the payroll system produces wrong contributions for everyone with that fund
- Changes can take effect during the year and then force corrections
- The average rate under Section 242a SGB V is regularly confused with a fund's own rate
- For employers with many different funds the maintenance effort rises
- The special right to leave is subject to a short deadline and is unknown to many members
- Competition through the supplementary contribution favours funds with a favourable member profile
8. Best practices for implementation
Take the rates from a maintained source, not by hand
Fund-specific rates change during the year and by fund. A manually maintained master record goes out of date unnoticed and then takes effect across all employees with that fund at once.
Apply changes from the effective date, not the processing date
A change of rate applies from a particular month. Recorded later, the intervening months have to be corrected – through corrected contribution statements.
Point employees to the special right to leave
Section 175(4) SGB V opens a short-dated right to terminate on an increase. A factual note is not advice on choosing a fund but information about a deadline.
Do not use the average rate as a contribution rate
It is a reference figure under Section 242a SGB V. Using it in payroll calculates correctly for nobody.
9. Tips for employers and employees
For employers
- **Maintain the rate per fund** – an out-of-date value takes effect across all employees with that fund
- **Borne half and half** – Section 249 SGB V, as with the general contribution rate
- **Correct mid-year changes** – through corrected contribution statements
- **The average rate is not a payroll figure** – Section 242a SGB V serves other purposes
For employees
- **The supplementary contribution is the only price difference** – the general contribution rate is the same everywhere
- **On an increase there is a special right to leave** – Section 175(4) SGB V, but only briefly
- **Do not look at the rate alone** – benefits and additional services differ as well
- **Twelve months' commitment as the rule** – after that, notice to the end of the month after next
10. Conclusion
The supplementary contribution is the only element of price in which statutory health insurance funds differ – the general contribution rate is uniform nationwide. It is set by each fund, levied in relation to income and borne half by employer and half by employee under Section 249 SGB V.
In payroll it is one of the few figures that differ per employee and can change during the year. That is exactly where the typical class of error arises: an out-of-date rate in the master record affects not one person but every employee with that fund – and every month since the change. It is corrected through corrected contribution statements.
For employees the practically most important rule is the special right to leave under Section 175(4) SGB V: where a fund levies a supplementary contribution for the first time or raises its rate, notice can be given up to the end of the month for which the increased contribution is first levied. Otherwise the commitment of at least twelve months applies.
For an international group this is a data problem rather than a policy one. In systems with a single payer or employer-purchased cover there is no per-employee rate to maintain; here there is one for every fund the workforce has chosen, and it has to come from a maintained source rather than from a spreadsheet.
A note on sources: SGB V has an official English version, cited below. The provisions above are paraphrased rather than quoted.
Sources
- Section 242 SGB V – Fund-specific supplementary contribution (official English version) (opens in a new tab)
- Section 242a SGB V – Average supplementary contribution rate (official English version) (opens in a new tab)
- Section 249 SGB V – Bearing of contributions in employment subject to insurance (official English version) (opens in a new tab)
- Section 175 SGB V – Exercising the choice of fund (official English version) (opens in a new tab)
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