Employer allowance for your pkv and for your child, association of private health insurance

I get an employer grant for private health insurance?

In the case of privately insured employees, the employer pays the costs of health insurance. The member companies of the PKV association meet all the requirements of section 257 (2a) SGB V, so that you have a legal right to this subsidy.

In order to receive the grant, you must provide proof of your insurer to your employer. This contains information about

  • the type of contractual services
  • the beneficiaries and
  • the contributions.

The PKV company also certifies that it fulfills the requirements for the employer subsidy under SGB V. If the amount of the contribution, the insurance cover or the number of insured persons changes, you must inform your employer immediately.

I also get an employer allowance for my family?

You will also receive an employer’s allowance for the PKV contribution for your family members if they were covered by family insurance through an insurance in the GKV. Your relatives allowed to not be self-employed full-time and have no income of more than 455 euros (2020) per month. The income limit for marginally employed persons is 450 euros (2020).

Relatives are under the Social Code

  • spouse
  • life partner
  • Children, stepchildren, grandchildren and foster children, as far as they are mostly entertained. Children are considered up to a certain age, namely
  • generally up to 18 years,
  • up to 23 years if they are not employed,
  • up to 25 years with ongoing school or vocational training or during a voluntary social or ecological year or military service. If your child’s education is delayed due to the completion of a voluntary service, it can be taken into account longer, depending on the length of service.

If your child is unable to provide for his or her livelihood due to a physical, mental or mental handicap, he or she is considered an eligible relative without an age limit.

How much is the employer contribution to private health insurance??

Your employer grants half of your insurance contribution as a subsidy, but not more than the (average) maximum employer contribution for a legally insured employee (2020: 367.97 euros). This maximum employer share results from

  • the current contribution ceiling (2020: 4,687.50 euros / month),
  • the general contribution rate of the SHI (2020: 14.6 percent) and
  • the average additional contribution rate of the statutory health insurance funds (2020: 1.1 percent). Since employers have had to pay half of the additional contribution (equal funding) since 2019, its average value also becomes the maximum employer subsidy private Health insurance takes into account and increases this.

If the employer subsidy for your own contribution is below the maximum limit, your employer will also pay a subsidy of up to half of the contribution for the health insurance of your relatives. All grants together may not exceed the above limit.

If you have an income below the contribution ceiling, only your actual gross salary will be used to calculate the subsidy. This regulation applies to you, among other things, if you have reduced your working hours as part of parental leave or partial retirement, thereby becoming insured in the SHI and have been released from it.

The employer grant is only granted for contributions actually made. Expenditure within the scope of a deductible is therefore borne by you, unless your employer does not voluntarily share the costs. The statutory 10 percent surcharge and any contributions for fee relief tariffs, on the other hand, are eligible. If you receive a premium refund, this will not affect the grant. The refund will only benefit you.

Do I get an employer’s allowance for my private long-term care insurance??

You will also receive an employer grant for your private long-term care insurance. The same rule applies here as in health insurance: half of your actual contribution, but not more than if you were legally insured. The maximum grant will be 71.48 euros in 2020 (in Saxony: 48.05 euros). Under the conditions also mentioned for health insurance, you will also receive a grant for your spouse or life partner. Children are insured free of charge in the compulsory long-term care insurance.

The private health insurance service portal for privately insured

If sick, then at least well informed. The service portal for privately insured persons offers a lot of information about doctor visits and hospital stays:

  • extensive doctor, clinic and drug search
  • Audit software for private bills
  • Legal bases and consumer tips


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Christina Cherry
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