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Does an employer have to contribute to an employee's spouse's/children's private health insurance premiums?

Employees in Germany have either compulsory or voluntary public health insurance (depending on their income) with a Krankenkasse or fully comprehensive private insurance, the latter only being an option if their salary is  more than 5,362.50 euros per annum ( as of 2022). 

If you have public insurance: the employer has to contribute 50% if you have at least one child or a little bit less if you are childless.

What about private health insurance? The employer contributes 50 per cent but it is capped at (currently) 384.58 euros a month  plus 73.77 euros for compulsory nursing care/Pflegepflichtversicherung.

Is that the end of it? NO!

There is a law, §257 (2) Satz 1 SGB V, which states in highly bureaucratic language that the employee´s spouse earning only  up to 470 euros a month (as of 2022)  or children whose total worldwide income is under 470 euros a month (as of 2022) MUST also be subsidised by the employer if two conditions are met:

1. The spouse or child/ren must be privately health insured with the same provider
2. There must be financial leeway.

What is that then?

Well, as previously mentioned above, the total employer subsidy runs at 384.58 plus 73.77 euros a month= 458.35
So if the employer´s contribution is under 458.35 euros a month for the employee´s current private insurance contract, there is some money left over to (partly) subsidise other members of the family.

Example: the employee´s private contract at insurance company A currently costs 400 euros a month plus 30 for the nursing care.
The low-earning spouse has private insurance costing 300 euros a month plus 20 for nursing care and their two children each pay 150 a month with no payments required for nursing care.

This adds up to 1,050 euros a month. But half of that would be 525 euros…somewhat  more than the maximum employer subsidy of 458.35 euros.

So, in this example, both spouses would be subsidised by the employer plus one child fully subsidised and the second child wouldn´t be because there is no money left in the pot!

Shame!!
Published | 15/11/2022 |