For employees who are privately insured in health insurance (HI), the employer's allowance is not adjusted to the days qualifying for social insurance coverage (SI-days) as it is done for voluntary insured employees.
Cause and prerequisites
§257 SGB V (code of social law) states how the employer's HI-allowance has to be calculated for private health insurance. From Jan/1/1996, this rule changed and this change is also described in the decision of the leading associations of December 20. 1995.
The following applies to privately insured employees who are not in early retirement:
The employer's allowance is half of the comparison amount, but at the most half of the amount the person employed has to pay for the health insurance.
The comparison amount has to be calculated according to the average general contribution rate of the health insurance funds and the income threshold on Jul.1.
You will not find in the law how the employer's allowance for health insurance for partial periods has to be calculated.
In accordance with the federal associating of the AOK (statutory health insurance fund) the SI accounting for partial periods responds as follows:
For a month with reduced work remuneration due to
incapacity to work (20 SI-days)
monthly contribution for private insurance 600,- DM
(no reduction of SI-days)
half of it 300,- DM
Comparison amount (constant KVVBP, Jul/1/1996) 804.00 DM
adjusted to SI-days (* 20 SI-days / 30 SI-days) 536.00 DM
half of it 268.00 DM
The employers allowance is half of the private
contribution, but at the most half of the
comparison amount, that is 268.00 DM
It is explicitly not required that the contribution for private health insurance in the allowance calculation is adjusted to the SI-days since for private health insurance as opposed to the statutory health insurance the HI-contribution is independent of SI-days.
Nursing insurance
As a contribution allowance in private nursing insurance the amount has to be paid which the employer would have to pay if the employee was insured in the social nursing insurance but at the most half of the amount which the employee spends on the nursing insurance.
(This is also valid if the employment location lies in Sachsen:
From July 1st 1996 the contribution allowance in Sachsen is 0,35% of the work remuneration but at the most half of the nursing insurance contribution)
For partial periods the SI accounting responds as follows:
For a month with reduced work remuneration due to
incapacity to work (20 SI-days)
monthly contribution for private nursing insurance 70,- DM
(no reduction of SI-days)
half of it 35,- DM
ER contribution for compulsory insurance contribution
NI assessment threshold 6000,- DM
adjusted to SI-days (* 20 SI-days / 30 SI-days) 4000,- DM
0,85% reduced assessment threshold 34,- DM
The employer's allowance is half of the private contribution but at the most the employer's contribution for compulsory insurance 34,- DM
For attribute 25 in infotype 0013, exempt under the annual renumeration limit (or SI attribute 26 for people liable to HI insurance contribution), SI accounting responds as follows:
For a month with reduced work remuneration, approximately 3000,-DM, due to incapacity to work (20 SI-days)
monthly contribution for private nursing insurance 70,- DM
(no reduction of SI-days)
half of it 35,- DM
ER contribution for compulsory insurance coverage
NI gross assessment amount 3000,- DM
0,85% NI gross assessment amount 25.50 DM
The employer's allowance is half of the private
contribution but at the most the employer's
contribution for compulsory insurance 25.50 DM
(The difference, 34,00DM - 25,50DM, is stored for the employee as permanent credit balance. In a later payroll with the contribution determination of a one-time payment, from this credit balance a permanent clearing is paid.)
Note:
If you enter 'amount + allowance' in infotype 0079 the allowance calculation can be changed:
For private contribution, all individual contributions created for the same SI division in infotype 0079 are added. If the field 'amount + allowance' is filled, then the system uses the allowance amount instead of the individual contribution.
No solution, since correct display of regulations
Key word: employer's allowance, private health insurance and private nursing insurance
Additional key words
End of continued pay, days qualifying for social insurance coverage, SI-days, reduction
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