Annual health insurance reconciliation

What it means

The annual health insurance reconciliation is the calculation in which a health insurer, after the year ends, compares how much the insured person should have paid based on their income with what they paid in advances. The result is either an overpayment to be refunded or an underpayment to be settled.

The reconciliation is carried out for employees, sole traders and people with other income. Employers send the insurer data on employees’ income, while sole traders and people with other income provide figures from their tax return. The health insurer then announces the result within the statutory deadline.

For employees, the reconciliation most often settles differences arising from the contribution allowance, changes in income during the year or the minimum assessment base if the employee earned less than the minimum wage.

How it works in practice

For sole traders, the reconciliation follows the tax return. The assessment base and contributions are derived from the year’s income and expenses. If the year went better, an underpayment arises and advances for the next period rise too, which we warn clients about in advance.

For employees, most of the work falls to the employer, who sends the insurer the necessary data. In the payroll system we check that the contribution allowance was applied correctly and that periods when the employee was insured by the state, for example on maternity leave, are recorded.

We go through the insurers’ results with the client. An underpayment must be paid on time, otherwise the insurer issues an arrears statement and enforces it. An overpayment is refunded on request or offset against future advances.

What to watch out for

People who had several sources of income or several employers during the year often receive an unexpected underpayment. Contributions are calculated on total income, and advances paid by individual payers may not have covered it.

Health insurance is reconciled separately for each insurer the person was with during the year. When changing insurer, it is important to follow the results from both and not overlook an underpayment with the previous one.