What are health insurance plans?

Health insurance in general provides financial security against the risks of illness or injury, while also promoting preventive care. The legal basis for health insurance is the Fifth Book of the Social Code (SGB V).

Health insurance companies provide coverage to people—both through mandatory and voluntary plans—based on the so-called principle of solidarity: Contributions are primarily based on income, and the resulting benefits are largely set by law for all insured individuals. 

For more information on statutory health insurance, please see our article on the theme. 

Task of health insurance companies

The task of health insurance companies is to ensure and finance medical care for their policyholders: 

1. Coverage of services such as medical and hospital care, medications, preventive care, and rehabilitation
2. Providing support to insurance companies through consultations, information services, processing of claims, and reimbursement of expenses. 
3. Promoting health through preventive services and health promotion programs.
4. Collection and management of premiums that fund the healthcare system. 

Contribution statements to health insurance companies 

The employer is required to submit various contribution statements to health insurance providers as part of the social security and reimbursement system. These include: 

• DEÜV contribution statements (Data Collection and Transmission Regulation): These include social security contribution statements such as registrations and deregistrations, annual contribution statements, and contribution statements regarding interruptions or changes
• AAG contribution statements (Cost-Sharing Act): These include contribution statements related to the compensation procedure (U1/U2), particularly regarding the reimbursement of employer expenses in the event of illness or maternity leave. 
• EEL contribution statements (electronic wage replacement benefits): These forms are used to apply for income replacement benefits, such as sickness benefit, including the submission of income data and relevant periods.

Manage health insurance plans in Personio

Before you begin

Before setting up a health insurance plan in Personio, first make sure you have the following permissions: 

• You must have admin rights in Personio 
• Personio Payroll must be activated for your organization and the corresponding legal entity.

Set up a new health insurance provider in Personio

Always make sure that the information you enter matches the actual details on file with your health insurance provider. This includes contribution rates and provider details. Incorrect information can cause problems such as: 

• Rejection of contribution statements by a health insurance company
• Rejection of payment by the health insurance company. 

Please note:
Changes made in Personio do not affect your agreements with health insurance providers. Any changes to the agreements must be handled directly with the health insurance company.  

Health insurance plans are generally registered at the company level. Therefore, separate health insurance plans must be created for each legal entity. 

To add a new health insurance provider in Personio Payroll, follow these steps:

1. In the main navigation menu, click on Payroll 
2. Go to the Manage tab > Health Insurance
3. Click on "Set up health insurance"
4. Select the effective date
5. Search for the appropriate health insurance provider and then, if necessary, select the premium tier and payment method
6. Click Save.

Please note:
The contribution level can only be set up if your organization participates in the U1 pay-as-you-go system. You can set this up under Payroll under the Manage > Social Security tab. 

Customize the contribution rates for the sickness contribution 

Contribution rates should only be customized in consultation with or at the request of the relevant health insurance provider. This happens, for example, at the start of the new year on January 1. Also, be sure to check in advance whether you are generally required to pay the U1 contribution.

To customize the U1 contribution rates, follow these steps: 

1. In the main navigation menu, click on Payroll 
2. Go to the Manage tab > Health Insurance
3. Click on the appropriate health insurance provider in the list 
4. Enter the new effective date.
5. Select the new allocation rate and click Save

Please note:
Be sure to enter the correct effective date. An incorrect effective date can result in retroactive changes to the payslip. 

Signing up for an employer account with Personio Payroll

What is a DSAK contribution statement?

As of July 1, 2023, employers must set up accounts within the health insurance company’s electronic registration system. This is done using a certified payroll software program or through the Social Security Reporting Portal.

DSAK contribution statements (Employer Account Data Set) are contribution statements used in the electronic data exchange system of the German social security agencies; they transmit employer data electronically to the relevant health insurance fund, where it is used to maintain the employer account.

The DSAK contribution statement is used as part of the DEÜV reporting procedure (Data Collection and Transmission Regulation) and serves to

1. Setting up and maintaining employer accounts with statutory health insurance providers 
2. Providing the information that health insurance companies need to correctly manage premiums and reimbursements
3. Updating employer information when changes occur within the organization

When is a DSAK contribution statement generated?

A DSAK contribution statement is automatically generated and sent when the payslip is approved. This happens in two cases

At the request of the health insurance company

Health insurance companies may request additional information about the employer's account if necessary. In this case, an electronic request is sent to the payroll system using the Health Insurance Report data record (DSKK) with submission reason 6. 

Personio responds automatically and sends back a corresponding DSAK contribution statement containing the requested employer data. 

Such a request is typically made when the health insurance provider becomes aware of an employer account for the first time or after a long period of time through data exchange, for example: 

• An initial social security registration (registration) of an employee via the DEÜV reporting procedure 
• contribution report 

If there are changes to organization or employer information

A DSAK contribution statement is also triggered automatically when certain employer-related master data is changed. Typical triggers may include, for example: 

• Changes to contact information (e.g., phone number or email) and the company address
• Changes to participation in the U1 cost-sharing scheme and changes to cost-sharing rates
• Changes to the configuration of a specific health insurance provider 
• Changes to the payment method (e.g., switching from direct debit to bank transfer)
• Change in the principal place of business assigned to a legal entity

View DSAK contribution statements in Personio

In Personio, the DSAK contribution statement is automatically sent to the health insurance provider as soon as changes are made to the company's data. No live action is required on their part. 

You can view the information that has been sent to your health insurance provider as follows:

1. In the main navigation menu, open the payroll section.
2. Go to the compliance tab and select the appropriate month. 
3. Search for DSAK and click on "View Details."