Health insurance contributions of a sole trader and the annual reconciliation

Health insurance contributions are an obligation for a sole trader from the first day of doing business. Unlike social insurance, advances are paid during the year, and once the year is over they are compared with the actual figures through the annual health insurance reconciliation. The result may be an underpayment or an overpayment, so it pays to understand the principle.

Advances during the year

A sole trader pays an advance on health insurance every month. A new sole trader who does not yet have business income from the previous year usually pays the minimum advance. Once the tax return has been filed, the amount of the advance is adjusted according to the income earned, and the health insurance company notifies you of the new amount.

• the advance is due by the 8th day of the following month
• a new sole trader starts on the minimum advance
• the health insurance company notifies you of the amount after the annual reconciliation

What the annual reconciliation is

The annual health insurance reconciliation is a calculation in which the health insurance company compares the advances paid with the actual amount of insurance calculated from your real income for the whole year. The result is either an underpayment, which you have to pay, or an overpayment, which the insurance company refunds to you. It is therefore a “settling of accounts” for the past period.

Who carries it out

The annual reconciliation is carried out by the health insurance company itself, not by the entrepreneur. The insurance company draws the data from the tax return, which is passed on to it by the Financial Administration (Finančná správa). It delivers the result to you in writing or to your electronic mailbox within the statutory deadline and also sets a date for settling the underpayment or refunding the overpayment. Your task is to check the result and pay on time.

Why an underpayment arises

An underpayment is typical when you paid low (for example minimum) advances during the year but your real income was higher. The system then “brings you into line” with the actual amount of insurance. That is why it is worth thinking about a financial reserve so that an underpayment does not take you by surprise, especially after a successful year with higher sales.

• low advances with a high income = underpayment
• high advances with a lower income = overpayment
• build up a financial reserve for an underpayment

New advances after the reconciliation

The result also includes the new amount of the monthly advance for the next period, which reflects your most recent income. You need to start paying this amount from the specified month; otherwise a debt arises, which the insurance company may recover, and it may also put you on its list of debtors. The list of debtors is public and being on it means complications, for example when applying for certain benefits or certificates, so it is worth recording the new advance amount as soon as the result of the reconciliation is delivered.

Changing health insurance company and overpayments

If you changed your health insurance company during the year, the annual reconciliation is carried out by the company with which you were last insured, and it also takes into account the advances paid to the previous company. That is why it is important to keep track of where and how much you paid during the year. The insurance company transfers an overpayment to your account within the set deadline, but it may also use it to settle other amounts you owe. So check the result of the reconciliation and, if there are discrepancies, lodge an objection within the statutory deadline – once it has passed, the result is considered accepted.

Summary

A sole trader’s health insurance contributions are not a one-off payment but a cycle of advances and annual reconciliation. At Bilvao, we monitor our clients’ reconciliation results, alert them to underpayments and check whether the insurance company worked from the correct data in the tax return. Check the specific minimum advances and deadlines for the period concerned.

Current figures (2026)

Minimum contributions of a self-employed person (SZČO) in 2026

Figures valid for 2026; check the current wording.

Related articles: Contributions when you combine a trade licence with employment, Voluntary social insurance: when it pays off, Registering and deregistering an employee with the Social Insurance Agency (Sociálna poisťovňa).

Frequently asked questions

Do I have to file the annual health insurance reconciliation myself?

No. The annual reconciliation is carried out by the health insurance company on the basis of the data from your tax return. It delivers the result – an underpayment or an overpayment – to you in writing or to your electronic mailbox, together with the deadline for settling it.

Why do I have an underpayment when I paid my advances on time?

An underpayment most often arises because the advances were lower than the insurance calculated from your actual income for the year. In the reconciliation, the insurance company brings you into line with the real amount. That is why it is advisable to build up a reserve for a possible underpayment.