The business case for corporate health management in Germany: what is proven, what is disputed, and what we do not promise you

The economic benefit of workplace health promotion is less well evidenced than the German market claims. The most widely cited German return figure comes from a report that admits on the same page that the evidence is 'limited'. Three things, by contrast, are well evidenced, and none of them is a cost saving.

This page puts the counter-evidence on the table first and then builds the narrower case, one that will survive your finance team's scrutiny. We will not quote you a return on investment. We will show you where the market's figures come from, what the methodologically best studies found, and which German figures are robust enough to base a decision on.

The three key figures at the top of the page:

Summary

• The ROI range of '1:2.5 to 1:4.8' that is common in the market does not exist as a range anywhere. The source gives '1:2.5 and 1:4.85 respectively', two separate study results.
• The trail leads via iga.Report 13 (2008) and iga.Report 3 (2003) to Aldana (2001), a US literature review covering three studies in US dollars.
• The second German ROI tradition, 'five to 16 euros', cites the same source in its own footnote. Germany appears to have two independent ROI traditions; in fact it has one.
• iga itself writes that US figures are not transferable, because German employers do not bear their employees' direct medical costs.
• The best-resourced German study on mental health at work (FRIAA, n = 550) had days of incapacity for work as its primary endpoint, found no effect and was not cost-effective in the formal cost-utility analysis.
• The well-documented effect is something other than cost savings: services at the workplace increase uptake. That is exactly what we provide.

Not evidenced

'ROI 1:2.5 to 1:4.8.' This range appears on dozens of German-language provider websites. We do not use it. Here is where it comes from.

The trail first leads to iga.Report 13 from 2008, which states, verbatim:

'The studies assume a cost-benefit ratio (return on investment, ROI) of 1:2.3 to 1:5.9 for illness costs. Savings in absence are given as between 1:2.5 and 1:4.85 respectively, up to 1:10.1 (cf. Kreis and Bödeker 2003). This means that, for example, for every dollar spent, US$2.3 is saved through reduced illness costs in the first result mentioned.'

Sockoll, Kramer, Bödeker: iga.Report 13, 1st edition, April 2008, chapter 6, p. 57

Four things about this are noteworthy.

First, it is not a finding of iga.Report 13. The report cites Kreis and Bödeker from 2003, that is, iga.Report 3. It is a quotation of a quotation.

Second, iga.Report 3 is itself quoting. It says:

'Three of the studies also determined the cost-benefit ratios (cost-benefit ratio; return of investment); these are 1:2.5 and 1:4.85 respectively in quasi-experimental studies and 1:10.1 in a correlational study.'

Kreis, Bödeker: iga.Report 3, 2003, pp. 29-30

The source of these three studies is Aldana, S. G.: Financial Impact of Health Promotion Programs. A Comprehensive Review of the Literature. American Journal of Health Promotion 2001;15(5):296-320. Three US studies, in US dollars, two of them quasi-experimental and one purely correlational. All from before 2001. At no point in this chain is there any German data.

Third, the range the market quotes does not exist. The source says '1:2.5 and 1:4.85 respectively'. These are two individual results from two studies, not a range. In the retelling, 'respectively' became 'to'. Anyone who quotes '1:2.5 to 1:4.8' today is quoting a garbled summary of a summary of three US studies.

Fourth, iga.Report 13 partly describes itself as a sales aid. It is meant to serve 'players and decision-makers in workplace health promotion as a guide and practical aid for action', 'be it in the context of consulting and acquisition'. That is not an accusation but the report's own description of itself. It puts the whole citation chain in context.

And every later citation leaves out Kreis and Bödeker's own caveat:

'Because the studies lasted 3.25 years on average, it remains unclear how long these gains last and whether they grow or shrink over time.'

1.1 The second German ROI tradition is the same source#

Alongside the iga line, a second figure circulates in Germany: 'Every euro invested in workplace prevention pays back five to 16 euros.' It comes from Booz & Company / Felix Burda Stiftung, 'Vorteil Vorsorge', 2011.

Its own footnote 6 reads, verbatim:

'The sources for the calculation are mainly of US origin and mostly relate to individual case analyses. According to Aldana (2001), the range of return on investment (ROI) is between 5.3 and 16 USD per dollar invested.'

The same literature review from 2001. The German market has two apparently independent ROI traditions, and both go back to a single US review.

To put the Booz study in context: by its own account it was 'carried out by the international strategy consultancy Booz & Company as a pro bono project for the Felix Burda Stiftung'. The disclosed methodology consists entirely of a 'qualitative survey ... of more than twenty German companies'. No peer review, no methods section, no data appendix. The study itself concedes: 'Research into the return on investment of preventive measures is still in its infancy.'

1.2 And another press release that still has an effect today#

Not evidenced

On 31 March 2015, BKK Dachverband, DGUV, AOK-Bundesverband and vdek jointly published a press release on iga.Report 28. It said: 'Sickness-related absence falls by a quarter on average', 'based on around 2,400 studies', and 'For every euro invested, €2.70 can be saved as a result through reduced absence.'

Both core statements are a single US meta-analysis (Baicker et al. 2010), reproduced in a German press release with the currency symbol swapped. The '2,400 studies' are the sum of the primary studies within the included reviews, not studies read by iga.

If someone works out '€2.70 per euro invested' for you, that figure comes from here.

Disputed and the source says so itself

The most recent evidence synthesis of the German prevention landscape is iga.Report 40 (2019), published by BKK Dachverband, DGUV, AOK-Bundesverband and vdek. It has not been superseded to this day.

The scope is more sobering than the headline: 100 systematic reviews met the inclusion criteria. Quality was assessed using AMSTAR 2. Only 40 of 100 were convincing (36 moderate, 4 high). 49 reviews remained for data extraction. Of these, six deal with economic benefit, and iga included all six regardless of their AMSTAR rating because there were so few.

The figures, verbatim from chapter 11.2:

'Across all studies, the mean ROI is 2.7. ... The minimum ROI of minus 3.3 is set against a maximum of 15.6. 85% of the ROIs are greater than one.'

'... whereas the five studies carried out in the EU give an indifferent picture. However, an average ROI of 1.7 is also achieved here.'

'On this basis, the studies rated as high quality, with an ROI of 1.8, show the lowest value on average. 27% of these studies could not demonstrate any saving. By contrast, the studies of low or medium quality show an average ROI of 3.'

'Although the studies with a randomised controlled design also yield a mean ROI of 1.8, more than 50% of the studies here show no saving.'

The table that no German page has published so far. iga.Report 40, figure 3, p. 63:

Read the table from the bottom up: the better a study is designed, the smaller the benefit it finds. That is the classic pattern of an effect that arises mainly from study design.

The report's verdict, verbatim in two places:

'Despite the predominantly positive results of the individual studies, the reviews therefore speak overall of limited evidence for the economic benefit ... the benefit has thus not yet been rigorously proven scientifically.' (chap. 11.1)

'By comparison, controlled and randomised studies show a lower economic benefit, or none at all, than methodologically less robust studies.' (chap. 12)

And a footnote showing that iga did not calculate these ROI values itself. Footnote 28:

'The ROI figures were taken from Baxter et al. (2014). The ROI from the study by Mills et al. 2007 was apparently printed incorrectly as 28.7. The authors give 6.2 in the original.'

The German '2.7' is the figure from a British-Australian review of predominantly US studies, with a corrected misprint. The maximum of 15.6 comes from a single US school district with around 6,000 employees (Aldana et al., 2005).

Our editorial rule for this page: if we print 2.7, we print 1.8 in the same sentence. There is no honest way to use the mean without the quality stratification, and iga.Report 40 prints both on the same page.

Well evidenced

The decisive sentence is in chapter 11 of the same report:

'Internationally, however, these cost types are of differing importance to institutions. Companies in Germany, for example, unlike many US companies, do not contribute to covering direct illness costs and are therefore primarily interested in reducing indirect costs.'

US ROI figures are dominated by savings on direct treatment costs. A German employer structurally cannot realise that saving, because it does not pay for its employees' healthcare. Every imported US ROI figure is inflated for a German audience by exactly the component that does not exist here. And the umbrella organisation of the German prevention players writes this itself, in German, in print.

On top of that, there is very little German evidence at all. iga.Report 40, chapter 11.1:

'Overall, about 140 studies with about 500,000 participants are reported. While the majority of studies were again conducted in the USA ... Apparently only one study could be found from Germany, namely on screening for colon cancer.'

Across all reviews evaluated in the report: 978 individual studies, of which 257 are from Europe (26%), of which 18 are from Germany, that is, 7% of the European studies and 2% of all studies.

4.1 International#

Well evidenced

The methodologically strongest investigation is the Illinois Workplace Wellness Study (Jones, Molitor and Reif, Quarterly Journal of Economics, 2019), a randomised controlled trial with around 12,000 employees of the University of Illinois. After one year it found no significant effects on healthcare spending, absence or work performance, and rules out a large part of the effect estimates published up to then.

Song and Baicker (JAMA, 2019, n = 32,974, 33 sites of a US retailer) found improvements in self-reported health behaviour after 18 months, but no differences in clinical measurements, healthcare spending or employment data.

Katherine Baicker's role is remarkable: she is the first author of the 2010 meta-analysis from which the '2.7' and the '25%' come, and a co-author of the 2019 randomised study that could not reproduce those effects. The correction comes from the author of the original finding.

4.2 Germany#

Well evidenced

There is no German randomised study on the economic benefit of an entire corporate health management programme. There are, however, two well-resourced German randomised studies on mental health at work, and both are negative.

FRIAA ("Frühe Intervention am Arbeitsplatz", early intervention at the workplace), multicentre randomised controlled trial at five German centres, n = 550, recruitment 09/2021 to 01/2023. A psychotherapeutic consultation hour at the workplace.

• The primary endpoint was self-reported days of incapacity for work: 21 days in the intervention group against 22 days in the control group, no significant effect (p = 0.679). The clinical secondary endpoints improved markedly. Rothermund et al., Psychotherapy and Psychosomatics, December 2025.
• The formal health economic evaluation: additional annual costs of €3,484.29 (95% CI 1,033.91 to 5,934.67; p = 0.005), a QALY gain of 0.021 (p = 0.203, not significant), hence an ICUR of around €165,919 per QALY. The authors' conclusion: not cost-effective. Mulfinger et al., Journal of Mental Health Policy and Economics 2026;29(1):23-35.

SEEGEN ("Seelische Gesundheit am Arbeitsplatz Krankenhaus", mental health at the hospital workplace), multicentre cluster-randomised study, three German hospital sites, 18 clusters, n = 415, five modules. No statistically significant effect on the primary endpoint or on the secondary endpoints after eleven months, Cohen's d = 0.18.
Mulfinger et al., PLOS ONE 2025;20(8):e0330490.

There is also German academic criticism that is rarely cited:

• Gloede and Ducki (2011): earlier cost-benefit ratios 'cannot claim validity, at least for team-based health training'.
• Auer, Sennefelder and Meier (2022): behaviour-oriented workplace health promotion has 'hardly any positive effects on work productivity and communication structures'.

Nothing in the German market cites FRIAA. We do, because a finance department that does its own research will come across it anyway, and because a design principle follows from the finding.

The null findings are not an argument against workplace health. They are an argument against a particular way of running it. iga.Report 40 itself names the most likely mechanical explanation:

'Participation rates are reported only irregularly in the studies, but are predominantly low.'

If participation is the binding constraint, then the format decides, not the content of any single module. Four design principles follow, which we openly label as such:

The last point has an additional regulatory twist in Germany: the GKV Prevention Guide (Leitfaden Prävention) excludes 'screenings without interventions from the workplace health promotion fields of action' from funding, and the BMF letter of 20 April 2021 excludes them from the tax exemption in para. 34. Linking screening to an intervention makes the measure eligible for funding and tax-free, and it is also what the international evidence suggests. For once, regulation and evidence point in the same direction.

Well evidenced

What is robust in Germany is not return figures but cost figures. And they are good: the Federal Institute for Occupational Safety and Health publishes them every year, free of charge, by diagnosis group and industry.

6.1 BAuA, Volkswirtschaftliche Kosten durch Arbeitsunfähigkeit, data year 2024#

Data basis: 32.6 million statutory health insurance member years. The industry tables are based on 16.0 million and are correspondingly less robust.

Three points of precision that separate a serious presentation from a careless one:

1. BAuA relates these values to gross national income, not gross domestic product. '3% of GDP' is wrong.
2. Table 1 of the fact sheet contains a misprint ("20.08 days of incapacity for work"). 881.5 ÷ 42.283 = 20.85. The correct value is 20.8, and it appears in the running text of the document.
3. The reported figure of €2,040 loss of gross value added per day of incapacity in real estate and housing is a statistical artefact of very high value added combined with a very small workforce. It is not suitable as a benchmark, and BAuA says so itself.

BAuA's own caveats, which we print rather than hide:

'the incapacity data used here [do] not cover all days of incapacity ..., but only those reported to the health insurance funds with a sick note from a doctor. This leads to underestimation of short-term incapacity for work.'

'The estimate of production losses ... indicates, in macroeconomic terms, a prevention potential and possible benefit potential.'

BAuA calls this potential, not savings. We use the same word.

One caveat that BAuA leaves implicit and that we make explicit: the model assumes that the output of an absent person is lost entirely, with no cover and no catching up. The €227bn is an upper limit, not a net loss.

Disputed

And a small, honest observation: in 2023 there were more days of incapacity for work (886.2 million) than in 2024, but production loss was lower, at €128bn. Costs rose because employee compensation and gross value added per working year rose, not because more people were absent.

6.2 What employers actually pay out#

Well evidenced: a well-documented estimate

The BAuA figures are macroeconomic. The most direct German figure from a business perspective comes from the Institut der deutschen Wirtschaft:

'Continued payment of wages to sick employees cost employers an estimated €85.6 billion in 2025.'
Pimpertz, J.: IW-Kurzbericht No. 57, 29 August 2026. Method: gross wages from the social budget (€72.5bn) plus estimated employer social insurance contributions (€13.1bn). In nominal terms, the amount has more than doubled in fifteen years.

This is a documented estimate, not a measurement. But it is the only German figure that describes money employers actually pay out.

6.3 Where the days of absence are concentrated#

Well evidenced

3% of cases account for 40% of days of absence.

This is the most important structural feature of German absence from a business perspective, and it is an argument for targeting, not for broad-based programmes.

One comparison ban we take seriously: AOK/WIdO, BKK, DAK and TK report 23.3 / 22.3 / 19.5 / 18.5 days of incapacity for overlapping periods. These figures are not comparable. TK standardises by age and sex and counts the economically active population including recipients of unemployment benefit; AOK and BKK report unstandardised figures for a population with more manual trades; DAK counts calendar days. We do not place them side by side and we do not average them.

7.1 The eAU effect: more transparency, not more illness#

Well evidenced

Since 1 January 2022, doctors' practices have reported incapacity for work electronically to the health insurance funds. That has changed the recording, not the incidence of illness.

WIdO's own model calculation: for 2025 the figure would be 20.8 days of absence instead of the 23.3 measured, that is, 2.5 days or more than 10% lower, if there were no electronic sick note. Short illnesses of up to 14 days rose from 6.7 days of incapacity (2016) to 10.1 (2022) and stood at 9.1 in 2025. The share of respiratory infections with a sick note rose from 65% (2019) to almost 86% (2024). BKK Dachverband sums it up as 'more transparency, not more illness'.

Practical consequence: do not draw a before-and-after line across the turn of the year 2021/2022. And if someone offers you a 'record sickness absence rate since 2022' as a sales argument, discount it by at least that amount.

7.2 The six-week limit: why your direct costs are capped#

Well evidenced

Section 3(1) of the Continued Remuneration Act (Entgeltfortzahlungsgesetz) gives employees the right to continued payment of wages 'for a period of up to six weeks'. After that, the health insurance fund pays sickness benefit. The employer's direct wage cost per episode of illness is therefore capped.

This matters because long-term cases of over six weeks account for around 40% of all days of incapacity (WIdO, data year 2024). A calculator that multiplies the total number of days of incapacity by €152 overstates your direct costs by exactly that share. Our calculator works out the six-week average separately, and we know of no other German tool that does.

These two paragraphs are where a German finance team decides whether to trust the rest of the page.

A tool may put a figure on a burden. It may not put a figure on a saving it cannot substantiate.

The calculator offers two routes. The federal benchmark (BAuA) calculates top-down using the published daily rates by industry and shows production loss and loss of gross value added side by side. The own-pay route works bottom-up from a gross annual salary. Both routes are technically defensible and answer slightly different questions. Values from official sources and your own assumptions are labelled separately in the tool.

Disputed

Presenteeism, that is, working while ill, is the strongest argument for workplace health and at the same time the least well evidenced. We make both clear.

9.1 A misattribution that circulates in Germany and that we correct#

Several German sites describe BAuA's €227bn as the 'cost of presenteeism'. That is wrong. The €227bn is the loss of gross value added through incapacity for work, that is, through absenteeism, valued at gross value added rather than at wage costs. It has nothing to do with presenteeism.

There is currently no official German cost figure for presenteeism. If someone quotes you one, ask for the primary source.

9.2 What the most-cited German source actually says#

Steinke and Badura, 'Präsentismus. Ein Review zum Stand der Forschung', BAuA 2011 (541 sources screened, 285 studies included, narrative review, no meta-analysis). The operative sentence reads:

'The studies presented show that the costs of illness-related restrictions on work productivity are considerable and exceed the costs of absenteeism.'

There is no ratio in it. No 2:1, no 3:1, no 'two thirds'. And the statement refers to 'the studies presented', which are overwhelmingly American. Anyone who cites Steinke and Badura for a numerical presenteeism multiplier is citing them wrongly.

The report's own caveats:

'With regard to the majority of instruments, however, there is still a need for validation.'
'In future, what is needed above all is the development of German-language measurement instruments.'

In 2011 the federal institute stated that German-language measurement instruments did not yet exist. Every German euro figure from that period is therefore based on instruments that were never validated for Germany.

Where the 2:1 ratio really comes from: the 2011 Booz study (€1,199 for absenteeism, €2,399 for presenteeism per employee per year, reference year 2009). Its authors themselves write: 'The costs caused by presenteeism have so far not been quantified in a binding way. ... In an approximate calculation, it can be put at €2,399 per head per year.' as a cost figure.

Not evidenced

9.3 The current German data we work with#

Well evidenced

BAuA, "Präsentismus und Absentismus", 2025, based on the BAuA Working Time Survey 2023, n = 11,199 people in employment, dual-frame telephone sample:

• Absenteeism 76% (at least one sick day in twelve months)
• Presenteeism 54% (worked at least one day while ill)
• Women 60%, men 48%; days worked while ill: women 7.8, men 5.0
• Associations with high work intensity, frequent changes to working hours and low autonomy

A national sample of 11,199 respondents is an order of magnitude better than any commercial German presenteeism survey. And it shows presenteeism less often than absenteeism, a more sober picture than the promotional literature.

DAK-Gesundheitsreport 2023, routine data on 2.4 million insured people in employment plus over 7,000 people surveyed representatively by forsa, provides the most useful German presenteeism figure from a business perspective, because it is a comparison of drivers within the same study:

'70% of those with regular staff shortages [worked] in the past twelve months although they were ill, compared with 41% without staff shortages.'

Institut DGB-Index Gute Arbeit, Kompakt 01/2025, 2024 survey wave, n = 6,985: 63% worked although they felt "really ill", 44% for a week or longer.

9.4 The range, and why it is not a trend#

German presenteeism prevalence is quoted at anywhere between 51 and 78%. This range is an artefact of how the question is asked, not a change in the phenomenon. 'At least one day while ill' (BAuA, 54%) and 'felt really ill' (DGB-Index, 63%) measure different thresholds. We present them neither as a contradiction nor as a trend.

And five reasons why we do not convert presenteeism into euros:

Well evidenced

1. Throughout this literature, no measured productivity is used, only self-reporting.
2. The instruments are not validated for the work being priced. They were validated on simple service tasks and are applied to knowledge work.
3. The usual method overestimates by design. Where compensation and catching up were measured, only around 25 to 30% of the originally calculated costs remained (Jacob-Tacken et al. 2005; Brouwer et al. 2002).
4. The multipliers come from a few US studies with interested funders. US studies focus on costs because employers there pay for healthcare.
5. Presenteeism is not automatically a loss. For some conditions, continued work is part of the therapy.

Our position: presenteeism is the right question and the wrong number. We use it as an argument for how work is designed and for low-threshold access to medical assessment, not as an item in a cost-effectiveness calculation.

None of the following four pillars depends on a claim about health costs saved.

Pillar 1: access and uptake#

Well evidenced

This is the only effect with good evidence, and it is exactly what we deliver. In Germany it is also unusually easy to frame.

Much of what a company health day provides is already a statutory entitlement that goes unused. Under the Health Examination Guideline (Gesundheitsuntersuchungs-Richtlinie) of the Federal Joint Committee, people with statutory health insurance aged 18 to 34 are entitled to a one-off health examination between the ages of 18 and 34, and to one every three years from the age of 35, which also includes urine, blood sugar and cholesterol tests.

Our service is not additional medicine. It lowers the threshold for medicine that your employees are already entitled to.

This wording is more honest, cheaper to defend and more likely to persuade an occupational physician than any claim of novelty.

What we expressly do not claim: on this page we make no claim that screening reduces mortality or disease burden. The international evidence on general preventive check-ups is not sufficient for that, and expert bodies assess individual examination modules differently. What can be evidenced is uptake. The medical direction decides which modules we offer and why, based on German guideline sources.

Pillar 2: concentration instead of volume#

Well evidenced

Mental illness runs at 28.5 days of incapacity per case against an average of 10.5 days and has risen by 47% since 2014. Long-term cases of over six weeks account for 3.3% of cases and 40% of days of absence. That is an argument for targeted outreach and early assessment pathways, not for blanket sports programmes.

Pillar 3: employer attractiveness and retention#

Disputed because correlational and self-reported

iga.Report 49 (2026), 'Gesunde, sichere Arbeit: ein Schlüssel für die Arbeitgeberattraktivität?', a literature analysis, eight company interviews and a survey of 1,847 employees, finds 'a positive association' between health measures and employer attractiveness and retention. The report contains no ROI or euro figures, and the finding is correlational and self-reported. We present it for what it is.

The same report has a secondary finding you can use directly: systematic, structurally embedded implementation matters more than the breadth of the programme.

Pillar 4: meeting statutory obligations and a robust data architecture#

Well evidenced

Unlike in Switzerland, Germany has a statutory starting point: a risk assessment that includes mental stress is mandatory under Section 5(1) and Section 5(3) no. 6 of the Occupational Safety and Health Act (ArbSchG). Only 52.0% of the organisations surveyed carry one out, and 24.6% carry out none at all (#whatsnext 2025, n = 1,441). And Section 21(1a) ArbSchG requires, from calendar year 2026, that "at least 5% of the establishments present in the Land are to be inspected", from which Land law may not deviate.

Important, and most competitor sites get it wrong: workplace health promotion does not replace the risk assessment. The GKV Prevention Guide says so explicitly: workplace health promotion 'supplements' statutory occupational health and safety. Details on our page Introducing a health programme.

The fourth pillar has a second half. In Germany a properly built data architecture is a procurement criterion, not a footnote: it has to convince not only the data protection officer but also the works council and the occupational physician. That is the subject of our page Data protection, confidentiality and co-determination.

11.1 What the tool answers#

'How much of our health budget can we use tax-free, and what counts towards it at all?'

11.2 The legal position in brief#

Section 3 no. 34 of the Income Tax Act (EStG), verbatim:

'The following are tax-free: … benefits that the employer provides in addition to the wages already owed, to prevent and reduce health risks and to promote health in the workplace, and that meet the requirements of Sections 20 and 20b of Book V of the Social Code (SGB V) in terms of quality, earmarking, targeting and certification, provided they do not exceed €600 per calendar year'

Five points that are regularly misrepresented in the German market:

1. It is an allowance, not an exemption limit. If it is exceeded, only the amount above it is subject to tax and contributions. Tax-free also means exempt from social insurance contributions.
2. The increase from €500 to €600 did not come from the Annual Tax Act 2019 (Jahressteuergesetz 2019). It came from the Third Bureaucracy Relief Act (Drittes Bürokratieentlastungsgesetz) of 22 November 2019, BGBl. I 2019 p. 1746, with effect from 1 January 2020. The error appears everywhere.
3. Salary sacrifice is excluded. Additionality is legally defined in Section 8(4) EStG: no offsetting, no reduction, no replacement of an already agreed increase, no increase if it lapses.
4. No certification is required for workplace health promotion services under Section 20b. BMF letter of 20 April 2021, para. 4: 'In principle, certification is not envisaged for workplace health promotion services under Section 20b SGB V.' The word 'certification' in the statutory text applies only to courses under Section 20(4) no. 1 SGB V.
5. The process is the real condition. BMF para. 20 requires that the services be provided 'within a structured in-house process (for example steered by an internal company committee) with analysis of needs ... and with the involvement of employees or their representatives as well as ... the specialists responsible for safety and health'. The tax office itself therefore requires a steering group, a needs analysis and involvement of the works council. Anyone who bypasses the works council risks not only a co-determination dispute but the tax exemption.

11.3 The second, usually larger route that almost nobody explains#

Well evidenced

BMF para. 35: 'Independently of the provision in Section 3 no. 34 EStG, services provided by the employer for workplace health promotion are not wages if they are provided in the predominant interest of the employer's own business.' The test follows BFH (Federal Fiscal Court), judgment of 9 May 2019 - VI R 28/17.

The list in para. 37 is long and not capped at €600. It expressly includes: analysis services (incapacity, work situation and age structure analyses, employee surveys, needs workshops), advice to company managers on health-promoting work design and health-conscious leadership behaviour, advice on goal and framework development, advice to individual employees on workplace-related problems, occupational reintegration management (BEM) measures, setting up project management, moderation of working groups, internal communication, documentation, evaluation and quality assurance, multiplier training, protective vaccinations in line with STIKO recommendations, and:

'Expenses for health check-ups and preventive examinations, up to a maximum of the amount that the statutory health insurance funds would reimburse for these services.'

In many projects, this uncapped category is worth more than the €600. It covers exactly the analysis, advice, leadership and evaluation work of a serious programme.

11.4 What is expressly not covered#

BMF para. 34 names, among other things: membership fees for sports clubs and fitness studios, physiotherapy treatments, massages, 'screenings (health examinations, preventive examinations) without a link to interventions from the fields of action of the health insurance funds' workplace health promotion', work equipment and structural measures, subsidies for canteen meals, and ancillary or additional benefits such as meal, travel and accommodation costs.

In addition, para. 30: if measure, accommodation, meals and travel are 'invoiced at a flat total amount', an apportionment by estimate is 'not permitted'. The BFH has confirmed this (judgment of 23 November 2023 - VI R 24/21).

Practical consequence: demand separate invoice items from every provider. An externally run health day invoiced as a package is a payroll tax risk for you, not for the provider.

For corporate fitness the route is different: the €50 benefit-in-kind threshold under Section 8(2) sentence 11 EStG. This is a threshold, not an allowance: one cent over and the entire amount is taxable.

11.5 The budget helper#

The tool gives an assessment for each measure, with the legal reference, including where a measure does not fall under Section 3 no. 34 EStG. A calculator that treats everything as tax-free would be a liability at the next payroll tax audit.

First, some context: in 2024 the statutory health insurance funds spent around €282 million on workplace health promotion. In 86% of the funded activities, a success evaluation took place or is planned. The indicators reported were: employee satisfaction 73%, employer satisfaction 68%, acceptance and uptake 62%, processes and workflows 25%. Health outcomes, absence and costs do not appear among the reported indicators at all (GKV/MD Bund, Präventionsbericht 2025, reporting year 2024).

This is no criticism of the insurers, who are open about it. It does mean that a provider cannot borrow credibility from the funding body.

Our three-level model:

Two warnings on level 3, which we record in writing before the programme starts:

1. A successful screening can raise the short-term sickness absence rate, because referrals turn presenteeism into visible incapacity for work. That is a success and looks like a failure in the statistics.
2. There is no valid before-and-after comparison across the turn of the year 2021/2022 (eAU structural break, see section 7.1). For us, the sickness absence rate is a context measure over 24 months, not a target measure.

Benchmarks against which we can set your result, all with a source: BIBB/BAuA Employment Survey (58% uptake among those informed), Präventionsbericht 2025 (mean duration of workplace health promotion activities 24 months, 42% with a steering committee), #whatsnext 2025 (26.8% with holistic corporate health management).

You will come across these figures in proposals. Here is why we do not use them.

Can you guarantee us a return on investment?
No. And that answer is worth more than a yes. The most recent evidence report from Germany's prevention stakeholders gives an ROI of 1.8 in the methodologically strong studies. In the randomised trials, more than 50% show no savings at all, and the same report states that US figures cannot be transferred because German employers do not bear treatment costs. Anyone who promises you a return has either not checked or is counting on you not to.

Why do you set out the weaknesses of your own market so plainly?
Because a finance department that does its own research will find them anyway. It is better to put the counter-evidence on the table yourself than to have it put to you in the second meeting. All the incriminating sources cited here are German, free of charge and published by the statutory health and accident insurers themselves.

If the studies find nothing, why should we do anything at all?
Because what was measured was mostly untargeted programmes with low participation over short periods. iga.Report 40 itself names the low participation rates. From this we derive design principles (section 5) rather than promises of a return. And the four pillars in section 10 do not presuppose any cost savings.

How many German organisations actually have systematic corporate health management?
26.8% say they have holistic corporate health management; 32.0% implement workplace health promotion measures and are building up corporate health management; 30.6% have individual measures; 8.8% have nothing at all. The study notes: "there has been no increase since 2022" (#whatsnext 2025, n = 1,514).

And what about budgets?
17.6% of organisations have no financial resources for corporate health management, and 33.0% have less than €10,000 a year. Around half are therefore at or below €10,000, and this distribution has been stable since 2022. Only 18.3% expect a larger budget over the next three years (#whatsnext 2025, n = 1,424; personnel costs not included).

Doesn't the statutory health insurance fund pay for this anyway?
In part, and with conditions. In 2024 the funds reached around 28,142 establishments and 2.06 million employees, which is roughly 5 to 6% of employees. At the same time, 53% of employees say their employer provides some form of programme. The vast majority of workplace health promotion in Germany is funded by employers. Details are on our page Introducing a health programme.

What is the most honest sentence on this page?
This one: in 2024 the statutory health insurance funds spent around €282 million on workplace health promotion, and they judge its success essentially by whether participants and employers were satisfied.

Every figure on this page has a named publisher, the year of the data, the year of publication and a link to the primary document.

Official statistics and ministries

1. Bundesanstalt für Arbeitsschutz und Arbeitsmedizin (BAuA): Volkswirtschaftliche Kosten durch Arbeitsunfähigkeit 2024. Data year 2024, national accounts as at 21 October 2025. https://www.baua.de/DE/Themen/Monitoring-Evaluation/Zahlen-Daten-Fakten/Kosten-der-Arbeitsunfaehigkeit · PDF: https://www.baua.de/DE/Themen/Monitoring-Evaluation/Zahlen-Daten-Fakten/pdf/Kosten-2024.pdf
2. BAuA, Fassbender, L.; Perleberg, M.; Meyer, S.-C.: Präsentismus und Absentismus. Verbreitung und Zusammenhänge mit ausgewählten Arbeitsbedingungen. baua: Bericht kompakt, 2025, data source BAuA working time survey 2023, n = 11,199. https://www.baua.de/DE/Angebote/Publikationen/Bericht-kompakt/Praesentismus
3. BAuA, Steinke, M.; Badura, B.: Präsentismus. Ein Review zum Stand der Forschung. Dortmund 2011, ISBN 978-3-88261-126-7. https://www.baua.de/DE/Angebote/Publikationen/Berichte/Gd60.html
4. BAuA: Betriebliche Gesundheitsförderung 2024: Entwicklung von Angebot und Teilnahme. baua: Fakten, series BIBB-BAuA-57, 2026. https://www.baua.de/DE/Angebote/Publikationen/Fakten/BIBB-BAuA-57
5. Bundesministerium der Finanzen: letter of 20 April 2021, ref. IV C 5 - S 2342/20/10003 :003, Umsetzungshilfe zur steuerlichen Anerkennung von Arbeitgeberleistungen nach § 3 Nummer 34 EStG, published as Annex 18c to the Lohnsteuer-Hinweise. https://esth.bundesfinanzministerium.de/lsth/2023/B-Anhaenge/Anhang-18c/anhang-18c.html
6. Statistisches Bundesamt: press release no. 148 of 29 April 2026, Arbeitskosten je geleisteter Arbeitsstunde 2025. https://www.destatis.de/DE/Presse/Pressemitteilungen/2026/04/PD26_148_624.html

Statutory health and accident insurance

7. Initiative Gesundheit und Arbeit (iga), Barthelmes, I.; Bödeker, W.; Sörensen, J. et al.: iga.Report 40. Wirksamkeit und Nutzen arbeitsweltbezogener Gesundheitsförderung und Prävention. Zusammenstellung der wissenschaftlichen Evidenz 2012 bis 2018, 1st edition November 2019. https://www.iga-info.de/fileadmin/redakteur/Veroeffentlichungen/iga_Reporte/Dokumente/iga-Report_40_Wirksamkeit_und_Nutzen_Gesundheitsfoerderung_Praevention.pdf
8. iga, Sockoll, I.; Kramer, I.; Bödeker, W.: iga.Report 13, 1st edition April 2008.
9. iga, Kreis, J.; Bödeker, W.: iga.Report 3. Gesundheitlicher und ökonomischer Nutzen betrieblicher Gesundheitsförderung und Prävention, 2003. https://www.dguv.de/medien/inhalt/praevention/praev_lohnt_sich/wirtschaftlichkeit/wirtschaftlichkeit_volkswirtschaft/iga-rep-03.pdf
10. iga: iga.Report 28. Wirksamkeit und Nutzen betrieblicher Prävention, 1st edition February 2015. https://www.iga-info.de/fileadmin/redakteur/Veroeffentlichungen/iga_Reporte/Dokumente/iga-Report_28_Wirksamkeit_Nutzen_betrieblicher_Praevention.pdf
11. Joint press release of BKK Dachverband, DGUV, AOK-Bundesverband and vdek of 31 March 2015 on iga.Report 28. https://www.vdek.com/presse/pressemitteilungen/2015/iga_report_28.html
12. iga: iga.Report 49. Gesunde, sichere Arbeit: ein Schlüssel für die Arbeitgeberattraktivität?, 2026, n = 1,847. https://www.iga-info.de/veroeffentlichungen/igareporte
13. GKV-Spitzenverband und Medizinischer Dienst Bund, Kaun, L.; Brunoni, C.: Präventionsbericht 2025, reporting year 2024, as at November 2025, ISSN 2198-0004. https://www.gkv-spitzenverband.de/media/dokumente/krankenversicherung_1/praevention__selbsthilfe__beratung/praevention/praeventionsbericht/2025_GKV_MD_Praventionsbericht_barrierefrei.pdf
14. GKV-Spitzenverband: Leitfaden Prävention. Handlungsfelder und Kriterien nach § 20 Abs. 2 SGB V, version of 17 December 2025. https://www.gkv-spitzenverband.de/media/dokumente/krankenversicherung_1/praevention__selbsthilfe__beratung/praevention/praevention_leitfaden/20251218_Leitfaden_Pravention_2025_barrierefrei.pdf
15. Zentrale Prüfstelle Prävention, Prüfprozess. https://www.zentrale-pruefstelle-praevention.de/

Health insurance fund data and research

16. Wissenschaftliches Institut der AOK (WIdO): Fehlzeiten-Report 2025, data chapter Krankheitsbedingte Fehlzeiten in der deutschen Wirtschaft im Jahr 2024, Springer 2025, DOI 10.1007/978-3-662-71885-8_24. https://www.wido.de/fileadmin/Dateien/Dokumente/Publikationen_Produkte/Buchreihen/Fehlzeitenreport/wido_fzr2025_ki_und_gesundheit_krankheitsbed_fehlzeiten.pdf
17. WIdO: Fehlzeiten-Bilanz 2025, press release of 16 March 2026, with the model calculation on the eAU effect. https://www.wido.de/news-presse/pressemitteilungen/2026/fehlzeiten-bilanz-2025-leichter-rueckgang-der-krankheitstage-weiterhin-hohe-ausfallzeiten-wegen-langzeiterkrankungen/
18. DAK-Gesundheit: Gesundheitsreport 2023, 19 April 2023, routine data on 2.4 million insured people plus over 7,000 forsa respondents. https://www.dak.de/dak/unternehmen/reporte-forschung/gesundheitsreport-2023_34592
19. Institut DGB-Index Gute Arbeit: Kompakt 01/2025, survey wave 2024, n = 6,985.
20. Institut der deutschen Wirtschaft, Pimpertz, J.: Entgeltfortzahlung bei Krankheit kostet 85,6 Milliarden Euro, IW-Kurzbericht Nr. 57 of 29 August 2026. https://www.iwkoeln.de/studien/jochen-pimpertz-entgeltfortzahlung-bei-krankheit-kostet-856-milliarden-euro.html
21. Techniker Krankenkasse, IFBG und Haufe Personalmagazin: #whatsnext 2025: Gesund arbeiten in herausfordernden Zeiten, fieldwork 6 January to 14 February 2025, n = 1,529 organisations. https://www.tk.de/resource/blob/2197646/74c9dbc71dac772c8cd5d7bb71d2729b/whatsnext-2025-data.pdf

Studies

22. Jones, D.; Molitor, D.; Reif, J.: What Do Workplace Wellness Programs Do? Evidence from the Illinois Workplace Wellness Study. Quarterly Journal of Economics 2019;134(4):1747-1791.
23. Song, Z.; Baicker, K.: Effect of a Workplace Wellness Program on Employee Health and Economic Outcomes: A Randomized Clinical Trial. JAMA 2019;321(15):1491-1501, n = 32,974.
24. Rothermund, E. et al. (FRIAA): Psychotherapy and Psychosomatics, December 2025, n = 550.
25. Mulfinger, N.; Waldmann, T.; Herold, R. et al. (FRIAA, health economics): Journal of Mental Health Policy and Economics 2026;29(1):23-35.
26. Mulfinger, N.; Jarczok, M. N.; Müller, A. et al. (SEEGEN): PLOS ONE 2025;20(8):e0330490, DOI 10.1371/journal.pone.0330490.
27. Gloede, D.; Ducki, A.: Die Effizienz betrieblicher Gesundheitsförderung. Prävention und Gesundheitsförderung 2011;6:131-137, DOI 10.1007/s11553-010-0275-9.
28. Auer, T. F.; Sennefelder, L.; Meier, H.: Betriebliche Gesundheitsförderung: Ein leeres Versprechen? Public Health Forum 2022;30(3):214-216, DOI 10.1515/pubhef-2022-0069.
29. Maar, C.; Fricker, R.; Hildebrandt, N.; Drechsler, M.: Vorteil Vorsorge. Booz & Company / Felix Burda Stiftung, 2011. https://www.felix-burda-stiftung.de/sites/default/files/documents/Studie_FBS_Booz_Vorteil_Vorsorge_2011.pdf
30. Aldana, S. G.: Financial Impact of Health Promotion Programs: A Comprehensive Review of the Literature. American Journal of Health Promotion 2001;15(5):296-320.
31. Hollederer, A.: Betriebliche Gesundheitsförderung in Deutschland: Verbreitung, Inanspruchnahme und soziale Disparitäten in der BIBB-/BAuA-Erwerbstätigenbefragung 2018. Das Gesundheitswesen 2022;84(08-09):753, n = 20,012, DOI 10.1055/s-0042-1753687.

Legal sources

32. Section 3 no. 34 EStG: https://www.gesetze-im-internet.de/estg/__3.html
33. Section 8(2) sentence 11 and Section 8(4) EStG: https://www.gesetze-im-internet.de/estg/__8.html
34. Section 42e EStG (binding ruling): https://www.gesetze-im-internet.de/estg/__42e.html
35. Section 3(1) EntgFG (continued payment of wages for up to six weeks): https://www.gesetze-im-internet.de/entgfg/__3.html
36. Sections 20 and 20b SGB V: https://www.gesetze-im-internet.de/sgb_5/__20.html · https://www.gesetze-im-internet.de/sgb_5/__20b.html
37. Sections 5 and 6 ArbSchG (risk assessment, including Section 5(3) no. 6 mental stress): https://www.gesetze-im-internet.de/arbschg/__5.html
38. Section 21(1a) ArbSchG (minimum inspection rate of 5% from 2026): https://www.gesetze-im-internet.de/arbschg/__21.html
39. Drittes Bürokratieentlastungsgesetz of 22 November 2019, BGBl. I 2019 p. 1746 (increase from €500 to €600 as of 1 January 2020).
40. Gemeinsamer Bundesausschuss, Gesundheitsuntersuchungs-Richtlinie. https://www.g-ba.de/richtlinien/10/

Cross-references: Introducing a health programme in Germany (/de-de/bgm-einfuehren), Data protection, confidentiality and co-determination in corporate health management (/de-de/datenschutz-bgm) and the key figures with full source references (/de-de/bgm-zahlen-deutschland).

This page explains the publicly available evidence and the legal position. It is not legal or tax advice and does not replace a review of your individual case. For tax questions, what counts is the view of your tax adviser or a binding ruling under Section 42e EStG.

As at September 2026. Next review: March 2027 (WIdO Fehlzeiten-Bilanz), then November 2027 (GKV Präventionsbericht).