Additional solidarity tax (France, TSA)
A tax levied on supplementary health insurance premiums, varying according to whether the contract is responsible or not, which funds notably the solidarity supplementary health cover.
Supplementary health contracts are not subject to the ordinary insurance premium tax, but to a specific tax, the additional solidarity tax, provided for by the Social Security Code. It is calculated on premiums and collected by supplementary insurers, which pass it on to insureds. Its rate is the main tool of public policy in supplementary health: about 13 percent for responsible and solidarity contracts, and markedly higher, around 20 percent, for contracts that do not meet the specifications or that select insureds by health status. The gap is enough to make non-responsible contracts marginal on the market. The tax's proceeds fund the body that pays for the solidarity supplementary health cover of low-income households, making it a redistribution mechanism internal to the market: each insured contributes to the cover of those who cannot afford it. The tax weighs significantly on the final price of contracts, and its evolution is a recurring issue in the social security financing acts. For the analyst, it shows how the state steers a private market without administering it, through taxation rather than prohibition.
Hypothetical case: a mutual offers two contracts with the same benefits, one responsible, the other not. For a pre-tax premium of 1,000 euros, the insured pays about 1,130 euros for the first and 1,200 euros for the second; the tax difference alone steers almost all customers toward the responsible contract.
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