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National Health System for Expats in Malta

Submitted: November 2013

Malta’s healthcare system is strongly inspired from that of the UK, except that it sounds slightly more continental than the British system.

National health services are primarily funded by general tax revenue and national insurance contributions. There is generally no charge to pay at user-point, unless you are not entitled to healthcare benefits.

Nevertheless, Malta departs from the British tradition in that entitlement depends on whether an individual is subject to social security legislation. Unlike the UK, the system is not residence-based. Foreign nationals can get healthcare benefits, but they have to work and pay social security contributions in Malta.

Furthermore, there is a growing private healthcare sector as more and more Maltese residents choose to go private. The share of public healthcare expenditures as a proportion of total expenditures (public and private) has recently decreased in Malta (around 65%) whereas it has stayed high in the UK (around 83%).

Social insurance

Insured persons

Under section 3 of the Social Security Act, you are an insured person if:

  • you are aged 16 or over
  • you are not a retiree, and
  • you are “employed”, “self-occupied” or “self-employed”.

In Malta, a self-employed individual earning at least €910 per annum is treated as “self-occupied”. On the other hand, you are “self-employed” if:

  • you are neither “employed” nor “self-occupied”
  • you are aged below 65
  • you are ordinarily resident in Malta
  • you are not in full-time education or training, and
  • you are not in receipt of welfare benefits.

Contributions

Maltese national insurance contributions are income-tested, although there are minimum contributions. These payments are towards social security benefits generally, such as unemployment, maternity, etc.

As in the UK, national insurance contributions are paid to the Inland Revenue along with income taxes. There are class 1 contributions and class 2 contributions. The former are paid by students, employees and employers while the latter are paid by “self-occupied persons” earning more than €910 per year and “self-employed persons”.

The cost of class 1 contributions is equally shared by employees and employers. Employees normally pay 10% and employers pay a further 10%, subject to a minimum (on each side) of around €850 a year and a maximum of about €2,100 a year.

Generally speaking, class 2 contributions are charged at 15% of your insurable earnings. The minimum is around €1,300 per year and the maximum is about €3,100 per year.

Other situations

Typically, family members of an insured person (spouse and dependent children) are also eligible for free healthcare services. You would also qualify if you receive a pension from the Government.

In addition to that, there are social assistance programmes for low-income and chronically ill individuals.

International considerations

If you think you can get free treatment in Malta, you must register with the Entitlement Unit immediately. Do not stay unregistered unless you are just a temporary visitor.

Generally speaking, you can only get free treatment in Malta. If you require a complex surgery for which Malta does not have enough equipment, you would have to be flown abroad. In such case, treatment would not be free unless you are a Maltese citizen.

Australian visitors

Australian residents travelling to Malta can get free healthcare for the first six months of their stay. This bilateral agreement works only if a medical necessity arises while an Australian resident is in Malta.

EU expatriates

If you are an EEA resident travelling temporarily to Malta, you should apply for a European Health Insurance Card (EHIC) in your home country before coming to Malta. EHIC is designed to grant you access to free public healthcare services on the same basis as Maltese residents. You can use EHIC only for medical necessities arising whilst you are in Malta.
The EHIC is just designed for temporary travel, and the EU strongly recommends to take out private health insurance in addition to an EHIC.

Certain EU expats in Malta, e.g. pensioners or workers on secondment, may apply for a portable document S1 in their home country. Such workers keep paying social insurance contributions in their home country, but not in Malta. If you have been issued a portable document S1, do immediately apply for a certificate of entitlement from the Entitlement Unit. You will need to keep certificate of entitlement with you to secure free healthcare services in Malta.

UK expatriates

Under the Reciprocal Health Agreement (RHA) UK/Malta, UK nationals who can prove that they are ordinarily resident in Malta are entitled to certain free healthcare services. They can then apply for an RHA entitlement card. Such a card does not entitle you to:

  • Free NHS services back home in the UK, even for a surgery that cannot be made in Malta
  • Free healthcare services outside Malta
  • A Malta-issued EHIC card

Due to the rights conferred by EU law (see above), the RHA has become less attractive for UK expats. Instead, British nationals should consider using a UK-issued EHIC (temporary visitors only) or a UK-issued portable document S1.

 

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