Sickness, maternity, and equivalent paternity benefits

Sickness benefits can be in the form of benefits in kind or in cash.  Benefits in kind refer to the healthcare benefits you receive in the form of medical care, treatment, and pharmaceuticals.  Benefits in cash refer to the monetary benefits/compensation paid by the social security institution due to a sickness claim.

It is important to note that sickness benefits in kind are provided by the country of residence according to the conditions which apply there, regardless of where the person is insured for social security purposes.

On the contrary, benefits in cash are provided from the country where the person insured, regardless of the country of residence and of the conditions which apply there.

• Benefits in Kind

Benefits in kind provide, pay directly, or reimburse the cost of medical care, related products, such as medicines, and related services.  In other words, sometimes benefits in kind are provided in cash, e.g. when the person receives a payment that reimburses healthcare treatment expenses previously incurred.

As a rule, these benefits are provided by the country of residence or stay as if the person was insured in that country for social security purposes.  This may or may not be to the person’s advantage in comparison to the legislation of the country where the person is insured.

All procedures, deadlines and conditions for entitlement are decided at the national level.

In Malta, the Ministry for Health is the competent institution for Sickness Benefits in Kind.

• Benefits in Cash

The country where a person is insured for social security purposes is always responsible for paying the sickness, maternity, or paternity benefits in cash, i.e. benefits that replace a wage that has been suspended due to sickness. These benefits will be paid according to the rules of the country where the person insured, regardless of where the person is living or staying.

Benefits in cash are normally intended to replace an income (wages, salaries) which is suspended due to sickness or maternity/paternity.   Benefits provided in a specific situation, e.g. the dependence of a sick or disabled person on another person’s assistance, may also be regarded as sickness benefits in cash, such as carer’s benefits.

The amount and duration of these benefits depend entirely on the legislation of the country where the person is insured for social security purposes. All benefits in cash will normally be paid to the person directly by the competent institution of that country.

In Malta, the Department of Social Security is the competent institution for Sickness Benefits in Cash.

In terms of the Maltese scheme, the following benefits are considered as Sickness Benefits in Cash:

• Sickness Benefit
• Maternity Benefit
• Maternity Leave Benefit

Malta does not provide paternity benefits in cash under the national scheme.

When a person’s work activity has been confined to the Maltese social security scheme only, or when the periods of insurance completed in Malta are such that the eligibility criteria are satisfied, the national procedures will apply.  However, if a person’s work activity involves one or more EU Member States, the EU rules on social security coordination are applied as outlined in the following scenarios.

Frequently Asked Questions

As a rule, Sickness Benefits, Maternity and Equivalent Paternity Benefits in cash are always paid according to the legislation where a person is insured, regardless in which country one is residing or staying.

1. I am insured and resident in Malta, but I am not eligible for sickness benefits in cash. What can I do?

When a person insured under the Maltese social security scheme claims sickness benefits according to the national procedures, but does not satisfy the contribution conditions (at least 50 weeks of contribution payments in Malta and for at least 20 weeks in the 2 years preceding the sickness benefits claim),  the insurance record for the purposes of sickness benefits completed in another EU Member State is required.  This record (document S041 or E104) is exchanged between social security institutions.  In such case, therefore, the person should contact the Department of Social Security to initiate the procedure.  Once the S041 or E104 document is received, the sickness benefits claim is revised accordingly.

2. I was insured in Malta but now moved to another EU Member State. How can I obtain a record of my insurance periods in Malta?

When a person moves to another EU Member State and is required to provide information about the previous insurance completed in Malta (document S041 or E104), the competent institution in that Member State should request the information directly from the Maltese social security institution.  In order to hasten the process, the person should provide the competent institution with the documents relevant to the Maltese scheme such as:

• the social security number
• the FS3 documents (issued by the Maltese employer) covering the periods of employment in Malta, or
• the social security contributions receipts in case of self-employed persons

Once completed, the insurance periods are sent directly to the competent institution in the Member State of residence.

3. I am insured in Switzerland but reside in Malta. How can I claim sickness benefits?

A person resident in Malta but insured in another Member State, who needs to claim sickness benefits in cash from the Member State of insurance, should contact the Department of Social Security in order to initiate the procedure.   The person should provide:

• a medical certificate
• details of the Member State of insurance
• the relative social security number

Based on this information, the claim form will be compiled and forwarded to the competent Member State, who will then get in touch with the person directly.

4. I am insured in Malta but reside in Italy. How can I claim sickness benefits?

A person resident in another Member State but insured in Malta, who needs to claim sickness benefits in cash from Malta, should submit a medical certificate issued by the treating doctor in the Member State of residence to the Department of Social Security. Alternatively, the person can also contact the social security institution in the Member State of residence together with the relative medical certificate as supporting evidence.  The institution in the Member State of residence will compile the claim from and forward the claim to the Department of Social Security.  When received, the Department will contact the applicant directly to request the information required to process the claim.  This may include:

• bank details
• working schedule
• civil status
• employment status of spouse or partner (where applicable)
• If the person has not yet contributed in the Maltese scheme for a minimum of 50 weeks and for at least 20 weeks in the 2 years preceding the sickness benefits claim, the Department may also require form S041 or E104 from the Member State of previous insurance (see question 1)

Once all the required information is available to the Department, the sickness benefits claim is processed accordingly.  If it results that the benefit is due, this is paid in the bank account provided, be it local or foreign.  The duration of the benefit is in accordance with national procedures.

5. I am insured and resident in Malta but fell sick while on holiday in Ireland. How can I claim sickness benefits?

A person resident and insured Malta who falls sick during a temporary stay abroad, should claim sickness benefits from Malta in accordance with the national procedures.  In the event that the treating doctor or company doctor is not in a position to issue the blue medical certificate provided under the national procedures, the person should forward the medical certificate issued by the treating doctor in the Member State of stay, to the Department of Social Security and provide also:

• social security number,
• bank details,
• working schedule,
• civil status,
• employment status of spouse or partner (where applicable).

Unless further information is required, the claim is processed accordingly.

6. I am pregnant and have just moved to Malta to be with my partner who found a job in Malta. Am I entitled to maternity benefits?

Maternity benefit in Malta is based on residence and does not depend on whether a person is insured in the social security scheme.  Therefore a person who has been granted a residence status in Malta and is not working, can follow the national procedures.

However, if before moving to Malta the person was insured in an EU Member State, the latter would be competent for the payment of the Maternity Benefits.  In that case, the person should contact the institution of the country of last insurance to check how to claim the benefits.  Alternatively, the Department of Social Security can initiate the procedure on the person’s behalf.   A medical certificate and details of the Member State of insurance as well as the relative social security number should be provided.  Based on this information, the claim form will be compiled and forwarded to the competent Member State who will then get in touch with the person directly.

7. I was living and working in Malta but returned to my Member State of origin until after the childbirth. Am I entitled to maternity benefits?

Maternity Benefit is paid by the country of last insurance.  Hence, if during the period of stay in the country of origin the person did not start working there, Malta would remain competent for the payment of the Maternity Benefits.  In order to claim the benefits, the person should contact the social security institution in the country of stay to fill out the claim forms which will be sent over to the Department of Social Security.  Once processed, the person is informed directly of the outcome of the claim.

8. I was insured in Malta while residing in another Member State. How can I claim Maternity Benefits?

Provided that the person is not entitled to Maternity Benefits based on residence in the other Member State, Malta would be competent for the payment of the Maternity Benefits even if the person never resided in Malta.  In order to claim the benefits, the person should contact the social security institution in the country of stay to fill out the claim forms which will be sent over to the Department of Social Security.  Once processed, the person is informed directly of the outcome of the claim.

9. I am living and/or insured in Malta. How can I claim Paternity Benefits?

Malta does not provide for Paternity Benefits in cash under its social security scheme.