Updated 8.10am with health ministry response

A couple who are legally cohabiting and were waiting to give birth were denied free medical treatment in hospital two weeks before the due date because the woman, who is German, was told she is not entitled for free healthcare unless she is employed.

Sandra Binder and Jan Frenznick have been together since 2019 and decided to enter into legal cohabitation a year ago. Later, they found out Sandra was pregnant and she decided to stop working three months before her due date.

Jan is Maltese and Sandra had been living and working in Malta for three years but, due to worries that the pandemic might affect her pregnancy, the couple decided it would be safer for her to stop working temporarily.

“We were legally cohabiting and we were told by some hospital staff and the notary that the law covered her healthcare because cohabitation was meant to grant us the same legal rights as marriage,” Jan explained.

It was a great shock because we realised we had no financial means or insurance to pay for our healthcare two weeks before she gives birth- Jan Frenznick

“We checked about this before we entered into cohabitation and it really seemed like the wording of the law vowed to protect cohabiting couples just like married ones. But it doesn’t and we learned that the hard way.”

The couple were visiting the hospital for medical appointments and normal check-ups during pregnancy and they were never asked to pay for the healthcare service, which further let them to believe this would not be an issue.

Home without a check-up

One day, two weeks ahead of due date, hospital staff asked Sandra for a payslip to prove she work in Malta.

“As we walked in for one of our routine visits, they refused to check her and only wanted to see a payslip or a credit card. We went back home, heavily pregnant and crying, without ever getting a check-up,” he said.

Because Sandra could not provide a payslip that proved she worked and paid national insurance in Malta, she was denied medical care, despite the fact that she is a EU national.

“It was a great shock, not just because this was the first time we had ever heard something like this but also because we realised we had no financial means or insurance to pay for our healthcare two weeks before she gives birth,” Jan said.

“I’m Maltese, I’ve been paying social security all my life, so have my parents. My girlfriend did the same back home in Germany and for three years here. How come a country, that is so against abortion, does not cover a pregnant European Union citizen with a Maltese father?

“Also, why does the Cohabitation Act cover nearly all aspects of a marriage but not free medical care?”

It turns out the law does grant couples who choose cohabitation most of the rights that married couples enjoy.

They share the same work and family-related rights as married couples and also have the right to take all decisions relating to medical care of the other cohabitant and are entitled to various social security entitlements.

‘No reference’ in the law

To Jan and Sandra, some staff at Mater Dei Hospital and their notary, this sounded like cohabiting couples were also entitled to free healthcare, just like married couples.

But the authorities disagreed, arguing that nowhere in the law is there a direct reference to free healthcare.

They told them “labour and family-related rights” referred to workplace and family rights that had nothing to do with free healthcare.

That taking decisions related to medical care referred to having a say in extreme cases and not to accessing the public health service.

And that, even though the law says they are entitled to various social security entitlements, free medical aid or access to the public health service is not mentioned.

“We argued that free healthcare is not directly mentioned in the law for married couples and they still get it,” Jan said.

Free healthcare only after birth

The Government Entitlement Unit eventually told Jan that, because he is Maltese, the baby would be entitled to free healthcare here but only once it is born, leaving the young father panicked, not knowing what to do until labour.

“It was all futile. I am self-employed and eventually I had to employ my partner with me so that she has a payslip and I could pay her national insurance through my company.”

Sandra eventually gave birth a few weeks ago and they say all is fine now  and they are trying to regain normality but they wanted to raise awareness about the issue, which could still affect other couples like them.

Late last year, the same issue was raised by a British national living in Malta who petitioned the European Parliament to investigate a possible breach of EU law, claiming that Mater Dei Hospital is discriminating on the basis of nationality and failing to guarantee equal access to health treatment.

Non-Maltese EU, EEA or Swiss citizens should not be treated less favourably than the Maltese nationals are- European Commission

According to her petition, the hospital requires European Union citizens to provide payslips as proof of payment into Malta’s social security system while Maltese citizens are only asked to show their ID cards.

The European Parliament forwarded the petition to the European Commission, which said the hospital is probably discriminating against non-Maltese European Union nationals.

“In other words, this means that non-Maltese EU, EEA or Swiss citizens should not be treated less favourably than the Maltese nationals are,” it said in an opinion published last November.

“The same conditions of eligibility for sickness benefits in kind as provided by the Maltese legislation apply to all insured persons regardless of their nationality.”

'Cohabitation not sufficient for healthcare benefits'

In response to questions from Times of Malta, the health ministry said that cohabitation status was not enough to grant partners entitlement to healthcare benefits.

The ministry said standard procedure at Mater Dei was for patients' entitlement status to be crosschecked with JobsPlus data.

Until recently, the ministry said, payslips would be requested if the patient was not employed.

"Following discussions with the European Commission, the Health Authorities have updated the way these cases are handled to ensure equal rights to patients and to improve the overall petient experience when visiting Mater Dei Hospital.

"These discussions are still ongoing, however a number of actions have already been implemented," a spokesperson said.