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ASM arranges benefit coordination with BPJS

Reporter: Christine Novita Nababan | Editor: Sanny Cicilia

JAKARTA. In order to keep the health insurance business line alive, PT Asuransi Sinar Mas is arranging the coordination of benefits (coordination of benefits) with the Social Security Administering Body (BPJS) in the health sector. This benefit coordination will later regulate the application of social security with additional insurance from private insurance.

Several points were coordinated, among others, related to the health service provider system and claims. ASM wants the 1,000 hospital providers that have worked with him so far remain the hospital of choice for inpatient facilities.

Particularly regarding claims, ASM wants the claim procedure to be centralized by the system, not manually, as was done by BPJS Kesehatan, the former PT Askes (Persero), namely by each region. “Many of our proposals are being considered by BPJS. Indeed, it cannot be fast, because the coordination of benefits is a lot of points that are cooperated, “said Dumasi MM Samosir, Director of ASM, Monday (14/4).

Therefore, ASM does not want to rush to finalize the coordination of these benefits. Like a word, let me slow down as long as you safely reach your destination. Please understand, in addition to the health service provider system and claims, the coordination of benefits must also be related to the payment of premiums. This is because social security claims to cover all costs of health services, inpatient and outpatient care.

Meanwhile, additional insurance will only play a role in the inpatient process. That, too, is limited to the cost of non-medical health services, such as inpatient rooms. “Given, 80% of health insurance claims in ASM actually come from outpatient care. Not hospitalization. Well, how about this, “he concluded.

As of the third quarter of this year, the ASM health insurance business line itself contributed 19 percent or Rp 418.346 billion. This business is the second highest contributor after the fire insurance line. The company’s total premiums reached Rp. 2,214 trillion as of March 31, 2014.

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