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Let's take a peek at the principles of BPJS-insurance benefit coordination

Reporter: Christine Novita Nababan | Editor: Sanny Cicilia

JAKARTA. Coordination of atawa benefits coordination of benefits (COB) between the Health Social Security Administration (BPJS) and the private insurance industry has been completed. What are the principles of benefit coordination covered by BPJS Health and private insurance. Come on, take a peek at the cooperation grid.

First, Fajriadinur, Director of BPJS Health Services, said that the coordination of benefits applies if BPJS Kesehatan participants buy additional health insurance from the Provider of the Additional Health Insurance Program or other insurance agency which is in fact commercial insurance in collaboration with BPJS Kesehatan.

Second, the coordination of benefits received by BPJS Kesehatan participants does not exceed the total cost of health services.

Third, the coordination of benefits covered by BPJS Kesehatan is health services according to the agreement between BPJS Kesehatan and commercial insurance.

“The cooperation contract has been signed between BPJS Kesehatan and the Indonesian Life Insurance Association (AAJI) and the Indonesian General Insurance Association (AAUI). This will be a reference for each individual member who wants to cooperate with us by COB. Well, later business to business between BPJS Kesehatan and each company, “said Fajriadinur, Thursday (2/4).

For your information, several COB regulations in BPJS Kesehatan health services include following a tiered referral system, using a BPJS Health card and a private insurance card, advanced outpatient admission to the executive poly, advanced inpatient admission to care above the class rights granted BPJS Health.

BPJS Kesehatan guarantees fees according to the rates applicable to the National Health Insurance program. Meanwhile, the difference is the responsibility of the private insurance company in accordance with the agreed policy to the policy holder.

COB in non-BPJS Health services is another story. Here, participants only receive inpatient services at certain hospitals (according to the agreement between BPJS Kesehatan and private insurance). Service fees are paid in advance by private insurers or participants (participants submit reimbursements to the policy issuer).

“Furthermore, commercial insurance bills to BPJS Kesehatan and we reimburse the cost with type C hospital rates based on the regionalization of INA CBG’s rates where the health facilities are located. There are no individual claims to BPJS Kesehatan in this case, “he concluded.

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