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New BPJS benefit coordination scheme

Reporter: Dina Farisah | Editor: Rizki Caturini

JAKARTA. Benefit coordination scheme or coordination of benefits (CoB) BPJS Health and commercial insurance renewed. The new CoB scheme is more attractive to commercial insurance.

Wahyuddin Bagenda, Director of Information Technology for BPJS Kesehatan, said that the new CoB scheme still refers to BPJS Health Regulation No. 4/2016 on Technical Guidelines for Benefit Coordination.

This new scheme benefits participants as well as commercial insurance or additional health insurance (AKT). “In the past, the JKN-KIS (National Health Insurance-Healthy Indonesia Card) product was separated from additional health insurance products, now JKN-KIS is a riders product from additional health insurance,” said Wahyuddin.

There are three things that are different from this new scheme. First, membership. Previously, the company registered JKN-KIS directly to BPJS Kesehatan. Now companies can register their JKN-KIS membership through AKT. Second, payment of dues. In the past, the JKN-KIS premium and the AKT premium were paid separately, now the JKN-KIS premium can coincide with the AKT premium.

However, if the company has more than one AKT, then CoB is only for one health insurance partner that partners with BPJS Kesehatan. Alternatively, participants or business entities can register and pay dues to BPJS Kesehatan without going through the AKT.

Third, health services. If the old CoB limits referrals from first level health facilities (FKTP) in collaboration with BPJS Kesehatan. The new rule is that participants can use referrals from non-BPJS Health FKTPs in partnership with AKTs, provided that they refer to non-specialized cases.

Currently there are 23 insurance companies that are part of the 53 companies that signed a memorandum of understanding with BPJS Health but have not implemented the CoB scheme in the field. This CoB collaboration is valid for one year. This rule is effective on March 1, 2017.

Irfan Humaidi, Head of the Communication and Public Relations Department of BPJS Kesehatan, said that the CoB scheme can attract many BPJS Kesehatan participants. He is sure that the claims that are borne will not swell.

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