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Seven reasons for coordinating road benefits in place

Reporter: Christine Novita Nababan | Editor: Hendra Gunawan

JAKARTA. The Indonesian Life Insurance Association (AAJI) notes that there are at least seven reasons for the coordination of benefits or the Coordination of Benefit / CoB between the National Health Insurance program implemented by the Health Social Security Administering Body and private road insurance in place.

First, the participant registration process and contribution payments that must be made by business entities or corporate participants directly to BPJS Kesehatan. In fact, the previous agreement still allowed registration and payment of contributions to be made through private insurance companies.

Second, the limited number of non-BPJS Kesehatan health facilities that can accept CoB participants is only 16 hospitals from the previous 20 hospitals. “Where previously, our proposal was as many as 1,200 hospitals,” said Maryoso Sumaryono, Head of Regulation of AAJI, Friday (12/12).

Third, he continued, the quality of primary health care facilities (outpatient first level) was inadequate and the distribution was not evenly distributed. Fourth, the elimination of CoB benefits for advanced outpatient care in the executive clinic. This statement is clearly written in the draft addendum to the CoB cooperation agreement in October 2014.

Fifth, the absence of CoB for individual participants who become customers of private insurance companies. Sixth, advanced outpatient procedures at non-BPJS Kesehatan health facilities that can accept CoB participants, namely tiered procedures can be performed at BPJS Kesehatan primary health facilities and the need to upgrade to treatment classes.

“Seventh, referring to the reasons above, it is very unlikely that risk sharing will occur. Thus, the reduction in premiums expected by business entities cannot occur, instead it has the potential to cause a high cost economy, ”explained Maryoso.

According to him, in principle, life insurance industry players support government policies in implementing the National Health Insurance program. In fact, at least 30 private insurance companies also signed a benefit coordination cooperation with BPJS Kesehatan. Unfortunately, the design of the CoB addendum has made it difficult for industry players.

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