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The implementation of the coordination of the benefits of the BPJS is still minimal

Reporter: Christine Novita Nababan | Editor: Hendra Gunawan

JAKARTA. The implementation of coordination of benefits (COB) between commercial insurance and the Social Security Administration for Health (BPJS) is still far from perfect. Instead of working, only from the six aspects of the scope of benefit coordination, only one of them can be coordinated.

This is the participation coordination that is currently under way. This coordination, among others, regulates the implementation of the national health insurance program with additional benefits from commercial insurance for participants. “That is only limited to corporate or group participants, not including individual health insurance participants,” said Angelia Agustine, Head of Group Policy Management and Claim Allianz Life Indonesia, Monday (15/9).

In fact, in addition to membership coordination, the COB scheme between commercial insurance and BPJS Health also includes health service benefit coordination, premium and premium coordination, information system coordination, socialization coordination and claims collection coordination.

In coordinating the benefits of health services, Angelia explained that her party is still constrained by the implementation of COB in the field. Please understand, the principle of health services in the BPJS Kesehatan health facility hospital, the inpatient procedure requires that participants get a referral from a family doctor / clinic / puskesmas. This also applies to participants who purchase additional benefits from commercial insurance.

Obviously different from commercial insurance that uses the system cashless who do not depend on referrals for inpatient services at the hospital. “The problem is, if participants do not follow these procedures, COB cannot be run between commercial insurance and BPJS Kesehatan,” he explained.

Another thing, namely the coordination of the information system, where BPJS Kesehatan collects about 34 participant data from 7 – 10 information that can be provided by commercial insurance. The data includes salary, complete home address, data on family members and others. Meanwhile, commercial insurance specifically for corporate participants relies more on company data.

Coordination of premiums and contributions also hinders the implementation of COB because corporate participant contributions for the social health insurance program are adjusted to salaries. Meanwhile, corporate health insurance is in nature bussines to bussines. “Because of B2B, we don’t know what the employee’s salary is, the important thing is what kind of benefits they want,” added Angelia.

Due to the lack of COB implementation between commercial insurance and BPJS Health, the Technical Team for BPJS Kesehatan, the Indonesian Life Insurance Association (AAJI) even asked for an extension of the implementation time. “It takes time and process to run the claim mechanism, health services at BPJS Kesehatan health facilities. COB is still constrained, “he concluded.

For your information, until now, BPJS Kesehatan has collaborated on benefit coordination with about 30 life and general insurance companies. They include, PT Asuransi Central Asia, PT Asuransi Allianz Life Indonesia, PT Asuransi Jiwa Bringin Sejahtera and PT Equity Life Indonesia.

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