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The operational guidelines for the insurance benefit scheme - BPJS will be published soon

Reporter: Handoyo | Editor: Sanny Cicilia

JAKARTA. The Social Security Administering Body (BPJS) for Health is finalizing the implementation instructions of the Coordination of Benefit (CoB) program for the National Health Insurance.

These operational guidelines are needed as the basis for the cooperation agreement in implementing the benefit coordination scheme between BPJS Kesehatan and the insurance company. “We are targeting completion in September,” said spokesman for BPJS Kesehatan, Irfan Humaidi, Wednesday (31/8).

Although he did not go into detail, Irfan said the contents of the operational guidelines were guidelines from commercial insurance companies when they became BPJS Kesehatan partners in implementing JKN. The regulation is more technical than BPJS Health Regulation Number 4 of 2016 concerning Technical Guidelines for the Implementation of Benefit Coordination in the National Health Insurance Program.

Just a note, with the old scheme, the number of additional health insurance (AKT) that has collaborated with BPJS Kesehatan is 50 companies. Of these, 13 companies have been actively implementing the COB system with the old scheme.

President Director of BPJS Kesehatan Fahmi Idris said, BPJS Kesehatan Regulation Number 4 of 2016 concerning Technical Guidelines for Coordination of Benefits there are several points that benefit the public and private insurance companies.

One of them is the absence of double payments by private insurance participants to pay BPJS Health contributions. “BPJS has opened the opportunity not to double costs, then all medical costs are as needed according to the provisions of the JKN Law,” said Fahmi.

There are several principles in implementing the COB scheme. First, the application of COB is carried out by JKN-Healthy Indonesia Card (KIS) participants who have the right to additional health insurance program (AKT) protection.

Second, ensure that participants obtain their rights according to the mechanisms applicable to BPJS Kesehatan. Third, do not exceed the total amount of health service costs. Fourth, the COB provisions between BPJS Kesehatan and AKT, namely BPJS Health as the first guarantor, and AKT as the first payer.

Fifth, if you have more than one AKT then the coordination of benefits is only done by one AKT who is working with BPJS Kesehatan. Participants or business entities can directly register and pay dues to BPJS Kesehatan without going through the AKT administrators.

Chairman of the Indonesian Employers’ Association (Apindo) Hariyadi Sukamdani said his party welcomed the new benefit coordination scheme. “With this coordination, the benefits received will be maximized,” said Hariyadi.

In addition, the burden borne by participants will not be large because health insurance payments are synergized and are not split between BPJS Kesehatan and additional insurance used by participants.

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