Coordination of the benefits of the BPJS is in danger of being disbanded
Reporter: Mona Tobing | Editor: Barratut Taqiyyah Rafie
JAKARTA. It has been two years since the national health insurance program run by the Health Social Security Administration (BPJS) has been running. However, this noble program still has a number of problems.
Not only is the BPJS deficit growing, the coordination of benefits, aka coordination of benefits (CoB) between insurance companies and BPJS Health, is threatened with dissolving because there is no common ground.
In fact, a number of insurance companies have threatened to withdraw from CoB. Moreover, of the 47 companies that have signed a benefit coordination cooperation with BPJS Health, only 12 insurance companies have implemented the agreement.
Santosa, President Director of PT Asuransi Astra Buana, mentioned several things that make coordinating benefits with the BPJS difficult.
First, about the claim submission system. The claim system that is applied by having to visit the BPJS Health office makes it difficult for insurance companies.
Second, health service standards. Insurance companies want insurance customers who are also BPJS participants who do not need to follow health service procedures with a referral or tiered system.
Santosa said, health insurance participants, in fact, premium class customers want to be served immediately when they are sick so they don’t need to follow referral procedures. If BPJS Kesehatan does not have a solution to this problem, Astra Buana will withdraw from CoB with BPJS Kesehatan.
“Our interests are more in business. After all, many of our participants choose to use insurance,” he said.
Hendrisman Rahim, President Director of PT Asuransi Jiwasraya, added that insurance companies are better off leaving CoB if they are not given business space.
“If BPJS Kesehatan wants everything in front, why would a private insurance company join in,” he said.
Executive poly services for CoB participants are also not a solution for this collaboration.
Ronny A. Iskandar, President Director of Takaful Insurance, assessed that the implementation of indirect executive poly can be carried out simultaneously throughout Indonesia.
Head of Public Relations of BPJS Kesehatan Irfan Humaidi asked insurance to be patient. He said, the improvement of BPJS Health rules, systems and services is currently still ongoing.
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