Coordination of benefits will boost BPJS participants
Reporter: Handoyo | Editor: Rizki Caturini
JAKARTA. The Social Security Administering Body (BPJS) for Health is optimistic that the Coordination of Benefits (COB) policy can immediately increase the number of participants. Private insurance companies in synergy with BPJS Kesehatan are also projected to increase.
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,” Fahmi said, Wednesday (3/8).
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.
BPJS Kesehatan Participation and Marketing Director, Andayani Budi Lestari said, in the COB scheme, the amount of fees paid by commercial insurance includes BPJS Health contributions. “If his medical needs are covered by BPJS Kesehatan, his wish must be paid for by commercial insurance,” said Andayani.
Spokesperson for BPJS Kesehatan, Irfan Humaidi, said that currently there are 50 AKTs who have collaborated with BPJS Kesehatan. Of these, 13 companies have been actively implementing the COB system with the old scheme.
For the new COB rule scheme, there is currently no update. This month, the technical guidelines of the regulation will be disseminated. When the socialization of these technical guidelines is completed, a new agreement will be made. “The number is expected to increase,” said Irfan.
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