BPJS in Concert with Private Insurance Companies

Ady Thea Dian Achmad, Andin Aditya Rahman
 
The Social Security Agency for Health (BPJS Kesehatan) has officially entered into cooperation with five private insurance companies under the coordination of benefits (COB) mechanism to provide healthcare for Indonesian citizens.
 
These private insurance companies are PT Asuransi Sinar Mas, PT Asuransi Mitra Maparya, PT Asuransi AXA Mandiri Financial Service, PT Asuransi AXA Financial Indonesia, and PT. Asuransi Lippo General Insurance.
 
Fachmi Idris, Executive Director of BPJS Kesehatan, explained that the cooperation aims to accommodate policyholders in seeking out better treatment rooms than what is provided by default under the basic health coverage scheme, namely Class-1 treatment rooms.
 
Mr. Idris further elaborated that those wishing to be treated in better facilities must secure an additional policy from another health insurance provider through a COB mechanism.
 
“Or pay the difference between the cost covered by BPJS Kesehatan and the cost that must be paid for the treatment class upgrade,” Mr. Idris said during the signing ceremony of the cooperation in Jakarta on Tuesday. 
 
Those taking advantage of this COB mechanism will be covered by more diverse insurance coverage. For example, the cost for VIP treatment rooms will be covered by both BPJS Kesehatan and the selected private insurance company. BPJS Kesehatan will provide coverage up to the cost of a Class-1 treatment room, while the private insurance company will pay for the remaining cost.
 
Representing the five private insurance companies, Dumasi M. M. Samosir, Director of PT Asuransi Sinar Mas, confirmed the private insurance corporations’ support for the national health insurance programs provided by BPJS Kesehatan.
 
In light of the great demand for additional health insurance coverage, Mr. Samosir said that it is important for private insurance companies to work with BPJS Kesehatan through the COB mechanism.
 
“We hope that the COB mechanism will answer the call of the people for upgraded services and coverage compared to the basic coverage provided by BPJS Kesehatan,” said Mr. Samosir.
 
This cooperation is also welcomed by other stakeholders and commentators. One such commentator Timboel Siregar, Advocate Coordinator of BPJS Watch, also applauded the cooperation. Mr. Siregar, however, emphasized that BPJS Kesehatan still needs to  issue a regulation on COB.
 
“What is more important is a technical regulation concerning COB. Workers and labors are looking out  for that regulation’s assurances,” asserted Timboel.
 
(For a complete elaboration on the Social Security Agency, see ILD No. 344, and ILD No. 345)
 
(hot/kc)