Government Updates the Premiums and Benefits for Public-Health Insurance

The Government has just issued Presidential Regulation No. 19 of 2016 (“Second Amendment”), which amends Presidential Regulation No. 12 of 2013 on Public-Health Insurance (“2013 Regulation”).[1]
 
In essence, the Second Amendment aims to improve the public-health insurance program organized by the Social Security Agency for Health (Badan Penyelenggaran Jaminan Sosial Kesehatan – “BPJS for Health”) by amending provisions relating to the following matters: (i) prevention of fraud; (ii) participants; (iii) registration; (iv) premiums; (v) benefits; and (vi) disbursement of compensation to health-facility providers by the BPJS for Health.
 
The Second Amendment is of relevance to employers, employees, workers in the informal sector, and non-employees (investors, employers, pensioners, and veterans).
 
Fraud
The Second Amendment adds fraud as a new concern as regards the organization of the public health-insurance program. Fraud in this context refers to any unlawful action consciously committed by a party in order to gain financial benefit from the national health-insurance program.[2]
 
In this regard, the Second Amendment mandates for the establishment of fraud-prevention systems by the BPJS for Health, regional/municipal health agencies, and/or health facilities, as regulated under Minister of Health  Regulation No. 36 of 2015 on the Prevention of Fraud in the Organization of the Public Healthcare Program under the National Social Security System.[3]
 
Participants
Two categories of public-health insurance participants are described under the 2013 Regulation:[4]