Senin, September 23, 2024

Guidelines Introduced on the Coordination of Health Insurance Payment Differences for Healthcare Service Upgrades

As Regulation of the Minister of Health ("Minister") No. 3 of 2023 ("Regulation 3/2023") allows participants in the National Health Security (Jaminan Kesehatan Nasional – "JKN") program who wish to enjoy higher levels of healthcare services to upgrade the class levels of the services that they receive, the Minister has now decided to introduce a set of applicable guidelines on coordination between insurance providers in order to resolve any health insurance cost margins for said healthcare service upgrades ("Coordination") through the issuance of Decree No. HK.01.07/MENKES/1366/2024 ("Decree 1366/2024"), which has been in force since 10 September 2024.
Outlined comprehensively under the Appendix to Decree 1366/2024, the guidelines for said Coordination should be used as a reference by healthcare services facilities, as well as by the Social Security Agency for Health (Badan Penyelenggara Jaminan Sosial Kesehatan – "BPJS Kesehatan") and JKN participants in relation to payments of the cost differences of additional health insurance through a Coordination mechanism.
Pursuant to Decree 1366/2024, the above-described payment of health insurance cost differences should be outlined in agreements that are drawn up between advanced-level healthcare service facilities and the relevant additional health insurance providers. The aforementioned agreements should be created through processes of Coordination between BPJS Kesehatan and additional health insurance providers.
The above-described Coordination should be outlined in special Coordination documents that address the following aspects at the least: 1) One-stop payment collection; 2) One-stop invoicing system; 3) The differences between health insurance costs borne by the BPJS Kesehatan and the relevant additional health insurance providers.
It should also be noted that advanced-level healthcare services facilities are also required to inform the relevant JKN participants or their family members of any health insurance cost differences before they receive the relevant healthcare services.

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As Regulation of the Minister of Health ("Minister") No. 3 of 2023 ("Regulation 3/2023") allows participants in the National Health Security (Jaminan Kesehatan Nasional – "JKN") program who wish to enjoy higher levels of healthcare services to upgrade the class levels of the services that they receive, the Minister has now decided to introduce a set of applicable guidelines on coordination between insurance providers in order to resolve any health insurance cost margins for said healthcare service upgrades ("Coordination") through the issuance of Decree No. HK.01.07/MENKES/1366/2024 ("Decree 1366/2024"), which has been in force since 10 September 2024.
Outlined comprehensively under the Appendix to Decree 1366/2024, the guidelines for said Coordination should be used as a reference by healthcare services facilities, as well as by the Social Security Agency for Health (Badan Penyelenggara Jaminan Sosial Kesehatan – "BPJS Kesehatan") and JKN participants in relation to payments of the cost differences of additional health insurance through a Coordination mechanism.
Pursuant to Decree 1366/2024, the above-described payment of health insurance cost differences should be outlined in agreements that are drawn up between advanced-level healthcare service facilities and the relevant additional health insurance providers. The aforementioned agreements should be created through processes of Coordination between BPJS Kesehatan and additional health insurance providers.
The above-described Coordination should be outlined in special Coordination documents that address the following aspects at the least: 1) One-stop payment collection; 2) One-stop invoicing system; 3) The differences between health insurance costs borne by the BPJS Kesehatan and the relevant additional health insurance providers.
It should also be noted that advanced-level healthcare services facilities are also required to inform the relevant JKN participants or their family members of any health insurance cost differences before they receive the relevant healthcare services.

......