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INSURANCE PROGRAM
Fachmi Idris
President Director of BPJS Kesehatan
OUTLINE
A. INTRODUCTION
B. MEMBERSHIP
C. BENEFITS OF HEALTH
INSURANCE
D. SANCTIONS AND FINE
A. INTRODUCTION
1
LEGAL FOUNDATION
1. LEGAL FOUNDATION
01
02
Act No 24/2011 on
Social Security
Administering Institution
(BPJS)
03
Government Decree
No. 86/2013
04
President Decree
No.19/2016
Everyone, including
foreigners who work at least
6 months in Indonesia, shall
be a member of Social
Security Program
LEGAL FOUNDATION
Vienna Convention
Article 33 Paragraph 1:
A Diplomatic Official,
because of his works
05 given to the sending
State, shall be exempt
from the provisions of
social insurance that
may be imposed on
the receiving State
For a Diplomatic
Official, shall not be
participant in the
Social Security
Program
5 Programs
Health Insurance
Humanity
Benefit
Social Justice for
All Indonesian Citizen
Occupational
Accident Insurance
9 Principles
Mutual Cooperation
Non Profit
Openness
Old-age Benefit
Prudent
Pension/ Retirement
Insurance
Accountable
Portability
Life Insurance
Compulsary membership
Trust Fund
The result of fund
management is used
for development
program and members
benefits
B. MEMBERSHIP
1
Type of Membership
Phasing of Membership
Members Identity
7
1. TYPE OF MEMBERSHIP
Non
Beneficiaries
of
Contribution
(PBI)
A
B
Poor People
Indigent People
Beneficiaries
of
Contribution
(PBI)
2. PHASING OF MEMBERSHIP
Business Model
2019
2016
2015
2014
Start from January 1st, 2014
PBI
Military / Policy
Eks Askes
Eks Jamsostek
article 6 (3)
Presidential Decree No :
111/2013
Universal Coverage
3. FORMAL WORKER/EMPLOYEE
a
Contribution
Class of Hospitalization
Easiness of Registration
Amount of Company
Member Non Member Total
Australia
34
16
50
Austria
0
1
1
Bangladesh
1
1
2
Belgium
6
0
6
Brunei Darussalam
1
0
1
Cambodia
1
0
1
Canada
3
0
3
Denmark
3
0
3
European Union
123
63
186
Finland
7
0
7
France
24
1
25
Republic of Germany 47
8
55
India
6
3
9
Italy
5
0
5
Japan
828
68
896
Kuwait
1
0
1
Malaysia
8
3
11
Netherlands
5
0
5
Country
No
Country
19 Norway
20 Pakistan
21 People's Republic of China
People's Republic of China
22
(Hongkong)
23 Qatar
24 Republic of China
25 Republic of Korea
26 Saudi Arabia
27 Singapore
28 Spain
29 Sweden
30 Switzerland
31 Thailand
32 United Kingdom
33 United States
TOTAL
Amount of Company
Member Non Member
Total
1
0
1
0
1
1
10
5
15
4
1
1
661
3
32
2
10
10
4
24
42
0
5
347
0
8
1
0
2
0
0
17
1
6
1008
3
40
3
10
12
4
24
59
1908
550
2458
Worker
Salary + Allowance
Max Rp. 8.000.000,-
3% Company
2% Worker
Including Five
Family member
Additional the other
family : 1%
Company
2)
Must register itself and its
workers as participant by
paying the contribution
3)
Must collect contribution
from workers , paying
contribution no later than
the 10th of each month
14
d. EASINESS OF REGISTRATION
FOR THE COMPANY
CONTRIBUTION
REPORT
PAYMENT
BILLING
REGISTRATION
01
02
03
04
15
Registration of Member
Registration of Company
Entry
Data
Register
Realtime
Entry
Data
Online
Registration Application
Notification by email
The New
Company
Successful activation
The New
Company
Approval of
Employees
data
(1)
VA, User id +
password will be
created max in 3
hours
E-dabu
Notes:
Branch office of BPJS Kesehatan will call the company to register all employees + family (Calling the company, visiting, inform about schedule of
socialization / gathering, receiving registration form using stamp and signature
If the company doesnt complete employees data dan pay the contribution in 3 months, then BPJS Kesehatan will report that company to BPTP
dan its account in E-Dabu will be suspended.
16
HEALTH SERVICE
PROCEDURES
ACCOMODATION BENEFITS
COORDINATION OF BENEFIT
18
19
Primary Health
Care Facilities
Puskesmas,
Clinic, and
General
Practitioner
cooporate with
BPJS Kesehatan
Referral /Referral
Back Program
Referral Based
on Medical Needs
IGD
BPJS Kesehatan
Specialis
tic
medical
service
Hospital
Claim
20
2. ACCOMODATION BENEFITS
Non-PBI
Formal
Worker
Non Formal
Worker
Non Worker
Member
Class
Poor People
3rd Class
Indigent
People
3rd Class
PBI
21
3. COORDINATION OF BENEFIT
(COB)
Additional Benefit
Commercial
Health
Insurance
COB
BPJS KESEHATAN
Additional Health Insurance ensure :
Increasing class of
hospitalization
Additional charge for medical
devices
excluded health service covered
by BPJS Kesehatan
23
24
Article 17 :
Paragraph 1 : The company doesnt obey the policy as mentioned in article 16, it will
get administrative sanction.
Paragraph 2 : Administrative sanction as mentioned in paragraph (1) can be :
a. Warning Letter;
b. Fine; and/or
c. The company will not get certain public services
Article 55 :
The company that is violate article 19 paragraph (1) and (2) will going to jail for 8
years or fine Rp 1 billion
Warning Letter 2
The company gets
10 days
BPJS Kesehatan
propose a sanctions
to the Government
for not giving public
services to the
company
Fine
Warning Letter 1
MONITORING
The Implementation of warning letter and fine will be made by BPJS Kesehatan
The Sanctions of public services will be made by Public Service Unit in
Government, Provincial government, and local government based on request
of BPJS Kesehatan.
COMPANY :
1. The permission of doing business
2. The permission for joining
project tender
3. The permission to employ
foreign employee
4. The permission of Workers
Service Providing Company
5. The permission of buliding
construction
EVERYONE :
Thank You
@BPJSKesehatanRI
BPJS Kesehatan
BPJS
Kesehatan
(Akun Resmi)
BPJS Kesehatan
bpjskesehatan
27