BPJS - Healthcare and Social Security Agency

BPJS - Healthcare and Social Security Agency

Regarding Healthcare Insurance managed by the newly established Healthcare and Social Security Agency (Badan Penyelenggara Jaminan Sosial Kesehatan or “BPJS Kesehatan”). Starting this year, companies in Indonesia are required to register employees in the Indonesian Government’s health and employment social security programs. This is part of an effort by the Government to expand social security benefits to more of the population, but questions remain about the implementation of the new programs and their effect on business. Regulations governing BPJS Ketenagakerjaan are still being drafted. BPJS Ketenagakerjaan will be in full operation effective 1 July 2015, and is expected to include an additional pension benefit scheme. It was compulsory for employers to provide basic health insurance under the previous Jamsostekprogram, although there was an opt-out clause. Most multinational companies chose to opt-out of this program and provide an alternative program for their employees. Companies would now need to re-assess whether to cease or continue the current healthcare program to ensure that their employees are receiving adequate coverage.

Who must Register for the BPJS Programs

Indonesian citizens and all residents of Indonesia, including long term expatriate employees, are required to join. Anyone who has worked in Indonesia for at least six months, including foreign nationals, must be registered for both types of social security at the BPJS of Health and BPJS of Employment. All companies in Indonesia are required to register their employees for both programs, including the Indonesian branches or representative offices of foreign companies.

Exemptions and Contributions

There is no longer a Health Social Security exemption for individuals with private health plans that offer greater benefits than those under the BPJS of Health, as was previously the case under Jamsostek. Contributions for Health Social Security will be split between employers and employees, with employers contributing 4% of an employee’s salary and the employee contributing 0.5% of his or her salary.

Deadline

1.            Companies in the private sector must register employees with the BPJS of Health by January 1, 2015. Starting July 1, 2015, all employees in Indonesia must participate in the BPJS of Employment, with the new Pension Program to be introduced as part of employee benefits.

2.            Contribution payments are due by the 10th of each month or the following work day if the 10th is a public holiday

Sanctions

a.            Not Register

Employers that fail to register employees for the programs will be ineligible to receive certain services from the Government, including the registration of business licenses, licenses to hire foreign employees, and building permits. Individuals who fail to register with the BPJS will be unable to obtain a driver’s license, land certificate, vehicle ownership certificate or a passport.

b.            Late payment

private employers will be sanctioned with a 2% interest penalty per month for a maximum of 3 months. If contributions are unpaid for more than 3 months, the healthcare coverage may be temporarily suspended along with the loss of certain public services, including the application/ renewal of business permits and expatriate work permits and also the application of driver licenses, certificates of vehicle numbers (STNK) and passports for individuals. 

Benefits for participants and their families

Each participant is entitled to health insurance benefits that are of personal health services, including promotive, preventive, curative and rehabilitative services, medicines and medical consumable materials according to the necessary medical needs. The benefits of health insurance as referred to consist of medical and non-medical benefits. The medical benefits do not include family accommodation or ambulance costs. Ambulance benefits are only given to referral patients from health facilities who meet certain conditions set by BPJS.

Availability of health facilities and health service delivery

The government and local governments are responsible for the availability of health facilities and the delivery of health services for the implementation of the health insurance program. The government and local governments may provide opportunities for the private sector to contribute to the availability of health facilities and meeting health service delivery needs. Health care services for the insurance participants must pay attention to the quality of service, patient safety, effectiveness, and comply with the needs of patients and cost efficiency.

Quality control of the health insurance will be performed comprehensively including the enforcing the standard of quality of health facilities, ensuring that processes run according to health standards set, and monitoring of health outputs for participants. The provisions concerning the application of quality control system for health insurance are defined in the BPJS regulation.

In conducting monitoring and evaluation of health care service delivery, the Ministry of Health willcoordinate with the National Social Security Council (DJSN). The DJSN assists the President in formulating public policies and synchronizing the implementation of the National Social Security System.

Source : http://bpjs-kesehatan.go.id/bpjs/

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