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NATIONAL HEALTH

INSURANCE PROGRAM

Fachmi Idris
President Director of BPJS Kesehatan

Jakarta, June 2nd 2016


1

OUTLINE
A. INTRODUCTION
B. MEMBERSHIP
C. BENEFITS OF HEALTH
INSURANCE
D. SANCTIONS AND FINE

A. INTRODUCTION
1

LEGAL FOUNDATION

NATIONAL HEALTH INSURANCE


SYSTEM

1. LEGAL FOUNDATION
01

02

Act No 40/ 2004 on National


Social Security System
(UU SJSN)

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

2. National Social Security System


3 Basis

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

Formal Worker / Employee

Informal Worker and


Non Worker

Members Identity
7

1. TYPE OF MEMBERSHIP

Non
Beneficiaries
of
Contribution
(PBI)

Formal Worker dan His Family Member

Informal Worker and His Family Member

Non Worker and His Family Member

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

At least January 1st 2015


State Owned Enterprise
Large Enterprises
Medium Enterprises
Small Enterprises

At least January 1st, 2016


Micro Enterprises

Universal Coverage

3. FORMAL WORKER/EMPLOYEE
a

Contribution

b The Obligation of the Company

Class of Hospitalization

Easiness of Registration

LIST OF FOREIGN STATE-OWNED COMPANY


MEMBER & NON-MEMBER OF JKN-KIS PROGRAM
No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18

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

Source : Ministry of Foreign Affairs


Republic of Indonesia

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

a. CONTRIBUTION OF FORMAL WORKER/EMPLOYEE


Civil Servant, Military, Policy, State
oficial, Members of the Regional
Representatives Council, Government
officials non Civil Servant

State Owned Enterprise,


Private Company, Regional
Wajib mendaftarkan dirinya dan pekerjanya sebagai
pesertaEnterprise
dengan membayar
Owned
iuran

Worker
Salary + Allowance
Max Rp. 8.000.000,-

3% Company
2% Worker

Including Five
Family member
Additional the other
family : 1%

Company

Based on President Decree No. 19/2016


12

b. THE OBLIGATION OF THE COMPANY


1)
Must register and provide
the data of company,
workers and their families
completely and correctly to
BPJS Kesehatan

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

If the company late for


paying the dues for 1 month,
then the insurance of
medical services will be
suspended for a while

*) The policy starts on July, 1st 2016

The membership will be active, if:


Paying the late contribution
If the company's overdue for more than 12
months, then the maximum 12 months and
current month contribution must be paid

For Workers, the


contribution and fine
will be paid by the
company

Within 45 days since the active membership status is back,


the participant must pay a fine of 2.5% of service charges
to BPJS multiplied by numbers of late months (maximum
12 months) or a maximum of Rp 30,000,000.00

c. THE CLASS OF HOSPITALIZATION

14

d. EASINESS OF REGISTRATION
FOR THE COMPANY

BPJS Kesehatan Regulation


Number 1/2016 About
Registration Procedures,
Billing, Payment and
Contribution Report by Online
System for Formal Worker
from New Company In Order
Ease of Doing Business

CONTRIBUTION
REPORT
PAYMENT
BILLING

REGISTRATION

01

02

03

04

15

Registration of Member

Registration of Company

THE REGISTRATION PROCEDURES OF COMPANY


THROUGH BPJS KESEHATANS WEBSITE
1 The new Company starts
browse www.bpjskesehatan.go.id

Entry
Data

Register

Realtime

Entry
Data

Online
Registration Application

Notification by email

The New
Company

Company activate by email

2 The company gets Virtual Account number (VA),


User id Password of Edabu, Registration Form
(pdf)

Successful activation

The New
Company

The company access EDabu application and


register its employee +
family

Approval of
Employees
data

(1)

First first contribution


invoice in 1x24 hours

Payment notification (email/ sms)

VA, User id +
password will be
created max in 3
hours

E-dabu

The Payment of first


contribution invoice
based on BPJS
Kesehatans policy

The company print


electronic identity

Accessing the Contribution


Reporting by application

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

5. IDENTITY OF JKN-KIS MEMBER

C. BENEFITS OF JKN-KIS PROGRAM

HEALTH SERVICE
PROCEDURES

ACCOMODATION BENEFITS

COORDINATION OF BENEFIT

18

BENEFITS OF JKN-KIS PROGRAM

A. Personal health services,


including promotive, preventive,
curative, rehabilitative, medicine,
medical material consumables
bsed on medical needs, namely :

1. Medical benefits that are not


tied to the amount of
contributions paid
2. Non medical benefits based
on amount of contributions paid,
include accomodation benefits

B. Promotive and preventive


service include :
a. Personal health consultation;
b. Routine immunization;
c. Family planning ; and
d. Health screening.
C. Referral Services include
examination, treatment and
medical consultations in UGD;
examination, treatment and
spesialistic consultation, family
planning program
D. A member who wants a
higher class than their
rights, can pay additional
charge : paid by himself,
paid by the company, or
additional health insurance

19

Member gets sick

Primary Health
Care Facilities
Puskesmas,
Clinic, and
General
Practitioner
cooporate with
BPJS Kesehatan

Gawat Darurat/ Emergency

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

1st & 2nd

Non Formal

1st, 2nd & 3rd


Class

Worker
Non Worker

Member

Class

1st, 2nd & 3rd


Class

Poor People

3rd Class

Indigent
People

3rd Class

PBI

21

3. COORDINATION OF BENEFIT
(COB)

Additional Benefit

Another Health Service


Based on Ministry
Regulation

Secondary and Tertiary


Health Care Facilities
Primary Health Care
Facilities

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

D. SANCTION AND FINE

23

UU No.24 Tahun 2011

Sanction and Fine


for The Company

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

PP No.86 Tahun 2013


Article 3 :
If the company doesnt register its
employee as member of BPJS
Kesehatan, then it eill get
administrative sanction as mentioned
in Government Regulation Number
86/2013 :
- Warning letter (two times)
- Fine 0,1% (zero point one percent)
of contribution each month and
starts from the end of the second
warning letter; and/or
- The company will not get certain
public services

Pepres No.19 Tahun 2016


Article 17A.1 Paragraph 1:
If the company doesnt pay dues for 1 month starts from 10th, then the health
care services will be suspended for a while
Article 17A.1 Paragraph 3:
Within 45 days since the active membership status is back, a member must pay
fine for every hospitalization service to BPJS Kesehatan.
Article 17A.1 paragraph 4 :
The fine as mentioned in paragraph 3 is 2,5% (two point five percent) of helth
service charge for every arrear month under the condition:
a. Maximum of late months is 12 (twelve) months.
b. The fine is maximum Rp. 30.000.000 (thirty million rupiahs).

ADMINISTRATIVE SANCTIONS FOR NONCOMPLIANCES OF


REGISTRATION AND MEMBERSHIP DATA CHANGES
Government regulation Number . 86 / 2013 about Procedures of Implementation Administrative Sanctions
to The Company Non Civil Servant and Everyone, excluding Employer, Employee, dan Beneficiaries of
Contribution in Social Security
The company will not
get public services

Warning Letter 2
The company gets
10 days

The company gets 10


days since warning
letter given by
government

The company gets


30 days since the
end of warning
letter

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 :

1. The permission of building


construction
2. Driving license
3. Land certificate
4. Passport
5. Vehicle registration certificate

Thank You

Kartu Indonesia Sehat


Dengan Gotong Royong, Semua Tertolong
www.bpjs-kesehatan.go.id

@BPJSKesehatanRI

BPJS Kesehatan

BPJS
Kesehatan
(Akun Resmi)

BPJS Kesehatan

bpjskesehatan

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