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

2
A. INTRODUCTION

1 LEGAL FOUNDATION

NATIONAL HEALTH INSURANCE

2 SYSTEM

3
 1. LEGAL FOUNDATION
Act No 40/ 2004 on National
01 Social Security System
(UU SJSN)

Act No 24/2011 on
Everyone, including
02 Social Security foreigners who work at least
Administering Institution
(BPJS) 6 months in Indonesia, shall
be a member of Social
Government Decree Security Program
03 No. 86/2013

President Decree
04 No.19/2016

4
 LEGAL FOUNDATION

Vienna Convention
Article 33 Paragraph 1:
A Diplomatic Official,
because of his works
For a Diplomatic
05 given to the sending Official, shall not be
State, shall be exempt
from the provisions of participant in the
social insurance that
may be imposed on Social Security
the receiving State
Program

5
2. National Social Security System

3 Basis 5 Programs 9 Principles

Health Insurance Mutual Cooperation
Humanity Occupational Non Profit
Benefit Accident Insurance
Openness
Social Justice for Old-age Benefit Prudent
All Indonesian Citizen
Pension/ Retirement Accountable
Insurance
Portability
Life Insurance
Compulsary membership
Trust Fund
The result of fund
management is used
for development
program and members
benefits

6
 B. MEMBERSHIP
1 Type of Membership

2 Phasing of Membership

3 Formal Worker / Employee

Informal Worker and

4 Non Worker

Member’s Identity
5
7
 1. TYPE OF MEMBERSHIP

A Formal Worker dan His Family Member

Non
Beneficiaries
of
Contribution B Informal Worker and His Family Member
(PBI)

C Non Worker and His Family Member

A
Poor People
Beneficiaries
of
Contribution 8
B (PBI)
Indigent People
 2. PHASING OF MEMBERSHIP
Business Model

2019

2016 Universal Coverage

2015 At least January 1st, 2016

 Micro Enterprises
2014 At least January 1st 2015
 State Owned Enterprise
 Large Enterprises
Start from January 1st, 2014  Medium Enterprises
 PBI  Small Enterprises
 Military / Policy
 Eks Askes
 Eks Jamsostek

article 6 (3)
Presidential Decree No :
111/2013
 3. FORMAL WORKER/EMPLOYEE

a Contribution c Class of Hospitalization

b The Obligation of the Company d Easiness of Registration

1
 LIST OF FOREIGN STATE-OWNED COMPANY
MEMBER & NON-MEMBER OF JKN-KIS PROGRAM
Amount of Company Amount of Company
No Country No Country
Member Non Member Total Member Non Member Total
1 Australia 34 16 50 19 Norway 1 0 1
2 Austria 0 1 1 20 Pakistan 0 1 1
3 Bangladesh 1 1 2 21 People's Republic of China 10 5 15
4 Belgium 6 0 6
People's Republic of China
5 Brunei Darussalam 1 0 1 22 4 0 4
(Hongkong)
6 Cambodia 1 0 1
23 Qatar 1 0 1
7 Canada 3 0 3
24 Republic of China 1 5 6
8 Denmark 3 0 3
9 European Union 123 63 186 25 Republic of Korea 661 347 1008
10 Finland 7 0 7 26 Saudi Arabia 3 0 3
11 France 24 1 25 27 Singapore 32 8 40
12 Republic of Germany 47 8 55 28 Spain 2 1 3
13 India 6 3 9 29 Sweden 10 0 10
14 Italy 5 0 5 30 Switzerland 10 2 12
15 Japan 828 68 896 31 Thailand 4 0 4
16 Kuwait 1 0 1 32 United Kingdom 24 0 24
17 Malaysia 8 3 11 33 United States 42 17 59
18 Netherlands 5 0 5 TOTAL 1908 550 2458
Source : Ministry of Foreign Affairs
Republic of Indonesia
 a. CONTRIBUTION OF FORMAL WORKER/EMPLOYEE
Civil Servant, Military, Policy, State
State Owned Enterprise,
oficial, Members of the Regional
Private Company, Regional
Wajib mendaftarkan dirinya dan pekerjanya sebagai pesertaEnterprise
dengan membayar Representatives Council, Government
Owned
iuran officials non Civil Servant

Worker
3% Company

Salary + Allowance
2% Worker
Max Rp. 8.000.000,-

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

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
3)
For Workers, the
contribution and fine
The membership will be active, if: will be paid by the
Paying the late contribution company
If the company's overdue for more than 12
months, then the maximum 12 months and
current month contribution must be paid
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
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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

04
02 03
01
 THE REGISTRATION PROCEDURES OF COMPANY
THROUGH BPJS KESEHATAN’S WEBSITE
Registration of Company

1 The new Company starts Register Entry

Data Entry
browse www.bpjs- Data
kesehatan.go.id
Realtime Online
Registration Application
Notification by email

The New Company activate by email

Company VA, User id +
password will be
2 The company gets Virtual Account number (VA), Successful activation created max in 3
User id Password of Edabu, Registration Form hours
(pdf)

3
Registration of Member

4 The company print

5
The company access E- Approval of The Payment of first electronic identity
Dabu application and Employee’s contribution invoice
register its employee + data based on BPJS
family Kesehatan’s policy
(1) First first contribution E-dabu
invoice in 1x24 hours
The New
Company
Payment notification (email/ sms) 6
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 doesn’t complete employee’s 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.

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5. IDENTITY OF JKN-KIS MEMBER
C. BENEFITS OF JKN-KIS PROGRAM

HEALTH SERVICE
1 PROCEDURES

2 ACCOMODATION BENEFITS

3 COORDINATION OF BENEFIT

18
 BENEFITS OF JKN-KIS PROGRAM
B. Promotive and preventive
service include :
a. Personal health consultation;
b. Routine immunization;
A. Personal health services,
c. Family planning ; and
including promotive, preventive,
d. Health screening.
curative, rehabilitative, medicine,
medical material consumables C. Referral Services include
bsed on medical needs, namely : examination, treatment and
medical consultations in UGD;
examination, treatment and
1. Medical benefits that are not spesialistic consultation, family
tied to the amount of planning program
contributions paid
2. Non medical benefits based D. A member who wants a
on amount of contributions paid, higher class than their
include accomodation benefits rights, can pay additional
charge : paid by himself,
paid by the company, or
additional health insurance

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 Member gets sick

Primary Health
Care Facilities

Referral /Referral
Puskesmas, Back Program
Clinic, and
General
Practitioner Referral Based
cooporate with on Medical Needs
BPJS Kesehatan
• Specialis
tic
IGD medical
Gawat Darurat/ Emergency
service
• Hospital

BPJS Kesehatan Claim

20
2. ACCOMODATION BENEFITS Formal 1st & 2nd
Worker Class
Non Formal 1st, 2nd & 3rd
Non-PBI
Worker Class

1st, 2nd & 3rd

Non Worker
Member Class

Poor People 3rd Class

PBI
Indigent
3rd Class
People

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 3. COORDINATION OF BENEFIT
(COB)

Commercial
Health
Additional Benefit
Insurance

Another Health Service

Based on Ministry
Regulation
Secondary and Tertiary
Health Care Facilities
Primary Health Care
Facilities
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 24
Sanction and Fine Article 17 :
Paragraph 1 : The company doesn’t obey the policy as mentioned in article 16, it will
for The Company 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 Pepres No.19 Tahun 2016

Article 3 :
If the company doesn’t 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
Article 17A.1 Paragraph 1:
If the company doesn’t 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

Warning Letter 2
• The company gets
10 days
•The company gets 10
days since warning
letter given by
government
Warning Letter 1
get public services
• The company gets
30 days since the •BPJS Kesehatan
end of warning propose a sanctions
to the Government
letter
for not giving public
services to the
company
Fine

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 : EVERYONE :

1. The permission of doing business

2. The permission for joining
1. The permission of building
project tender
construction
3. The permission to employ
2. Driving license
foreign employee
3. Land certificate
4. The permission of Workers
4. Passport
Service Providing Company
5. Vehicle registration certificate
5. The permission of buliding
construction
 Thank You

Kartu Indonesia Sehat

Dengan Gotong Royong, Semua Tertolong

www.bpjs-kesehatan.go.id @BPJSKesehatanRI BPJS BPJS Kesehatan

Kesehatan
(Akun Resmi)

BPJS Kesehatan bpjskesehatan

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