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NATIONAL HEALTH
INSURANCE PROGRAM
Jakarta, June 2nd 2016
Fachmi IdrisPresident Director of BPJS Kesehatan
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A. INTRODUCTION
B. MEMBERSHIP
C. BENEFITS OF HEALTH
INSURANCE
D. SANCTIONS AND FINE
OUTLINE
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2 NATIONAL HEALTH INSURANCESYSTEM
LEGAL FOUNDATION
3
A.
INTRODUCTION
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Act No 40/ 2004 on National
Social Security System
(UU SJSN)
Act No 24/2011 onSocial Security
Administering Institution
(BPJS)
Government Decree
No. 86/2013
President Decree
No.19/2016
Everyone, including
foreigners who work at least
6 months in Indonesia, shall
be a member of Social
Security Program
1.
LEGAL FOUNDATION
01
02
03
04
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Vienna Convention
Article 33 Paragraph 1:
A Diplomatic Official,
because of his worksgiven 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
LEGAL FOUNDATION
05
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2. National Social Security System
Health Insurance
Occupational
Accident Insurance
Old-age Benefit
Pension/ Retirement
Insurance
Mutual Cooperation
Non Profit
Openness
Prudent
Accountable
Humanity
Benefit
Social Justice forAll Indonesian Citizen
3
Basis 5 P
rograms 9
Prin
c
ip
les
Life InsurancePortability
Compulsary membership
Trust Fund
The result of fund
management is used
for development
program and members
benefits
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2 Phasing of Membership
Type of Membership
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B. MEMBERSHIP
3
4
Informal Worker and
Non Worker
Formal Worker / Employee
5 Members Identity
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Formal Worker dan His Family Member
Informal Worker and His Family Member
Non Worker and His Family Member
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1. TYPE OF MEMBERSHIP
Non
Beneficiaries
of
Contribution
(PBI)
A
B
Poor People
Indigent People
Beneficiaries
of
Contribution
(PBI)
A
B
C
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Business Model
2014
2015
2016
2019
Start from January 1st, 2014
PBI
Military / Policy
Eks Askes
Eks Jamsostek
At least January 1st 2015
State Owned Enterprise
Large Enterprises
Medium Enterprises Small Enterprises
At least January 1st, 2016
Micro Enterprises
Universal Coverage
article 6 (3)
Presidential Decree No :
111/2013
2. PHASING OF MEMBERSHIP
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3. FORMAL WORKER/EMPLOYEE
a c
b d
Contribution
The Obligation ofthe Company
Class ofHospitalization
Easiness ofRegistration
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Member Non Member Total
1 Australia 34 16 50
2 Austria 0 1 1
3 Bangladesh 1 1 2
4 Belgium 6 0 6
5 Brunei Darussalam 1 0 1
6 Cambodia 1 0 1
7 Canada 3 0 38 Denmark 3 0 3
9 European Union 123 63 186
10 Finland 7 0 7
11 France 24 1 25
12 Republic of German 47 8 55
13 India 6 3 9
14 Italy 5 0 5
15 Japan 828 68 896
16 Kuwait 1 0 1
17 Malaysia 8 3 11
18 Netherlands 5 0 5
No CountryAmount of Company
Member Non Member Total
19 Norway 1 0 1
20 Pakistan 0 1 1
21 People's Republic of China 10 5 15
22Pe ople's Republic of China
(Hongkong) 4 0 4
23 Qatar 1 0 1
24 Republic of China 1 5 6
25 Republic of Korea 661 347 1008
26 Saudi Arabia 3 0 3
27 Singapore 32 8 40
28 Spain 2 1 3
29 Sweden 10 0 10
30 Switzerland 10 2 12
31 Thailand 4 0 4
32 United Kingdom 24 0 24
33 United States 42 17 59
1908 550 2458TOTAL
No CountryAmount of Company
LIST OF FOREIGN STATE-OWNED COMPANY
MEMBER & NON-MEMBER OF JKN-KIS PROGRAM
Source : Ministry of Foreign Affairs
Republic of Indonesia
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Wajib mendaftarkan dirinya dan pekerjanya sebagai peserta dengan membayar
iuran
Company
Worker
Salary + Allowance
Max Rp. 8.000.000,-
Including FiveFamily member
Additional the otherfamily : 1%
State Owned Enterprise,Private Company, Regional
Owned Enterprise
3 Company
2 Worker
Based on President Decree No. 19/2016
a. CONTRIBUTION OF FORMAL WORKER/EMPLOYEE
Civil Servant, Military, Policy, State
oficial, Members of the Regional
Representatives Council, Government
officials non Civil Servant
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3)
2)
1)
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
Must register and provide
the data of company,
workers and their familiescompletely and correctly to
BPJS Kesehatan
If the company late for
paying the dues for 1 month,then the insurance of
medical services will be
suspended for a while
For Workers, the
contribution and fine
will be paid by the
company
*) 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
b. THE OBLIGATION OF 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
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c. THE CLASS OF HOSPITALIZATION
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04
CONTRIBUTION
REPORT
03
PAYMENT
02
BILLING
01
REGISTRATION
BPJS Kesehatan Regulation
Number 1/2016 AboutRegistration Procedures,
Billing, Payment and
Contribution Report by Online
System for Formal Worker
from New Company In Order
Ease of Doing Business
d. EASINESS OF REGISTRATION
FOR THE COMPANY
THE REGISTRATION PROCEDURES OF COMPANY
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THE REGISTRATION PROCEDURES OF COMPANY
THROUGH BPJS KESEHATANS WEBSITE
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.
Company activate by email
Register1
2
3
The new Company startsbrowse www.bpjs-
kesehatan.go.id
The company gets Virtual Account number (VA),
User id Password of Edabu, Registration Form
(pdf)
The company access E-
Dabu application and
register its employee +
family(1)
The Payment of first
contribution invoicebased on BPJS
Kesehatans policy
54
The New
Company
RegistrationofC
ompany
RegistrationofMember
Approval of
Employees
data
The company print
electronic identity
Realtime
First first contribution
invoice in 1x24 hoursThe New
Company
Entry
Data
Online
Registration Application
Entry
Data
Notification by email
Payment notification (email/ sms)
Successful activation
VA, User id +
password will be
created max in 3
hours
E-dabu
Accessing the Contribution
Reporting by application
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http://www.bpjs-kesehatan.go.id/http://www.bpjs-kesehatan.go.id/http://www.bpjs-kesehatan.go.id/http://www.bpjs-kesehatan.go.id/7/26/2019 Materi Sosialisasi Bpjs Kesehatan (English)
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5. IDENTITY OF JKN-KIS MEMBER
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2 ACCOMODATION BENEFITS
HEALTH SERVICE
PROCEDURES
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3 COORDINATION OF BENEFIT
C. BENEFITS OF JKN-KIS PROGRAM
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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 andmedical consultations in UGD;
examination, treatment and
spesialistic consultation, family
planning program
BENEFITS OF JKN KIS 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
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BPJS Kesehatan
Gawat Darurat/ Emergency
Referral /Referral
Back Program
Claim
Puskesmas,
Clinic, and
General
Practitioner
cooporate with
BPJS Kesehatan
Primary Health
Care Facilities
Member gets sick
Referral Based
on Medical Needs
S p e c i a l i s
t i c
m e d i c a l
s e r v i c e
H o s p i t a l
IGD
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Member
Non-PBI
Formal
Worker
1st & 2nd
Class
Non Formal
Worker
1st, 2nd & 3rd
Class
Non Worker1st, 2nd & 3rd
Class
PBI
Poor People 3rd Class
IndigentPeople
3rd Class
2. ACCOMODATION BENEFITS
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3. COORDINATION OF BENEFIT
(COB)
BPJS KESEHATAN
Commercial
Health
Insurance
COB
Additional Benefit
Another Health Service
Based on Ministry
Regulation
Secondary and Tertiary
Health Care Facilities
Primary Health Care
Facilities
Additional Health Insurance ensure :- Increasing class of
hospitalization
- Additional charge for medical
devices
- excluded health service covered
by BPJS Kesehatan
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D. SANCTION AND FINE
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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
UU No.24 Tahun 2011
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).
Pepres No.19 Tahun 2016
Sanction and Fine
for The Company
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
PP No.86 Tahun 2013
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ADMINISTRATIVE SANCTIONS FOR NONCOMPLIANCES OF
REGISTRATION AND MEMBERSHIP DATA CHANGES
The company gets10 days
Warning Letter 1
The company gets 10days since warningletter given by
government
Warning Letter 2
The company gets30 days since theend of warningletter
Fine
BPJS Kesehatanpropose a sanctionsto the Governmentfor not giving public
services to thecompany
The company will notget public services
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.
MONITORING
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
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1. The permission of doing business
2. The permission for joining
project tender
3. The permission to employ
foreign employee4. The permission of Workers
Service Providing Company
5. The permission of buliding
construction
COMPANY :
1. The permission of building
construction
2. Driving license3. Land certificate
4. Passport
5. Vehicle registration certificate
EVERYONE :
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Thank You
Kartu Indonesia Sehat
Dengan Gotong Royong, Semua Tertolong
www.bpjs-kesehatan.go.id @BPJSKesehatanRIBPJSKesehatan(Akun Resmi)
BPJS Kesehatan
BPJS Kesehatan bpjskesehatan
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