Materi Sosialisasi Bpjs Kesehatan (English)

7/26/2019 Materi Sosialisasi Bpjs Kesehatan (English)

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1

NATIONAL HEALTH

INSURANCE PROGRAM

Jakarta, June 2nd 2016

Fachmi IdrisPresident Director of BPJS Kesehatan


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2

A. INTRODUCTION

B. MEMBERSHIP

C. BENEFITS OF HEALTH

INSURANCE

D. SANCTIONS AND FINE

OUTLINE


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1

2 NATIONAL HEALTH INSURANCESYSTEM

LEGAL FOUNDATION

3

A.

INTRODUCTION


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4

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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5

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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1

2 Phasing of Membership

Type of Membership

7

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

8

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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1

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

6
http://www.bpjs-kesehatan.go.id/http://www.bpjs-kesehatan.go.id/http://www.bpjs-kesehatan.go.id/http://www.bpjs-kesehatan.go.id/


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5. IDENTITY OF JKN-KIS MEMBER


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1

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

23


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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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Materi Sosialisasi Bpjs Kesehatan (English)