BPJS; Indonesian Health Insurance System

What is BPJS?

BPJS stands for Badan Penyelenggara Jaminan Sosial (Social Insurance Administration Organization). BPJS adminsters the Indonesian national health insurance Jaminan Kesehatan Nasional or JKN for short.

There are two versions of BPJS: BPJS Kesehatan (the successor of PT Askes) and BPJS Ketanagakerjaan (the successor of Jamsostek). The first administers JKN for non-employees/self employed/informal workers, and the latter for employees. Both are government insurance companies formed by the law Undang-Undang no. 24 tahun 2011.

Eligibility

Individual participation is mandatory for all Indonesian residents, including expats on ITAS/P by January 2019. Meanwhile, employers must enroll their employees by January 2016. Expat employees who are working at least 6 months (and their dependent family members) must be registered by their employer.

How to register

Employers must register their employees and dependent family members.

For non-employees registration may be done online.

You will need to provide the following:

  • KK (kartu keluarga)
  • KTP (kartu tanda penduduk)
  • NPWP
  • Photo 3×4 cm (2)
  • Email
  • Phone number
  • Bank account number to pay premium from.

You will still need to go to the local BPJS office to pick up the card.

Since 2016, you have to enroll everyone on the same KK at the same time.
Click to see the complete list of local BPJS offices.

BPJS Card or Kartu Indonesia Sehat?

Both these cards signify participation in the BPJS insurance program. As such, they are functionally equal. You do not have to exchange one for the other. Initially Kartu Indonesia Sehat (Indonesian Health Card) was a campaign promise of President Joko Widodo. The KIS was given to people whose BPJS insurance was state subsidized. However, now KIS is issued to all new BPJS participant.

Premium for Non-employees/Self-employed/non-formal workers

As per the newest regulation Presidential Decree No 19 / 2016, the premiums are:

Class I Rp 80,000
Class II Rp 51,000
Class III Rp 25,500

Per person, per month, due on the 10th of each month.

Premium for Employees

For employees the premium is 5% of monthly salary, up to a salary cap of Rp 8 million. In the private sector, the employer is responsible for 4% and the employee is responsible for 1%.  Meanwhile, for public sector employees the split is 3% and 2%. This covers the employee, their spouse and up to 4 dependent children. Dependent children are unmarried children up to 21 years old, or 25 years old if attending university. You can add parents or children beyond the first 4 for 1% of monthly salary per person. Employees with monthly salary of Rp 4 million or less are eligible for Class II facilities. Meanwhile, those with higher salary will be eligible for Class I facilities.

There is a bit of unfairness in the case that both husband and wife are working as employees. In that case both have to pay the premium. Yet, the coverage of one should cover the other.

Note on taxes: The employer contribution is considered as taxable income (penghasilan kena pajak).  Similarly, employees can not deduct their contribution from taxable income.

Classes?

In Indonesia, hospitals have different levels of room comfort. They range from wards with 10 or more beds, to private luxury rooms the size of small apartments. The medical service itself is supposed to be equal regardless of room comfort. Therefore, classes in BPJS refer to the comfort of the room only. Typically, Class I will have 2-3 beds per room, Class II will have 3-5 beds, and Class III 5 or more beds.

You can upgrade to a higher class by paying the difference out of pocket. You can even upgrade to classes higher than Class I (VIP, VVIP etc). Be aware that the difference could be high, so it is best to ask for an estimate first.

You can also change your class (and payment) with BPJS once every 12 months.

Obtaining Care

As with many national healthcare systems, you must first seek care from an authorized primary care facility (FasKes 1). The primary care facility will recommend a more specialized care facility if needed. The exception is for medical emergencies.

A full list of FasKes 1 by area can be obtained by following this: LINK

Bring your BPJS/KIS card, copies passport/KTP, KK, and referral letters from FasKes 1 if they refer you to a specialized care facility.

Coverage

There are no exclusions due to preexisting conditions or age, nor are there coverage limits. However, the program does not cover:

  • Healthcare obtained outside the BPJS procedure
  • Healthcare obtained at facilities not participating with BPJS
  • Care obtained abroad
  • Cosmetic procedures
  • Infertility treatments
  • Orthodontics
  • Medical issues from drug or alcohol abuse
  • Self inflicted injuries or due to dangerous activities
  • Alternative medicine
  • Experimental medicine
  • Contraception, cosmetics, baby food and milk.
  • Medical care due to natural disasters, epidemics, special occurrences or state of emergencies.
  • Other care not related to the treatment of covered medical issue.

Penalties

If premiums are overdue for over 1 month, the coverage becomes inactive on the 10th of the following month. Therefore, you have to pay any outstanding premiums to reactivate. Within 45 days of reactivating coverage, any in-patient treatment will incur a penalty. The penalty is 2.5% x treatment cost x number of months inactive. This is up to a maximum of 12 months or Rp 30 million, whichever is lower.

BPJS Android App

In July of 2017, BPJS has released an Android app. You can download this free app via the Google Play store.

Among other things, the app can act as a virtual BPJS card. It can also lists the location of your care facility and check the status of your payments.

Other notes

Need more help? BPJS has a 24 hour hotline at 1500400 (Indonesian)

You can pay the premium via ATM, Internet Banking or at the teller at Bank Mandiri, BNI and BRI. Also, you can also set up auto-debit at those banks. Finally, other places you can pay includes Alfamart and Indomart, the Post Office, and your local BPJS office.

Don’t forget your household staff. BPJS Kesehatan is an ideal insurance product for them. It is customary to pay for the healthcare costs of your staff. Hence it is fair that you kick in for the premium.

FasKes 1s are typically small community clinics (Puskesmas), or general practitioners. English may not be spoken here. You may want to bring someone to help translate if needed.

Expat employees used to be able to opt out of Jamsostek (the predecessor of BPJS Ketenagakerjaan) if they have equal or better coverage. This is no longer the case with BPJS. Participation is mandatory even if they have other insurance.

Things to Know Before Considering Health Insurance

Buying one health insurance is a tough task when a lot of companies are selling it with great offers and benefits. There are numerous of plans, offers to attract the customers and mostly befuddle them.Here are a few things you should definitely check and know before falling for a health insurance deal:

1. Claiming procedure:

The claim process of the company should not be much complicated as it will cause a huge delay in settlement of claim. Health insurance is one of the most important types and you cannot risk your or life of your family by making it difficult. The simpler the claiming procedure the easier is claim settlement. Examine their process carefully and then decide.

2. Customer Support:

A 24*7 customer service is mandatory for health insurance. In case of any misunderstanding in the hospital the customer care executive should be present to handle such situations. Research about the company and their way of dealing with customers.

3. Waiting period:

Mostly insurance companies provide a waiting period for any previous ailment. This can range from one to around six years depending on your age and type of disease. The best way to avert this issue is to buy a health insurance plan in youth so that you can easily clear the waiting period.

4. Pre/Post Hospitalisation:

There are numerous of expenses added with Hospitalisation which include medicines, tests and doctor’s follow up. Make sure that your insurance plan covers these expenses too. From Hospitalisation of a patient to their discharge health insurance should cover all of the expenses. There should not be too much of burden on your side.

5. Insurance amount:

The most important decision to make is deciding on a right insurance amount. The right choice of amount shall only cover expenses. Take your age, health condition, salary levels in consideration before making a decision. The amount shouldn’t be too high for you to afford nor too less as you do not need a shortage of amount in emergency.

6. Family insurance:

In choosing a health insurance plan make sure that you insure your family members along with you. Decide the insurance amount by considering their age, existing or previous ailments.

7. Network hospitals:

The most important thing is to check their network hospitals. Mostly hospitals provide cashless options and the bills or receipts of all expenses are settled directly with the insurers. Make sure to ask the insurer about the network hospitals where this cashless system is available.

Health insurance schemes are designed so to protect you and your family in adversities but often we become forgetful of examining it by falling for the words of company. Avoid such hassles and make a list of questions you need to know from them and decide discreetly.

Article Source: ezinearticles

Reduction in Earnings Due to Serious Medical Problems

In the matter of all medical problems, being hospitalized is the toughest one. To determine this, a study has been conducted which says that it is considered as the most painful financial impact on the lives of the human. It has been found that there is 20% of the decrease in the earnings and 11% of the decrease in the employment that is creating negative impacts due to several health problems of the people.

People usually prefer health insurance services but that does not include full insurance. It is not due to the reason like cost-sharing and high-deductibles but health insurance ensures the economic consequences of poor health. From the records of various hospitals, it has been found that around 7,80,000 people with health insurance on the rough basis and about 1,50,000 are without the policy of health insurance, which further defines the income and expenditure capacity of the people and the family where at least one person is suffering from serious health problems.

The study also shows that people who have health problems and leading to a hospital have worse access to their credits. They have a large number of unpaid medical bills and expenditure. This problem can be resolved to a certain extent through medical insurance with Best Placement Colleges but a long-term and serious medical issue plays a significant role even after this insurance policy and services.

Above mentioned data is entirely based on the self- reported survey. It helps in quantifying the cause and effect relationships between different kinds of serious medical problems and different financial implications faced by the people. This data has also helped in establishing the method of altering economic trajectories of the individuals through their hospitalization functioning.

From all the studies; it has been found that the List of Engineering Colleges and hospitalization leads to the terrible economic consequences which create multiple scenarios at a time in the country. There are certain aspects which help in determining serious health problems that include people’s ability to work, lack in interested towards employers and reduction in the likelihood of new searching and jobs which has the high range of payee.

Due to this, it has become very significant to define various research and experiments as there are also people who have never been to hospitals in their previous lives and examine changes to the different economic situation of events that are constantly occurring. It helps in triggering different financial effects to the people who are working. This made the conclusion that it is the most casual relationship without any correlation to any other state.

Article Source: EzineArticles

You Are the Patient, Not the Customer

Healthcare is personal. When we start seeing the doctor, it is about us, or what is inside of us. These are things we do not go telling the public. Over time we build this relationship with the doctor. There is a comfort zone when it comes to our doctors. The unfortunate thing is, this relationship is one-sided. You are only a good relationship, as long as someone else is paying the bill.

Ever try calling a specialist and ask them for an appointment and tell them you are paying cash? Very few specialists will take a cash paying customer. Some will if you can find them. Why is this? Because you are the patient, but not the customer.

If we follow the money in healthcare, there are two entities, if you will, that control everything:

  1. Healthcare providers
  2. Insurance companies

Customer service is out of healthcare. Scheduling an appointment that is convenient for your doctor and not you. Then you show up only to wait for two hours in the waiting room. They do not even offer a refreshment, even though they will bill your insurance an hourly rate for an average of 7 minutes in a conversation with the doctor.

If you think about it, the doctor charged $150 for that visit, which is just under $22 per min they spend with you. The doctor fee does not include the fact that you took a personal or wellness day that could have been used for something else. In some cases, people lose a whole days pay and still have to pay for this doctor visit.

High deductible health plans are more common these days for money savvy people as well as a way to control cost to make premiums more affordable. With these plans, policyholders have to meet a larger deductible first for everything they need for medical and pharmacy to gain access to coverage from the insurance company. More and more providers can validate this information right away and require a payment from you before your visit with the doctor, or they will cancel your appointment.

Where is the customer service in healthcare?

Let’s say you have some pending items to take care of in your healthcare. You already know that the cost of the procedure will be credited towards your deductible. What does any smart shopper do when they know they will be coming out-of-pocket that much money?

Get some estimates and review the quality of the work.

However, in today’s healthcare world, we cannot get immediate access to pricing or the quality of work information. The industry does not publish the information. There is no menu board like at a restaurant or a service professional. When you call, they are clueless about your question because the staff does not have the information. Why is this?

Because you are not the customer, just the patient.

Now we head to the pharmacy. If you go to one of the biggest national chains and ask them for the cash price, and they know you have health insurance, they will not give you the cash price. In many cases, the cash price is less out-of-pocket for you than with the insurance coverage. Why is this?

Again, you are not the real customer.

The insurance company is in the business of calculating risk and build in financial reserves for future claims while trying to make a profit. They estimate how much they have to charge to do this. Over time, they can take a small hit on some years, knowing they will pass on the loss to the policyholder the following year.

It sounds like everything else, right? Sales taxes go up in a county or state, and then the customer pays for it. Additionally, if the cost of goods goes up, then the customer pays for it. In this case, it gets more in-depth than that.

It cost the insurance company money to review every single claim. Many insurance companies have a dollar amount threshold. I have heard these thresholds are as much as $50,000 but as little as $5,000. If the claim is under that amount, and no other red flags, they push the medical claim through automatically.

Red flags could be a medical claim code from a particular provider that are incorrect or supposed to be under a different code. It could be a wrong code entirely. This could be done unintentionally. In other cases, they will purposely add things and change the coding to get paid more money from the insurance company. They will do this knowing that its insurance fraud if they get caught. However, the repercussions are the insurance company will ask them to redo the billing. A small smack on the wrist compared to the reward they receive from the insurance company.

How does the insurance company combat this? They charge us more money in the premium. Even if the insurance company is a not-for-profit company, they still pad the reserves from the premiums for anticipated claims. They know providers do this over-billing practice. They add a little more to premium to cover this costs. To them, that is better than auditing these claims submitted by the providers.

Customer service in healthcare is gone. You are no longer the customer, just the patient. How do we get it back? We demand it. We put the control back in the real customer’s hands. Educate employees and their families how claims work and where they can go to control costs. You can even eliminate the fee per visit primary care and go to a Direct Primary Care facility and not worry about additional costs per visit.

You can get your employer to use real claims data to make adjustments with the employees to take back control. Some of this has no additional cost to the employer, and in some cases the employee.

Let’s move back to making the patient the real customer

Article Source: ezinearticles

Health Insurance: Why It Is Important

In case you don’t know, health insurance is a type of assurance that is given based on agreed terms in case the insured person falls sick or needs medical treatment. The insured life may have a chronic condition requiring medical care for years to come. Let’s know more about it.

Who will pay for the medical expenses?

This is one of the most common questions that people ask. If you have a health insurance, you can have the peace of mind that your health will be taken care of. Actually, it is a type of agreement or contract between you (policyholder) and the company providing health insurance. The purpose of the agreement or contract is to provide protection against costs. At times, the costs are so high that the sick person is unable to pay the bills. As a result, the person is unable to get the care he needs to recover.

While you will pay a monthly or annual premium, you should expect that the amount of premium you are going to pay would be far less than the amount you would pay in case of illness.

Keep in mind that health insurance is a type of benefit that a non-profit organization, private business or a government agency provides. In order to figure out the cost, the company gets an estimate of the collective medical cost of all of the people in the state. Then the risk is divided among the policy subscribers.

As far as the concept goes, the insurer knows that one person may suffer from huge unexpected health care expenses while the other person may incur no expenses at all. So, the expense is spread across a large group of people in an effort to make the health insurance much more affordable for all the insured lives.

Aside from this, public plans are funded by the government. Therefore, they offer extra health insurance to the vulnerable groups like people with disabilities and seniors.

Let’s take an example to understand the concept better. A person with Cerebral Palsy needs special treatment through their lifespan. It’s understood that a chronic illness costs a lot more money than a standard care. Cerebral Palsy may result in a physical impairment that may last for the whole life of the sufferer.

The treatment for this condition may require regular doctor visits, many therapies and long hospital stays. Based on the degree of impairment, you may need special health insurance. Many health care professionals will involve, such as vocational therapists, occupational therapists, physical therapists, orthopedic surgeons, radiologists, pediatrician, neurologists and so on.

Some patients may need the services of more than one. Some may even need a speech pathologist, registered dietician, cosmetic dentists or urologist, to name a few.

So, the coverage offered can help you get some relief as far as the burden of the expenses is concerned. If you don’t sign up, you may suffer from a lot of financial strain and you may need help from other sources like charity organizations and community groups. Therefore, it’s a good idea to benefit from a health insurance.

Article Source: ezinearticles

Which Health Insurance Plan is Best for me?

Health insurance has proven itself of great help and financial aid in certain cases when events turn out unexpectedly. In times when you are ill and when your health is in grave jeopardy and when finances seem to be incapable to sustain for your care, health insurance is here to the rescue. A good health insurance plan will definitely make things better for you.

Basically, there are two types of health insurance plans. Your first option is the indemnity plans, which includes the fee-for-services and the second is the managed care plans. The differences between these two include the choice offered by the providers, the amount of bills the policy holder has to pay and the services covered by the policy. As you can always hear there is no ultimate or best plan for anyone.

As you can see, there are some plans which may be way better than the others. Some may be good for you and your family’s health and medical care needs. However, amidst the sweet health insurance plan terms presented, there are always certain drawbacks that you may come to consider. The key is, you will have to wisely weigh the benefits. Especially that not among these plans will pay for all the financial damages associated with your care.

The following are a brief description about the health insurance plans that might be fitting for you and your family’s case.

Indemnity Plans

Flexible Spending Plans – These are the types of health insurance plans that are sponsored when you are working for a company, or any employer. These are the care plans inclusive in your employee benefit package. Some of the specific types of benefits included in this plan are the multiple options pre-tax conversion plan, medical plans plus flexible spending accounts, tax conversion plan, and employer credit cafeteria plans. You can always ask your employer of the benefits included in your health care/insurance plans.

Indemnity Health Plans – This type of health insurance plan allows you to choose your own health care providers. You are given the freedom to go to any doctor, medical institution, or other health care providers for a set monthly premium. The insurance plan will reimburse you and your health care provider according to the services rendered. Depending on the health insurance plan policy, there are those that offers limit on individual expenses, and when that expense is reached, the health insurance will cover for the remaining expenses in full. Sometimes, indemnity health insurance plans impose restrictions on services covered and may require prior authorization for hospital care and other expensive services.

Basic and Essential Health Plans – It provides a limited health insurance benefit at a considerably low insurance cost. In opting for this kind of health insurance plan, it is necessary that one should read the policy description giving special focus on covered services. There are plans which may not cover on some basic treatments, certain medical services such as chemotherapy, maternity care or certain prescriptions. Also, rates vary considerably since unlike other plans, premiums consider age, gender, health status, occupation, geographic location, and community rated.

Health Savings Accounts – You own and control the money in your HSA. This is the recent alternative to the old fashioned health insurance plans. These are savings product designed to offer policy holders different way to pay for their health care. This type of insurance plan allows the individual to pay for the current health expenses and also save for untoward future qualified medical and retiree health costs on a tax-free basis. With this health care plan, you decide on how your money is spent. You make all the decisions without relying on any third party or a health insurer. You decide on which investment will help your money grow. However, if you sign up for an HSA, High Deductible Health Plans are required in adjunct to this type of insurance plan.

High Deductible Health Plans – Also called Catastrophic Health Insurance Coverage. It is an inexpensive health insurance plan which is enabled only after a high deductible is met of at least $1,000 for an individual expense and $2,000 for family-related medical expense.

Managed Care Options

Preferred Provider Organizations – This is charged in a fee-for-service basis. The involved health care providers are paid by the insurer on a negotiated fee and schedule. The cost of services are likely lower if the policy holder chooses an out-of-network provider ad generally required to pay the difference between what the provider charges and what the health insurance plan has to pay.

Point of Service – POS health insurance plans are one of the indemnity type options in which the primary health care providers usually make referrals to other providers within the plan. In the event the doctors make referrals which are out of the plan, that plan pays all or most of the bill. However, if you refer yourself to an outside provider, the service charges may also be covered by the plan but the individual may be required to pay the coinsurance. Health Maintenance Organizations – It offers access to a network of physicians, health care institutions, health care providers, and a variety of health care facilities. You have the freedom to choose for your personal primary care doctor from a list which may be provided by the HMO and this chosen doctor may coordinate with all the other aspects of your health care. You may speak with your chosen primary doctor for further referrals to a specialist. Generally, you are paying fewer out-of-pocket fees with this type of health insurance plan. However, there are certain instances that you may be often charged of the fees or co-payment for services such as doctor visits or prescriptions.

Article Source : ezinearticles

Overusing Your Health Insurance

When reviewing health plans and evaluating cost, keep in mind health insurance wasn’t designed to cover every penny related to health care.

Everything under the sun on an open credit card is nice, but not when you are paying the bill. But you are.

The purpose of insurance is to cover sudden very expensive losses. It’s about making you whole again and not have the financial responsibility of a ton of money to do it. Somehow we all decided over the last 60 years that the traditional plan should pay for everything.

Health insurance is the only insurance product, for the most part, that pays for first dollar coverage like doctor visits and prescription drugs. The healthcare system gamed the system on the bigger bank account paying the bill, not the small guy. The tables have turned…

Employees are more responsible for their healthcare in paying more for premium dollars out of their check and higher costs. Employers should engage their employees in being more proactive in their healthcare. Here are a few ideas:

  1. Don’t run to the ER or the doctor visit for every little thing. What happened to home remedies or waiting to see the doctor instead of running to the ER? This will save you thousands in a year if you have kids.
  2. Try saving money on medication by finding alternatives. Sometimes skipping the drug may not have an impact on your health, but keeps you coming back to the doctor. The other thing you can do is shop around. Just because they are convenient doesn’t mean it is the most cost-effective.
  3. Just because your doctor recommends a test, it doesn’t mean you have to jump to it and have it done. The doctor went through many years of school, but they are also trying to run tests to protect them and get paid. Ask more questions to see if you feel it’s the right thing. Just like you would if your mechanic suggested items. It’s your money.
  4. If you are scheduling a procedure, take a look around. Many new facilities are popping up to help reduce cost from outpatient testing to outpatient surgical facilities. The hospital isn’t the cheapest. Far from it. This ends up driving the price up for you and the insurance company.
  5. You do not need to go to a state of the art teaching hospital, for most thing. There are a time and place for the advanced care that some of the predominant teaching hospitals bring to the table. However, for most things people go through its overkill and overcharged.

In the end, it will end up costing you more money, either in out-of-pocket expenses or premium. There is no free lunch.

Article Source : ezinearticles