Additional Cost to be paid by the Participant in Health Security Program in Indonesia in which will not be paid by BPJS Kesehatan
Ministry of Health of Republic of Indonesia (“MOH”) has recently issued MOH Regulation No. 51 Year 2018 regarding Imposing the Additional Cost and Reduction Cost within Health Insurance Program (“MOHReg 51/2018”) on 17 December 2018 which has regulated additional provisions that need to be taken into consideration by employers and employees in relation to the health insurance program in Indonesia managed by Health Social Security Agency (known as Badan Penyelenggara Jaminan Sosial Kesehatan - “BPJS Kesehatan”).
As participant in health security program in Indonesia whether a domestic or foreign employee (“Participant”), a Participant is oblige to pay monthly fees collected by Employer to BPJS Kesehatan. Under MOHReg 51/2018, BPJS Kesehatan may impose additional cost (urun biaya) to be charged to the participants for the relevant types of health services in which under the consideration of the MOH may be abusive. Further under MOHReg 51/2018, in order to make these provisions effective, MOH should determine in writing which services are considered to be abusive and will be charged with an additional cost. However, up to the issuance of this client alerts the MOH has not yet determine the said abusive health services.
In the event that, the MOH has determined the foregoing health services which will be imposed with additional costs, the health service provider (hospital, health center and any other health facility) should inform the Participant with the foregoing changes and prior to providing the said health services, the Participant should provide his/her consent on the said additional costs. MOHReg 51/2018 governs an exemption that this additional cost will not be imposed to the Participants which are considered poor and are not able to pay fees to the BPJS Kesehatan (PBI Jaminan Kesehatan).
The maximum amount of additional cost will be differentiated between outpatient and inpatient visits, here are the following amount of the additional costs:
- Additional amount of Rp. 20.000,- (twenty thousand Rupiah) for each of outpatient visits provided by a class A or class B Hospitals;
- Additional amount of Rp. 10.000,-(ten thousand Rupiah) for each of outpatient visits provided by a class C or class D Hospitals; or
- The maximum additional amount to be paid is Rp. 350.000,- (three hundred and fifty thousand Rupiah) for 20 (twenty) times of visit per 3 (three) months.
- Additional 10 % (ten percent) of the service fee; or
- The maximum additional amount to be paid is Rp. 30.000.000,- (thirty million Rupiah).
Thus, based on the abovementioned, the amount of claims to be paid by BPJS Kesehatan to the health service provider, i.e. Hospital, will be at the amount of the cost of the services minus the relevant additional costs which have been paid by the Participant.
MOHReg 51/2018 has also regulated other additional cost to be imposed to the Participants in the event that the Participant would like to increase the treatment (health services) level into one level higher than their given rights of treatment level as provided by BPJS Kesehatan (selisih biaya). The Participant shall pay the additional cost towards the difference between the increased level of treatment fees.
Based on the MOHReg 51/2018, there is no obligation for the employer to pay the abovementioned additional costs. However, both parties may agree on their employment agreement to use other health insurance company to pay the said additional costs.
For further information, please contact:
- Putu Surya Resa Aditya, S.H., LL.M.
- Business Development