Key Benefits:
make the payment, or make a replacement
payment to The First payer corresponds to
its obligations.
24. Branch Office Application next called
application BOA is the application that is in the Office
The BPJS Health Branch that displays the bill
claims for health care to Participant at
Facility Health.
BAB II
COORDINATION OF BENEFITS
Part Kesatu
General
Article 2
(1) BPJS Health Insurance and Organizing Health Insurance
Extra can do deep coordination
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provides the Benefits for Health Guarantee
National who have the rights to program protection
Additional Health Insurance.
(2) The purpose of coordinating benefits to ensure Attendees
obtaining its rights as the BPJS Health Participant and
as an Additional Health Insurance Participant accordingly
mechanism applicable to BPJS Health.
Section 3
Coordination in providing Benefits to Participant
National Health Guarantee as intended
in Section 2 is done by BPJS Health with
Additional Health Insurance Organizer who
sells indemnity, cash plan and managed care,
provided
with a provision:
a. BPJS Health as the first guarantor; and
b. Additional Health Insurance organizers as
The first payer.
Article 4
(1) The benefit coordination is enforced if BPJS Participants
Health buys Additional Health Insurance from
The program organizer Additional Health Insurance
which has worked closely with BPJS Health.
(2) The benefit Coordination obtained by the participant does not exceed
the total amount of his health care costs.
Section 5
Insurance Organizer Additional Healthcare that will
carry out cooperation coordination benefits with BPJS
Health must meet the administration requirements as
following:
a. attach a copy of the Operational License;
b. attach a photocopy of NPWP Agency;
c. attach evidence of registration or logging letter
or proof of Health Insurance reporting
issued by the Financial Services Authority;
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2016, No. 939 -7-
d. attach a Statement of Statement that:
1) Additional Health Insurance Organizers
are willing to do cost control
health care services performed by the Facility
Health;
2) Additional Health Insurance organizers are participating in
active participation in prevention efforts
cheating (fraud) in the implementation of the program
Health Guarantee; and
3) Additional Health Insurance Organizers
willing to provide primary health care
for Health Guarantee Participants National which
is warranted with the appropriate scope and quality
with the provisions of the laws.
e. are willing to provide information related to claims data, iuran
and the inclusion of BPJS Healthcare required; and
f. not to be subject to restrictions on business activities
or sanctions ban doing product marketing
health insurance.
g. It is an additional Health Insurance that
national and multinational status in accordance with
provisions of applicable laws.
Second Section
Benefit Coordination and Other Coordination
Paragraph Kesatu
Benefit Coordination
Article 6
(1) The Coordination Of Benefits between BPJS Health with
Additional Health Insurance Organizer can
be given at:
a. FKRTL that works closely with BPJS Health;
and
b. FKRTL that does not cooperate with BPJS
Health.
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2016, No. 939 -8-
(2) The benefit Coordination granted on FKRTL
in cooperation with BPJS Health as
referred to paragraph (1) the letter is performed for
Service awarding the Level Inap Advanced (RITL)
in accordance with medical indications and beyond Non-Specialistic Cases.
(3) The use of the use of the interchange in FKRTL
does not cooperate with BPJS Healthcare as
is referred to in paragraph (1) letter b, only given
emergency conditions.
Second Paragraph
Another Coordination
Section 7
(1) In addition to the Benefit Coordination as referred to in
Section 2, BPJS Health and Insurance Organizer
Additional health can do cooperation and
coordination:
a. Total membership;
b. Socialization;
c. Iuran collection; and
d. information systems.
(2) The ordination of the inclusion as referred to in the paragraph
(1) the letter a includes:
a. Coordinating the participant's registration of the Warranty Program
Health, performed with stage:
1. The entity lists all of its workers
and its Family Members to the Organizer
Additional Health Insurance;
2. Additional Health Insurance organizers
receives registration from the Business Agency for
all of its Members and Family Members;
3. Additional Health Insurance organizers
ensuring the Business Agency has registered
all its Staff and Family Members
as BPJS Healthcare Participants;
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2016, No. 939 -9-
4. Additional Health Insurance alignment
handed the Agency registration file
to BPJS Health; and
5. Additional Health Insurance organizers
reports the participants ' data following
Coordination of Benefits to BPJS Healthcare.
b. Coordinate coordination of less Coordinating participants
Benefits, performed with stage:
1. Entity or Participant may update the data
participants of the Benefit Coordination to Organize
Additional Health Insurance;
2. Additional health insurance organizers
reported the renewal of the Coordinating Participant data
Benefits to BPJS Health; and
3. Additional Health Insurance organizers
publishes a shared Identity Card for Participants
The Benefit Coordination.
(3) The socialization Coordination as referred to in the paragraph
(1) letter b, performed in the form:
a. The active socialization and marketing of the warranty program
national health by the Insurance Organizer
Additional Health; and
b. Shared socialization between BPJS Health and
Additional Health Insurance Organizing to 2016, No. 939 -5- The BPJS Health Benefits Coordinating Participant and Additional Health Insurance Organizer. 18. Guarantor is the party that performs the upper hand health care for the Participant. 19. The payer is the party that makes the payment over the bill of health care costs to the Facility Health. 20. The first guarantor is the first to perform a copy of the service health to the Participant. 21. The Second Guarantor is the party that does the disservice after the reincarnation was done The First Guarantee. 22. The First payers are the first to make payment on the service fee bill health to the health facility. 23. The Second payer is the party that performs payment on the health care costs bill to the Health Facility after t e:always; page-break-after:always">
2016, No. 939 -14- e. Organizer of the outpatient care service Additional Health Insurance is provided for one treatment episode. f. Additional Health Insurance organizers provide ease in the business administration administration to Participant. (7) In the days of care of the service that has been is given to the Participant as it is In paragraph (4), paragraph (5) and paragraph (6), Licensee becomes the responsibility of the Health Insurance Organizer Additional and unable to switch to the liability answer BPJS Healthcare. (8) Insurance Organizing Additional Health in provides health care benefits to Participant, mandatory for quality control and control charges. Section 12 (1) In case of the Participant having an emergency condition, system as referred to paragraph (1) d letters performed in the registration process participants Coordination of Benefits, data changes and mutations add less participants of the Benefit Coordination. (6) Further provisions regarding the coordination form as referred to in paragraph (1) are set in cooperation agreement between BPJS Healthcare with Additional Health Insurance Organizers. Article 8 In terms of the Participant or the Entity Entity to have more than 1 (one) Additional Health Insurance for itself, Workers and Her Family Member then: a. the coordination form referred to in Section 6 and Section 7 of the paragraph (1) is only done by one Additional Health Insurance Host in collaboration with BPJS Health; and/or b. Participants or Enterprise can directly register and payment dues to BPJS Healthcare without going through the Insurance Organizer Additional Health. BAB III IURAN BILLING MECHANISM Section 9 (1) The Participant or Entity may make the payment the Health Guarantee dues through: a. BPJS Healthcare; or b. Additional Health Insurance organizers. (2) In the event of an Participant or an Entity performs Health Guarantee payments through Additional Health Insurance Organizer, then payment of health insurance dues can be done along with the Insurance premium payment www.peraturan.go.id 2016, No. 939 -11- Additional Health. (3) The health insurance coverage provided by Participants or Effort through Organizing Additional Health Insurance in accordance with the provisions laws. (4) In the event of an Participant or an Entity performs the payment of health insurance dues through Additional Health Insurance Organizer as referred to in paragraph (2), Organizer Health Insurance Additional mandatory storage health assurance via Virtual Account Agency Effort to BPJS Healthcare the slowest of date 10 (ten) each month. (5) The health insurance coverage is through Additional Health Insurance organizers as referred to in paragraph (2), every month running performed monitoring by BPJS Health. (6) Technical implementation monitoring as intended on paragraph (5) is further set up in the Work Agreement Same. Section 10 (1) Health Warranty dues may be paid for more of 1 (one) month performed at the beginning. (2) In case of the Participant or the Business Agency pays dues health guarantees for more than 1 (one) month at the beginning as referred to in paragraph (1), Organizer Additional Health Insurance is required to provide all iuran received to BPJS Health. (3) In case there is an iuran payment delay Health Guarantee is more than 1 (one) month since date 10 as it referred to verse (3), imposed temporary termination sanction pursuant to the provisions of the applicable laws. (4) In the event of the Participant or the Effort late pay the dues as referred to in paragraph (1), Additional Health Insurance Organizing is mandatory www.peraturan.go.id 2016, No. 939 -12- invoice the health guarantee dues to the Participants or Entity ID. (5) The order of the reactivation of the dismissal while as an Participant as intended in paragraph (4), performed in accordance with regulatory provisions laws. BAB IV HEALTH CARE DELIVERY MECHANISM Article 11 (1) Health Service on the Benefit Coordination for Advanced Inap health services at outside Non-Specialistic cases. (2) The health service specified in paragraph (1) can be provided through the mechanism: a. Referrals from FKTP that work closely with BPJS Health; b. Referrals from FKTP that do not cooperate with BPJS Healthcare; or c. Without referrals for medical emergency cases. (3) The status of the Participant for health care as is referred to in paragraph (2), listed as Participant Additional Health Insurance. (4) The health care provision through the mechanism referral from FKTP that works closely with BPJS Health as referred to in paragraph (2) letter a as follows: a. Participants due to medical indications of getting the service Rawat Inap Advanced Level. b. Participants showed a Shared Identity Card. c. Participants attach a referral letter from FKTP that works closely with BPJS Health. d. Participants take care of the service administration as Additional Health Insurance participants. www.peraturan.go.id 2016, No. 939 -13- e. Advanced hospitalization service warranty by Additional Health Insurance Organizer is granted during one treatment episode. f. Additional Health Insurance organizers provide ease in management administration of services to Participants. (5) Health services through the mechanism referral from FKTP that does not work closely with BPJS Health as referred to in paragraph (2) letter b as follows: a. Participants due to medical indications of getting the service Rawat Inap Advanced Level. b. Participants showed a Shared Identity Card. c. Participants attach a referral letter from FKTP that works closely with the Insurance Organizer Additional Health. d. Participants take care of the service administration as Additional Health Insurance participants. e. Advanced hospitalization service warranty by Additional Health Insurance Organizer is granted during one treatment episode. f. Additional Health Insurance provides ease in administration of service administration to Participant. (6) Health service via mechanism with no referral to the medical emergency case as referred to in paragraph (2) of the letter c as below: a. Participants with the medical gawatation case came to FKRTL by showing the Identity Card Together. b. Participants get health care by FKRTL. c. Participants due to medical indications of getting the service Rawat Inap Advanced Level. d. Participants take care of the service administration as Additional Health Insurance participants. www.peraturan.go.id