Citizens can now pay for medical treatment in hospitals by combining\nbenefits from BPJS Kesehatan and commercial health insurance. This\nscheme is implemented through a Cooperation Agreement (PKS) for the\nCoordination of Benefit (CoB) between BPJS Kesehatan and commercial\ninsurance companies.<\/p>\n
The programme commenced following the signing of the first\ncooperation agreement involving five insurance companies and seven\nhospitals on Thursday (3\/9\/2026). The full implementation of the CoB\nscheme is expected to be completed by the end of 2026.<\/p>\n
Iwan Pasila, Deputy Commissioner for Insurance, Guarantee, and\nPension Fund Supervision at the Financial Services Authority (OJK),\nstated that this scheme allows participants who hold commercial\ninsurance policies and are also active members of the National Health\nInsurance (JKN) to access services at participating hospitals. One of\nthe primary advantages is that participants can visit hospitals directly\nwithout always requiring a referral from a primary healthcare\nfacility.<\/p>\n
\u201cPreviously, with BPJS, you had to be referred from a clinic. With\nthis, you can go directly,\u201d said Iwan following the signing ceremony in\nJakarta on Thursday (3\/9\/2026).<\/p>\n
Under the CoB scheme, participants arriving at a hospital with a\nclinic referral can coordinate BPJS Kesehatan benefits with commercial\ninsurance. BPJS Kesehatan will cover up to 75% of the service costs,\nwhile the remainder is covered by the insurance company in accordance\nwith the policy terms. For participants who visit a hospital directly\nwithout a referral, services can still be provided as long as the\nparticipant holds a commercial insurance policy and is an active JKN\nmember. In such cases, service costs will be covered by the insurance\ncompany with a maximum benefit limit of 250% of the base calculation\nrate.<\/p>\n
In addition to providing convenience for participants, the CoB scheme\nis also expected to increase incentives for hospitals to join the\ncooperative ecosystem. Previously, hospitals received payments\nequivalent to 100% of the BPJS Kesehatan rate. Through the CoB scheme,\nthe value of claims received by hospitals can reach up to 2.5 times that\nrate, subject to applicable regulations.<\/p>\n
OJK hopes this scheme will encourage more insurance companies and\nhospitals to establish partnerships. \u201cBy the end of this year, the hope\nis that all insurers will have cooperated with as many hospitals as\npossible. Because by the end of this year, if they do not have a\ncooperation agreement, they will not be permitted to sell health\ninsurance products,\u201d said Iwan.<\/p>\n
The CoB programme was marked by the signing of the agreement between\nfive insurance companies and seven hospitals on Thursday (3\/9\/2026). The\nsigning was witnessed by the Minister of Health, Budi Gunadi Sadikin,\nand the Executive Head of Insurance, Guarantee, and Pension Fund\nSupervision at OJK, Ogi Prastomiyono.<\/p>", "url": "https:\/\/jawawa.id\/newsitem\/hospital-bills-can-be-paid-using-bpjs-kesehatan-and-private-insurance-here-is-how-1789894360", "image": "" }, "sponsor": "Okusi Associates", "sponsor_url": "https:\/\/okusiassociates.com" }