Good News! BPJS and Private Insurance Officially Linked, Here is the Scheme

The public is expected to be able to receive medical treatment in hospitals by combining commercial insurance benefits with BPJS Kesehatan through a Cooperation Agreement (PKS) for the Coordination of Benefit (CoB) between providers. This programme is expected to be fully implemented by the end of 2026 at the latest.

The CoB, also known as Coordination of Benefit, officially commenced through the signing of the first cooperation agreement involving five insurance companies and seven hospitals on Thursday (3/9/2026).

Through this agreement, the public can utilise the coordination of benefit scheme between BPJS Kesehatan and commercial insurance. Under this scheme, the healthcare cost burden borne by the public, BPJS Kesehatan, and hospitals is expected to become lighter.

Deputy Commissioner for Supervision of Insurance, Guarantee, and Pension Funds at the OJK, Iwan Pasila, stated that for participants who hold commercial insurance policies and are registered as active participants of the National Health Insurance (JKN), services in hospitals involved in the CoB partnership can be accessed without always requiring a referral from a clinic.

“Previously, BPJS required a referral from a clinic. With this, it can be done directly,” said Iguan following the signing ceremony in Jakarta.

If a participant visits a hospital with a referral from a clinic, the service costs will be split between BPJS Kesehatan and the insurance company. Under this scheme, BPJS Kesehatan covers up to 75% of the service costs, while the remainder is covered by the commercial insurance in accordance with applicable regulations.

Meanwhile, participants who go directly to a hospital without a referral can still receive services as long as they hold a commercial insurance policy and are active JKN participants. In such conditions, the service costs will be covered by the insurance company with benefit limits of up to a maximum of 250% of the base calculation rate.

For hospitals, the CoB scheme is also considered to provide greater financial benefits. Whereas previously hospitals only received payments equivalent to 100% of the BPJS Kesehatan rate, through this cooperation, the value of claims received can reach up to 2.5 times that amount, providing an additional incentive for healthcare facilities to join the ecosystem.

“The hope is that by the end of this year, all insurance companies will have cooperated with as many hospitals as possible. Because by the end of this year, if they do not have a cooperation agreement, they will not be permitted to sell health insurance products,” said Iwan.