Hospital Bills Can Be Paid Using BPJS Kesehatan and Private Insurance, Here Is How
Citizens can now pay for medical treatment in hospitals by combining benefits from BPJS Kesehatan and commercial health insurance. This scheme is implemented through a Cooperation Agreement (PKS) for the Coordination of Benefit (CoB) between BPJS Kesehatan and commercial insurance companies.
The programme commenced following the signing of the first cooperation agreement involving five insurance companies and seven hospitals on Thursday (3/9/2026). The full implementation of the CoB scheme is expected to be completed by the end of 2026.
Iwan Pasila, Deputy Commissioner for Insurance, Guarantee, and Pension Fund Supervision at the Financial Services Authority (OJK), stated that this scheme allows participants who hold commercial insurance policies and are also active members of the National Health Insurance (JKN) to access services at participating hospitals. One of the primary advantages is that participants can visit hospitals directly without always requiring a referral from a primary healthcare facility.
“Previously, with BPJS, you had to be referred from a clinic. With this, you can go directly,” said Iwan following the signing ceremony in Jakarta on Thursday (3/9/2026).
Under the CoB scheme, participants arriving at a hospital with a clinic referral can coordinate BPJS Kesehatan benefits with commercial insurance. BPJS Kesehatan will cover up to 75% of the service costs, while the remainder is covered by the insurance company in accordance with the policy terms. For participants who visit a hospital directly without a referral, services can still be provided as long as the participant holds a commercial insurance policy and is an active JKN member. In such cases, service costs will be covered by the insurance company with a maximum benefit limit of 250% of the base calculation rate.
In addition to providing convenience for participants, the CoB scheme is also expected to increase incentives for hospitals to join the cooperative ecosystem. Previously, hospitals received payments equivalent to 100% of the BPJS Kesehatan rate. Through the CoB scheme, the value of claims received by hospitals can reach up to 2.5 times that rate, subject to applicable regulations.
OJK hopes this scheme will encourage more insurance companies and hospitals to establish partnerships. “By the end of this year, the hope is that all insurers 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.
The CoB programme was marked by the signing of the agreement between five insurance companies and seven hospitals on Thursday (3/9/2026). The signing was witnessed by the Minister of Health, Budi Gunadi Sadikin, and the Executive Head of Insurance, Guarantee, and Pension Fund Supervision at OJK, Ogi Prastomiyono.