Asuransi Kesehatan

Unveiling The Mystery Of The New Indonesia’s Bpjs Health Program “Kris”: What Does It Mean For You?

Liga Asuransi – Amid the uncertainty, we often become accustomed to surprises. However, on Thursday, May 16, 2024, the surprise from the government in the form of an announcement by Health Minister Budi Gunadi Sadikin at the DPR RI building in Jakarta was no ordinary news. For most people, it might not seem impactful. But the announcement was quite shocking for workers, business owners, professionals, and the private sector.

Why is that? Amidst inevitable changes, the government introduced a new BPJS Health program called KRIS. As a blog focused on risk management and insurance, we couldn’t miss the opportunity to delve deeper into this program that has caught many people’s attention.

If you’re intrigued by this significant change, let’s explore it together. Feel free to share this article with your colleagues, as our discussion could offer valuable new insights.

Health Minister (Menkes) Budi Gunadi Sadikin stated that the change in BPJS Health classes to Standard Inpatient Class (KRIS) aims to improve the quality of hospital services with uniform standards across Indonesia. This change, stipulated in Presidential Regulation No. 59 of 2024, does not eliminate BPJS classes I, II, and III but rather enhances service standards.

KRIS will reduce the number of beds in a hospital room from up to 8 beds to a maximum of 4 beds. Additionally, each room will be equipped with an ensuite bathroom and privacy curtains to enhance patient privacy. Budi emphasized that KRIS does not reduce services but raises the minimum standards for inpatient care. The implementation of KRIS will be gradual and has been piloted in various hospitals for over a year. Regulations to support KRIS implementation are being prepared, with full implementation targeted before June 30, 2025.

Furthermore, Budi stated that there would be adjustments to BPJS Health premiums in line with the implementation of KRIS, scheduled for next year. These premiums will be simplified gradually to reduce the significant differences between classes 3, 2, and 1. Going forward, premiums will become standardized because differences in service classes should be covered by private insurance, while BPJS Health must guarantee minimal services for all Indonesians without exception.

Budi also mentioned that the nominal premium limits are still under consideration, with a final decision to be made soon after discussions with BPJS and hospital associations. KRIS, regulated under Presidential Regulation No. 59 of 2024, does not eliminate BPJS Health classes but enhances hospital service standards to be uniform across all classes. The implementation of KRIS will be gradual, focusing on improving service quality.

 

UNDERSTANDING THE BENEFITS OF THE “KRIS” PROGRAM

The Standard Inpatient Class (KRIS) program is the latest initiative from BPJS Health, aimed at improving the quality of inpatient services in hospitals by implementing uniform standards across Indonesia. This program is regulated under Presidential Regulation No. 59 of 2024 concerning the Third Amendment to the Presidential Regulation on Health Insurance.

 

Main Objectives of the KRIS Program

Improving Minimum Service Standards:

  • Reducing the number of beds in a hospital room from 8 beds to a maximum of 4 beds. This is done to reduce crowding and enhance patient comfort.
  • Each room will be equipped with an ensuite bathroom and privacy curtains to enhance patient privacy. These facilities aim to provide a more comfortable and hygienic care environment.
  • KRIS aims to standardize the health services provided in all hospitals that collaborate with BPJS Health, ensuring that all patients receive the same level of care regardless of their social or economic status.

Gradual Implementation:

The implementation of the KRIS program will be carried out gradually and has been piloted in various hospitals for over a year. The target for full implementation of this program is before June 30, 2025, ensuring that hospitals have sufficient time to adjust their facilities and services according to KRIS standards.

Benefits of the KRIS Program

Patient Comfort:

With better facilities and maintained privacy, patients can feel more comfortable during their treatment period.

Improved Quality of Service:

Higher service standards ensure that patients receive better and consistent medical care.

Equal Access:

This program helps reduce disparities in health services across various regions, ensuring all Indonesian citizens receive proper care.

In conclusion, KRIS is a significant step in the government’s efforts to enhance the quality of health services in Indonesia, ensuring that every patient, without exception, receives adequate and high-quality care.

 

HOW IS THE SERVICES BEFORE “KRIS”?

For comparison, before the implementation of the Standard Inpatient Class (KRIS) program, BPJS Health provided inpatient services divided into three classes: Class I, Class II, and Class III. Each class had different facilities and benefits. Here is an explanation of the inpatient benefits of BPJS Health before KRIS:

Class I

  • Number of Beds: Usually 2-4 beds per room.
  • Room Facilities: Better facilities compared to other classes, with more spacious rooms and amenities such as wardrobes and chairs for patient attendants.
  • Privacy and Comfort: The higher level of privacy and comfort compared to Classes II and III.
  • Cost: Monthly premiums for Class I are higher compared to Classes II and III.

 

Class II

  • Number of Beds: Usually 3-6 beds per room.
  • Room Facilities: Adequate facilities with reasonably spacious rooms and basic amenities such as small wardrobes and chairs for patient attendants.
  • Privacy and Comfort: Moderate level of privacy and comfort, between Class I and Class III.
  • Cost: Monthly premiums for Class II are lower than Class I but higher than Class III.

Class III

  • Number of Beds: Usually 6-8 beds per room.
  • Room Facilities: Basic facilities with smaller rooms and minimal amenities such as small wardrobes or none, and limited chairs for patient attendants.
  • Privacy and Comfort: The lowest level of privacy and comfort compared to Classes I and II, due to many patients in one room.
  • Cost: Monthly premiums are the lowest among the three classes.

 

General Inpatient Benefits of BPJS Health

  • Medical Coverage: All classes cover medical treatment costs, including doctor consultations, medications, medical procedures, and surgeries as medically indicated.
  • Post-Surgery Care: Post-surgery care and recovery are also covered according to BPJS Health regulations.
  • Hospital Access: BPJS Health participants can access care in various hospitals that collaborate with BPJS, including both government and private hospitals.

 

Limitations

  • Service Standards: There is a significant difference in service standards between Classes I, II, and III. Class III often has simpler and less comfortable facilities.
  • Room Density: Higher room density in Classes II and III can reduce patient comfort and privacy.
  • Additional Facilities: Additional facilities such as ensuite bathrooms, large wardrobes, and more spacious rooms are typically only available in Class I.

Before KRIS, the benefits of BPJS Health inpatient care varied according to the chosen class. Although all classes offered the same basic medical coverage, significant differences in facilities and levels of comfort were major considerations for participants in choosing their classes. KRIS aims to standardize these service levels so that all participants receive more uniform and adequate quality care.

 

THE IMPACTS OF THE KRIS PROGRAM

The KRIS policy, which regulates the standard of inpatient services at hospitals affiliated with BPJS Health, has several negative impacts on the comfort of patient care, including:

  • Room Density

Reducing the number of beds in one room to a maximum of 4 beds can potentially increase room density. This can reduce patients’ movement space and increase noise levels in the room, decreasing comfort and privacy for patients.

  • Limited Facilities

With the emphasis on standard simplification, there may be a reduction in additional facilities such as ensuite bathrooms or more spacious rooms. This can diminish patient comfort, especially for those requiring intensive or long-term care in the hospital.

  • Decline in Service Quality

Implementing new standards can pressure hospitals to meet KRIS requirements, particularly if infrastructure changes or renovations are needed. This can disrupt hospital operations and lead to a temporary decline in service quality during the transition period.

  • Increased Additional Costs

Hospitals may need to invest to meet KRIS standards, such as constructing ensuite bathrooms or expanding rooms. These additional costs are likely to be passed on to patients in the form of extra fees or increased BPJS Health premiums.

  • Patient Dissatisfaction

Patients accustomed to certain facilities or service standards may feel dissatisfied with the changes implemented under the KRIS policy. This dissatisfaction can negatively impact their care experience and overall perception of BPJS Health.

 

THE IMPORTANCE OF SUPPLEMENTAL COVERAGE FROM PRIVATE INSURANCE

To ensure better healthcare services, it is crucial to consider obtaining supplemental health insurance coverage from private insurance companies. Here are the steps you can follow:

Steps to Obtain Health Insurance from Private Companies:

  • Research and Compare Plans: Investigate various insurance plans from different companies to find the best coverage that suits your needs.
  • Consult an Insurance Broker: A broker can provide expert advice and help you navigate through the options to select the most suitable policy.
  • Evaluate Coverage Details: Pay attention to the specifics of the coverage, such as hospital networks, types of services covered, and any exclusions.
  • Check for Coordination of Benefits (COB): Ensure that your private insurance policy can work in tandem with your BPJS Health coverage for maximum benefits.

Benefits of Collaboration between BPJS Health and Private Insurance through Coordination of Benefits (COB):

Optimal Utilization

Ensures that participants can fully utilize the health insurance benefits from both sources without overlap or double billing.

Participant Convenience

Provides comfort for participants in terms of access to healthcare services and financing, especially if they have additional private insurance policies offering extra benefits.

Continuity of Care

Enables participants to receive continuous care without worrying about costs not covered by one of the insurances.

COB between private insurance and BPJS Health is a crucial mechanism to ensure that participants maximize the benefits from their health insurance policies while minimizing financial and administrative burdens. By leveraging both types of coverage, individuals can achieve comprehensive and hassle-free healthcare.

 

WHY SHOULD INDIVIDUALS AND COMPANIES USE INSURANCE BROKERS INSTEAD OF INSURANCE AGENTS FOR HEALTH INSURANCE?

Obtaining the best health insurance coverage through an insurance brokerage firm offers several advantages over using an insurance agent. Here are some key reasons why utilizing an insurance brokerage firm is more advisable:

  • Access to a Wide Range of Options

Insurance brokerage has broader access to various health insurance products from multiple insurance companies. They can offer a more diverse selection tailored to your needs and preferences.

  • Independence and Client-Centric Approach

Insurance brokers are typically independent of any specific insurance company, allowing them to provide unbiased advice. They are not tied to a single product or brand, enabling them to offer recommendations that best suit the client’s needs.

  • Client Interests First

Insurance brokers prioritize their clients’ interests over selling products from a single insurer. They aim to find the most suitable products based on the client’s needs and budget, rather than those that offer the highest commission.

  • Professional Consultation

Insurance brokers generally have in-depth knowledge of the insurance industry and the products available. They can offer detailed and comprehensive consultations about the benefits, coverage, and premiums of various health insurance products.

  • Tailored Recommendations

Based on their understanding of the client’s needs, insurance brokers can provide more customized recommendations and the most appropriate solutions.

  • Client Representation

In the event of a claim, insurance brokers represent their client’s interests in the claims negotiation process with the insurance company. They help ensure that claims are processed quickly and fairly.

  • Ongoing Support

Insurance brokers offer continuous support to their clients, including assistance with claims, policy renewals, and resolving other issues.

  • Efficiency and Cost-Effectiveness

Insurance brokers can help compare premiums across different insurance products, ensuring you get the most competitive rates.

  • Time and Cost Savings

Using an insurance broker saves time and money that would otherwise be spent independently searching for suitable products.

In summary, using an insurance brokerage firm provides you with broader access to options, more in-depth consultation, stronger client representation, and greater efficiency in securing the best health insurance coverage that fits your needs and budget.

 

CHOOSE L&G INSURANCE BROKER: WHY?

As a leading insurance broker in Indonesia, L&G Insurance Broker offers advanced and client-oriented health insurance solutions. Here are several reasons why you should choose L&G Insurance Broker for your health insurance needs:

  • Access to the Best Products

L&G Insurance Broker has extensive access to health insurance products from various top insurance companies in Indonesia. They will help you select the most suitable product for your needs and budget.

  • Professional Consultation and Personalization

The professional team at L&G Insurance Broker provides in-depth consultations and personalized health insurance solutions tailored to your specific health situation and needs. They will understand your unique requirements and offer the right solutions.

  • Strong Client Representation

L&G Insurance Broker represents your interests in negotiations with insurance companies. They ensure that your claims are handled quickly and fairly, providing full support in dealing with any issues or questions that arise.

  • Modern Technology and Integrated Services

L&G Insurance Broker utilizes modern technology to offer more efficient and integrated services to their clients. You can easily access information about your insurance policy and submit claims online.

  • Continuous Post-Sale Support

After purchasing an insurance policy through L&G Insurance Broker, they provide ongoing support in handling claims, renewing policies, and resolving any other issues that may arise.

  • Trusted Reputation

L&G Insurance Broker has built a trusted reputation as a reliable insurance partner in Indonesia. They have deep experience and knowledge in the insurance industry and are committed to delivering high-quality service to their clients.

By using L&G Insurance Broker, you can be confident that you are getting the best health insurance solutions that meet your needs and expectations. Contact L&G Insurance Broker today for a free consultation and get the health coverage you need!

This article is brought to you by Insurance Broker L&G Insurance Broker.

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