People with active BPJS Kesehatan membership and commercial health insurance can now use both benefits for treatment at participating hospitals (3/9).

The arrangement is carried out through a Coordination Among Insurance Providers Agreement, known as KAPJ or Coordination of Benefit (CoB), between BPJS Kesehatan and commercial insurance companies.

The program began after the first KAPJ agreement was signed by five insurance companies and seven hospitals on Thursday, September 3, 2026. The implementation is expected to be carried out nationwide no later than the end of 2026.

BPJS Kesehatan and Private Insurance Can Now Be Combined

The scheme allows people with commercial insurance policies who are also active participants in the National Health Insurance (JKN) program to access services at hospitals participating in the cooperation.

OJK Deputy Commissioner for Insurance, Guarantee and Pension Fund Supervision Iwan Pasila said participants may go directly to a hospital without always needing a referral from a first-level health facility.

"Kalau yang selama ini BPJS kan harus dirujuk dari klinik, ya. Kalau ini bisa langsung," said Iwan after the signing ceremony in Jakarta on Thursday, September 3, 2026.

How the BPJS Kesehatan and Private Insurance Scheme Works

Participants who visit a hospital with a referral from a clinic can coordinate their BPJS Kesehatan and commercial insurance benefits.

Under this arrangement, BPJS Kesehatan will cover up to 75% of the service costs. The remaining costs will be covered by the insurance company according to the terms of the policy.

Participants who go directly to a hospital without a referral can also receive services if they have a commercial insurance policy and are active JKN participants.

In this situation, the insurance company will cover the service costs, with a maximum benefit of 250% of the tariff used as the basis for calculation.

Hospital Claims Can Reach 2.5 Times the BPJS Rate

The KAPJ scheme is also expected to provide greater incentives for hospitals to participate in the cooperation.

Previously, hospitals received payments equal to 100% of the BPJS Kesehatan tariff. Under KAPJ, the value of claims received by hospitals can reach up to 2.5 times the BPJS Kesehatan tariff, according to the applicable provisions.

The OJK expects the scheme to encourage more insurance companies and hospitals to establish cooperation agreements.

KAPJ to Expand Across Health Insurers and Hospitals

Iwan said the expectation is that all insurance companies will cooperate with as many hospitals as possible by the end of 2026.

He also said insurance companies without the required cooperation agreement would not be allowed to sell health insurance products by the end of the year.

The KAPJ or CoB program was marked by the signing of agreements between five insurance companies and seven hospitals on Thursday, September 3, 2026.

The signing was witnessed by Health Minister Budi Gunadi Sadikin and OJK Chief Executive of Insurance, Guarantee and Pension Fund Supervision Ogi Prastomiyono.

PHOTO: SHUTTERSTOCK

This article was created with AI assistance.

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