Heaptalk, Jakarta — State-run Healthcare and Social Security Agency (BPJS Kesehatan) introduced its recent program namely work accident and death insurance.
Head of BPJS South Jakarta branch Herman Dinata Mihardja delivered that many social security programs are managed by BPJS Kesehatan and BPJS Ketenagakerjaan. Therefore, the public must know the appropriate mechanisms and decisions when experiencing an incident that requires health services. “Thus far, several National Health Insurance (JKN) participants, particularly workers registered through their offices, still mistakenly use their membership to cover work accident cases,” Herman said at the JKN discussion with the press (03/25).
Herman further explained the flow of work accidents and occupational diseases insurance. He voiced, “When a case of suspected work accident or occupational disease first arises, the reaction begins with the provision of information by health facilities to participants and work accident insurance service agencies. Then the participant must coordinate with the employer to carry out the first stage of reporting to BPJS Ketenagakerjaan.”
Further, BPJS Ketenagakerjaan will carry out eligibility verification, to ensure that the participant is included in a work accident and can be guaranteed by the provisions. However, if a suspected work accident or work-related illness has not yet received a status determination, the guarantee is carried out by BPJS Ketenagakerjaan until the status is confirmed, no later than 30 days after the first stage report is received by BPJS Ketenagakerjaan.
“If a suspected work-related disease is proven not to be included in BPJS Ketenagakerjaan insurance, then at that time BPJS Kesehatan will cover the entire cost of the participant’s health services following the provisions of the applicable laws and regulations,” he added.
In addition, Herman also emphasized that providing insurance for suspected work accidents or work-related illnesses must be implemented comprehensively through benefit coordination between BPJS Ketenagakerjaan and BPJS Kesehatan. “As additional information for participants, first stage report of suspected work accidents or work-related illnesses must be carried out within 2 x 24 hours of the incident to the insurance agency following the provisions,” he concluded.
