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OJK Circular No. 15/SEOJK.05/2023 on Monthly Health Insurance Program Management Reports for Social Health Insurance Implementing Bodies
The Financial Services Authority (OJK) issued Circular No. 15/SEOJK.05/2023 to mandate Social Health Insurance Implementing Bodies (BPJS Kesehatan) to submit monthly management reports for enhanced regulatory oversight. The regulation requires these entities to file detailed profile and recapitulation reports via the OJK's digital communication system or official email within ten working days following the end of each month. This circular explicitly revokes the previous OJK Circular No. 19/SEOJK.05/2014 regarding the same reporting obligations.
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Monthly Health Insurance Program Management Report for Social Health Insurance Implementing Bodies


Sector:
IKNB


Sub-Sector:
Other Regulations


Regulation Type:
OJK Circular


Regulation Number:
15/SEOJK.05/2023


Effective Date:
9/21/2023


Attachment 1
SEOJK 15-SEOJK.05-2023 MONTHLY HEALTH INSURANCE PROGRAM MANAGEMENT REPORT FOR SOCIAL HEALTH INSURANCE IMPLEMENTING BODIES.pdf


SEOJK 15-SEOJK.05-2023 MONTHLY HEALTH INSURANCE PROGRAM MANAGEMENT REPORT FOR SOCIAL HEALTH INSURANCE IMPLEMENTING BODIES ABSTRACT.pdf


FAQ SEOJK 15-SEOJK.05-2023 MONTHLY HEALTH INSURANCE PROGRAM MANAGEMENT REPORT FOR SOCIAL HEALTH INSURANCE IMPLEMENTING BODIES.pdf


Page Content


OJK Circular Number 15/SEOJK.05/2023 regarding Monthly Reports on Health Insurance Program Management for Social Health Insurance Implementing Bodies


ABSTRACT:
To encourage OJK supervision over Social Health Insurance Implementing Bodies (BPJS Kesehatan), to ascertain the factual conditions of BPJS in executing its program management, and to align applicable regulations within BPJS with the current examination processes of financial service institutions.
The legal basis for this OJK Circular is Article 16 paragraph (10) of OJK Regulation Number 5/POJK.05/2013 regarding Supervision of Social Health Insurance Implementing Bodies by the Financial Services Authority (State Gazette of the Republic of Indonesia Year 2013 Number 258, Supplement to the State Gazette of the Republic of Indonesia Number 5487) as amended by OJK Regulation Number 1 of 2023 regarding Amendments to OJK Regulation Number 5/POJK.05/2013 regarding Supervision of Social Health Insurance Implementing Bodies by the Financial Services Authority (State Gazette of the Republic of Indonesia Year 2023 Number 2/OJK, Supplement to the State Gazette of the Republic of Indonesia Number 28/OJK).
This OJK Circular regulates the submission of monthly program management reports by BPJS Kesehatan, the format and structure of the monthly health insurance program management reports, which include profile reports and recapitulation reports, the deadline for submitting monthly health insurance program management reports, and the procedure for submitting monthly health insurance program management reports, including submission via the OJK data communication network system and/or official OJK email.


NOTE:
This OJK Circular takes effect on the date of establishment.
The preparation of Monthly Program Management Reports is required for periods ending on January 31, February 28 or 29, March 31, April 30, May 31, June 30, July 31, August 31, September 30, October 31, November 30, and December 31.
Monthly program management reports include:
a. Profile reports:


    

  1. general profile;
    2. 

  2. profile of the supervisory board and board of directors;
    3. 

  3. organizational structure profile;
    4. 

  4. office profile;
    5. 

  5. employee education level profile; and
    6. 

  6. expert personnel profile; and
b. Recapitulation reports:
    7. 

  7. membership recapitulation;
    8. 

  8. contribution recapitulation;
    9. 

  9. claim recapitulation;
    10. 

  10. health facility recapitulation;
    11. 

  11. complaint handling recapitulation; and
    12. 

  12. capitation payment recapitulation.
Reports must be submitted no later than 10 (ten) working days after the end of the relevant month.
Report submission is conducted online via the OJK data communication network system.
In the event that the aforementioned communication network is unavailable, experiencing technical disturbances, or in cases of force majeure, the Monthly Program Management Report (LPP Bulanan) is submitted online via email.
In the event that BPJS cannot submit the Monthly Program Management Report online, the Monthly Program Management Report is submitted offline in the form of an electronic copy (soft file) and sent to the Financial Services Authority via a letter signed by the Board of Directors.
OJK Circular Number 19/SEOJK.05/2014 regarding Monthly Health Insurance Program Management Reports for Social Health Insurance Implementing Bodies is revoked and declared invalid.
    13. 

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