OJK Circular No. 15/SEOJK.05/2023 on Monthly Health Insurance Program Management Reports for Social Health Insurance Implementing Bodies

To: Directors of the Social Health Insurance Implementing Bodies

COPY FINANCIAL SERVICES AUTHORITY CIRCULAR REPUBLIC OF INDONESIA NUMBER 15/SEOJK.05/2023

ON MONTHLY HEALTH INSURANCE PROGRAM MANAGEMENT REPORTS FOR SOCIAL HEALTH INSURANCE IMPLEMENTING BODIES

In relation to the mandate of Article 16 paragraph (10) of Financial Services Authority Regulation Number 5/POJK.05/2013 concerning Supervision of Social 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 Financial Services Authority Regulation Number 1 of 2023 concerning Amendments to Financial Services Authority Regulation Number 5/POJK.05/2013 concerning Supervision of Social 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), it is necessary to regulate provisions regarding the form and structure of monthly health insurance program management reports for social health insurance implementing bodies in this Financial Services Authority Circular as follows:

I. GENERAL PROVISIONS In this Financial Services Authority Circular, the following terms are defined:

1. Social Health Insurance Implementing Body, hereinafter abbreviated as BPJS Kesehatan, is a public legal entity established to implement the health insurance program as referred to in Law Number 24 of 2011 concerning Social Insurance Implementing Bodies.
2. Health Insurance is health protection so that participants obtain health maintenance benefits and protection in meeting basic health needs provided to every person who has paid health insurance contributions or whose health insurance contributions are paid by the central or regional government.
3. Monthly Health Insurance Program Management Report, hereinafter referred to as Monthly LPP, is a program management report compiled by BPJS Kesehatan for the needs of the Financial Services Authority, covering the period from January 1 to the end of the current month, presented and submitted according to the form and structure of monthly health insurance program management reports and according to the procedures determined by the Financial Services Authority.

II. FORM AND STRUCTURE OF MONTHLY HEALTH INSURANCE PROGRAM MANAGEMENT REPORTS

1. BPJS Kesehatan is required to compile Monthly LPP 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.
2. Monthly LPP includes: a. profile reports, consisting of:

1. general profile;
2. supervisory board and board of directors profile;
3. organizational structure profile;
4. office profile;
5. employee education level profile; and
6. expert personnel profile; and b. recapitulation reports, consisting of:
7. participant recapitulation;
8. contribution recapitulation;
9. claim recapitulation;
10. health facility recapitulation;
11. complaint handling recapitulation; and
12. capitation payment recapitulation.

3. BPJS Kesehatan must have an information system capable of processing and maintaining supporting data for the reports as referred to in item 2.
4. The Financial Services Authority may request BPJS Kesehatan to submit supporting data as referred to in item 3 for the purpose of supervising BPJS Kesehatan.
5. The form, structure, and guidelines for compiling the profile reports as referred to in item 2 letter a and the recapitulation reports as referred to in item 2 letter b are contained in Appendix I which is an integral part of this Financial Services Authority Circular.
6. Monthly LPP must be accompanied by a director's statement of responsibility for Monthly LPP as contained in Appendix II which is an integral part of this Financial Services Authority Circular.
7. Supporting data for reports as referred to in item 3 is as contained in Appendix III which is an integral part of this Financial Services Authority Circular.

III. SUBMISSION TIME FOR MONTHLY HEALTH INSURANCE PROGRAM MANAGEMENT REPORTS

1. BPJS Kesehatan is required to submit Monthly LPP to the Financial Services Authority at the latest 10 (ten) days after the end of the relevant month.
2. In the event that the submission deadline for Monthly LPP as referred to in item 1 is a holiday, the submission deadline for Monthly LPP is the first working day after the said deadline.
3. The Financial Services Authority is authorized to set different submission deadlines for Monthly LPP from the provisions as referred to in item 1 for certain conditions.

IV. PROCEDURES FOR SUBMISSION OF MONTHLY HEALTH INSURANCE PROGRAM MANAGEMENT REPORTS

1. Submission of Monthly LPP is done online through the Financial Services Authority's data communication network system.
2. In the event that the Financial Services Authority's data communication network system as referred to in item 1 is not yet available, experiences technical disturbances, or experiences force majeure, BPJS Kesehatan must submit Monthly LPP online via email to the Financial Services Authority.
3. In the event that the Financial Services Authority's data communication network system experiences technical disturbances or force majeure as referred to in item 2, the Financial Services Authority informs the occurrence of technical disturbances or force majeure in writing and delivered: a. through the Financial Services Authority's data communication network system; and/or b. via email from the official email address of the Financial Services Authority.
4. Force majeure as referred to in items 2 and 3 includes, among others, fire, mass riots, war, armed conflict, sabotage, pandemic, cyber attacks, and/or natural disasters such as earthquakes or floods.
5. In the event that BPJS Kesehatan must submit Monthly LPP online via email to the Financial Services Authority as referred to in item 2, the Financial Services Authority provides BPJS Kesehatan with the email address used for the submission of Monthly LPP.
6. In the event of submission online via email as referred to in item 2, BPJS Kesehatan must submit in writing to the Financial Services Authority the email address of BPJS Kesehatan used for the submission of Monthly LPP to the Financial Services Authority.
7. In the event that the Financial Services Authority's data communication network and email systems as referred to in items 1 and 2 experience technical disturbances or force majeure, or BPJS Kesehatan experiences technical disturbances so that it cannot submit Monthly LPP online, Monthly LPP 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 directors and addressed to: Financial Services Authority u.p. Director of Life Insurance Supervision Wisma Mulia 2 Building, 12th Floor Jalan Jenderal Gatot Subroto Kav. 40 Jakarta 12710.
8. In the event of changes to the email address (email) of the Financial Services Authority as referred to in item 5 and/or changes to the office address of the Financial Services Authority as referred to in item 7, the Financial Services Authority will communicate such address changes via letter or announcement.
9. Offline submission of Monthly LPP as referred to in item 7 is done by: a. hand delivery to the Financial Services Authority office; or b. sending via a courier service company.
10. Offline submission of Monthly LPP is delivered to the Financial Services Authority on working days and during Financial Services Authority working hours.
11. BPJS Kesehatan is deemed to have submitted Monthly LPP with the following provisions: a. for online submission via:

1. the Financial Services Authority's data communication network system is proven by a receipt from the Financial Services Authority's data communication network system; or
2. email to the Financial Services Authority is proven by a receipt from the Financial Services Authority in the event that submission through the data communication network system cannot be performed. b. for offline submission, is proven by a receipt from the Financial Services Authority.

12. The Financial Services Authority may request original printed documents of Monthly LPP that have been submitted by BPJS Kesehatan through the Financial Services Authority's data communication network system or email.

V. CLOSING

1. At the time this Financial Services Authority Circular takes effect, Financial Services Authority Circular Number 19/SEOJK.05/2014 concerning Monthly Management Reports of Health Insurance Programs for Social Health Insurance Implementing Bodies is revoked and declared invalid.

This copy is in accordance with the original Director of Law 1 Law Department signed Mufli Asmawidjaja

2. This Financial Services Authority Circular takes effect on the date of establishment. Established in Jakarta, on September 21, 2023 EXECUTIVE HEAD OF INSURANCE, INSURANCE, AND PENSION FUNDS SUPERVISOR FINANCIAL SERVICES AUTHORITY REPUBLIC OF INDONESIA, signed OGI PRASTOMIYONO

APPENDIX I FINANCIAL SERVICES AUTHORITY CIRCULAR REPUBLIC OF INDONESIA NUMBER 15/SEOJK.05/2023 ON MONTHLY HEALTH INSURANCE PROGRAM MANAGEMENT REPORTS FOR SOCIAL HEALTH INSURANCE IMPLEMENTING BODIES

MONTHLY HEALTH INSURANCE PROGRAM MANAGEMENT REPORT FOR SOCIAL HEALTH INSURANCE IMPLEMENTING BODIES

I. GENERAL PROFILE OF BPJS KESEHATAN

1. Institution Name : BPJS Kesehatan
2. Institution Address a. Full Address : ……………………………………………………. b. Building Ownership Status : ……………………………………………………. c. Location Code : ……………………………………………………. d. City Name : ……………………………………………………. e. Postal Code : …………………………………………………….
3. Telephone : …………………………………………………….
4. Website : …………………………………………………….
5. NPWP (Taxpayer Identification Number) : …………………………………………………….
6. Number of Offices a. Number of Regional Deputy Offices : ……………………………………………………. b. Number of Branch Offices : …………………………………………………….
7. Number of Employees a. Head Office : ……………………………………………………. b. Regional Deputy Offices : ……………………………………………………. c. Branch Offices : …………………………………………………….
8. Actuary Name :
9. Management a. Number of Directors : ……………………………………………………. b. Number of Supervisory Board Members : …………………………………………………….
10. Report Compiler and Person in Charge Person in Charge a. Full Name : ……………………………………………………. b. Position : ……………………………………………………. c. Telephone : ……………………………………………………. d. Email : ……………………………………………………. Compiler a. Full Name : ……………………………………………………. b. Position : …………………………………………………….

• 2 - c. Work Unit : ……………………………………………………. d. Telephone : ……………………………………………………. e. Email : ……………………………………………………. EXPLANATION: This form contains all information regarding the institutional profile of BPJS Kesehatan.

1. Institution Name Filled with the name BPJS Kesehatan.
2. Company Address a. Full Address Filled with the full address according to the domicile of the BPJS Kesehatan head office. b. Building Ownership Status Filled with the building ownership status, namely rent, own property, or loan use. c. Location Code Filled with the district/city location code according to the domicile of the BPJS Kesehatan head office. d. City Name Filled with the city name according to the domicile of the BPJS Kesehatan head office. e. Postal Code Filled with the postal code number of the domicile of the BPJS Kesehatan head office.
3. Telephone Filled with the telephone number of BPJS Kesehatan.
4. Website Filled with the website address of BPJS Kesehatan.
5. NPWP Filled with the taxpayer identification number of BPJS Kesehatan.
6. Number of Offices a. Number of Regional Deputy Offices Filled with the number of Regional Deputy Offices of BPJS Kesehatan. b. Number of Branch Offices Filled with the number of Branch Offices of BPJS Kesehatan.

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7. Number of Employees a. Head Office Filled with the number of employees at the Head Office of BPJS Kesehatan. b. Regional Deputy Offices Filled with the number of employees at the Regional Deputy Offices of BPJS Kesehatan. c. Branch Offices Filled with the number of employees at the Branch Offices of BPJS Kesehatan.
8. Actuary Name Filled with the name of the actuary who performs actuarial calculations at BPJS Kesehatan in the relevant year.
9. Management a. Number of Directors Filled with the number of directors of BPJS Kesehatan. b. Number of Supervisory Board Members Filled with the number of supervisory board members of BPJS Kesehatan.
10. Report Compiler and Person in Charge Filled with complete data of each personnel acting as the report compiler and the official in charge of the report. a. Person in Charge

1. Full Name Filled with the full name of the person in charge of the report.
2. Position Filled with the position of the Director in a specific field who is the person in charge of the report, for example, Finance Director.
3. Telephone Filled with the telephone number of the person in charge of the report.
4. Email Filled with the email address of the person in charge of the report. b. Compiler
5. Name Filled with the name of the report compiler.
6. Position Filled with the position of the report compiler.

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3. Work Unit Filled with the work unit of the report compiler.
4. Telephone Filled with the telephone number of the report compiler.
5. Email Filled with the email address of the report compiler.

II. PROFILE OF SUPERVISORY BOARD AND BOARD OF DIRECTORS OF BPJS KESEHATAN a. Supervisory Board Profile Reporting Period Supervisory Board Name Job Title Nomenclature Date of Appointment Start Appointment Decision Number Decision Date Decision Subject (1) (2) (3) (4) (5) (6) (7) b. Board of Directors Profile Reporting Period Board of Directors Name Job Title Nomenclature Date of Appointment Start Appointment Decision Number Decision Date Decision Subject (1) (2) (3) (4) (5) (6) (7) EXPLANATION: This form contains information on the management of BPJS Kesehatan consisting of the Supervisory Board and Board of Directors.

1. Reporting Period Filled with the date, month, and year of the end of the reporting period submitted.
2. Name of Supervisory Board/Directors Filled with the names of the Supervisory Board/Directors of BPJS Kesehatan.
3. Job Title Nomenclature Filled with the job title nomenclature of the Supervisory Board/Directors of BPJS Kesehatan.
4. Date of Appointment Start Filled with the date, month, and year of appointment start.
5. Appointment Decision Number Filled with the number of the appointment decision letter of the Supervisory Board/Directors, for example, KEP-100/MK/2023.

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6. Decision Date Filled with the date, month, and year the decision letter was issued.
7. Decision Subject Filled with the subject of the appointment decision letter.

III. ORGANIZATIONAL STRUCTURE PROFILE OF BPJS KESEHATAN Reporting Period Structure Name Official Name Structure Level Parent Structure Name (1) (2) (3) (4) (5) EXPLANATION: This form contains information on the organizational structure of BPJS Kesehatan.

1. Reporting Period Filled with the date, month, and year of the end of the reporting period submitted.
2. Structure Name Filled with the name of the organizational structure of BPJS Kesehatan, for example, finance section with order from the highest level.
3. Official Name Filled with the name of the official leading the organizational structure at BPJS Kesehatan.
4. Structure Level Filled with the structure level of the organizational structure at BPJS Kesehatan. No. Structure Level Code
5. Board of Directors 1
6. Division 2
7. Regional Deputy 3
8. Branch 4
9. Parent Structure Name Filled with the name of the parent organizational structure at BPJS Kesehatan, for example, Director of Human Resources and General Affairs.

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IV. OFFICE PROFILE OF BPJS KESEHATAN Table 1 of 2 Reporting Period Type of Office Full Address Office Location (1) (2) (3) (4) Table 2 of 2 Office Code Postal Code Telephone Total Employees (5) (6) (7) (8) EXPLANATION: This form contains information on the detailed list of office profiles of BPJS Kesehatan.

1. Reporting Period Filled with the date, month, and year of the end of the reporting period submitted.
2. Type of Office Filled with the Type of Office of BPJS Kesehatan: No. Type of Office Code
3. Regional Deputy Office 1
4. Branch Office 2
5. Full Address Filled with the full address of the office according to the domicile of the regional deputy office/branch office of BPJS Kesehatan.
6. Office Location Filled with the district/city location name according to the BPJS Kesehatan application system.
7. Office Code Filled with the district/city location code according to the BPJS Kesehatan application system.
8. Postal Code Filled with the postal code number of the domicile of the regional deputy office/branch office of BPJS Kesehatan.
9. Telephone Filled with the telephone number of BPJS Kesehatan.
10. Total Employees Filled with the total number of permanent employees at the BPJS Kesehatan office.

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V. EMPLOYEE EDUCATION LEVEL PROFILE OF BPJS KESEHATAN Reporting Period Education Level Code Male Female Total (1) (2) (3) (4) (5) (6) EXPLANATION: This form contains details of employee education levels both at the head office and offices other than the head office of BPJS Kesehatan.

1. Reporting Period Filled with the date, month, and year of the end of the reporting period submitted.
2. Education Level Filled with the education level of BPJS Kesehatan employees.
3. Code Filled with the employee education level code as follows: a. Head Office No. Education Level Code
4. Elementary School (SD) 9110
5. Junior High School (SMP) 9120
6. Senior High School (SMA) 9130
7. Diploma 1 (D1) 9140
8. Diploma 2 (D2) 9150
9. Diploma 3 (D3) 9160
10. Bachelor's/Diploma 4 (S1/D4) 9170
11. Master's (S2) 9180
12. Doctorate (S3) 9190
13. Foreign Personnel 9200 b. Outside Head Office No. Education Level Code
14. Elementary School (SD) 9210
15. Junior High School (SMP) 9220
16. Senior High School (SMA) 9230
17. Diploma 1 (D1) 9240
18. Diploma 2 (D2) 9250
19. Diploma 3 (D3) 9260
20. Bachelor's/Diploma 4 (S1/D4) 9270

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8. Master's (S2) 9280
9. Doctorate (S3) 9290
10. Foreign Personnel 9300
11. Male Filled with the number of male employees according to education level at BPJS Kesehatan.
12. Female Filled with the number of female employees according to education level at BPJS Kesehatan.
13. Total Filled with the total number of male and female employees according to education level at BPJS Kesehatan.

VI. EXPERT PERSONNEL PROFILE OF BPJS KESEHATAN Reporting Period Field of Expertise Qualification Number of Experts (1) (2) (3) (4) EXPLANATION: This form contains information on the detailed list of expert personnel profiles both at the head office and offices other than the head office of BPJS Kesehatan.

1. Reporting Period Filled with the date, month, and year of the end of the reporting period submitted.
2. Field of Expertise Filled with the field of expertise of BPJS Kesehatan expert personnel. No. Field of Expertise Code
3. Actuarial 1
4. Accounting, Audit and Finance 2
5. Insurance and Risk Management 3
6. Doctor 4
7. Information Technology 5
8. Others 6
9. Qualification Filled with the qualification of BPJS Kesehatan expert personnel. No. Field of Expertise Qualification
10. Actuarial FSAI/ASAI/Others
11. Accounting, Audit and Finance CFA/WMI/CPA/CISA/Acc/CA/QIA/CFE/CIA/Others
12. Insurance and Risk Management AAIJ/AAAIJ/AAIK/AAAIK/FLMI/ANZIF/ACII/BSMR/AAK/AAAK/CRMP/Others
13. Health Doctor/Doctor Specialist/Others
14. Information Technology Vendor Specific/Non Vendor Specific/Others
15. Others
16. Number of Experts Filled with the number of experts according to field of expertise and qualification at BPJS Kesehatan.

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RECAPITULATION REPORT I. PARTICIPANT RECAPITULATION Reporting Period Location Code Location Name Participant Segment Citizenship Dependent Status Class New Participants Participants Leaving Active Participants Inactive Participants Total (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) EXPLANATION: This form contains all information regarding the Participant Recapitulation of BPJS Kesehatan:

1. Reporting Period Filled with the date, month, and year of the end of the reporting period submitted.
2. Location Code Filled with the district/city location code according to the BPJS Kesehatan application system.
3. Location Name Filled with the district/city location name according to the BPJS Kesehatan application system.
4. Participant Segment Filled with the participant segment of the health insurance program as contained in the Participant Segment Table in Appendix III which is an integral part of this Financial Services Authority Circular.
5. Citizenship Filled with the citizenship of the health insurance program participants. No. Citizenship Code
6. Indonesian Citizens 1
7. Foreign Citizens 2

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6. Dependent Status Filled with the participant dependent status. No. Dependent Status Code
7. Participant 1
8. Husband/Wife 2
9. Child 3
10. Additional 4
11. Class Filled with the class of the health insurance program participants.
12. New Participants Filled with the number of new health insurance program participants, not including participants who move between participant segments.
13. Participants Leaving Filled with the number of participants leaving the health insurance program, for example, deceased or no longer Indonesian residents.
14. Active Participants Filled with the number of active health insurance program participants.
15. Inactive Participants Filled with the number of inactive health insurance program participants.
16. Total Participants Filled with the total number of active and inactive health insurance program participants.

II. CONTRIBUTION RECAPITULATION Reporting Period Location Code Location Name Participant Segment Class Contribution Receivable Category Total Due Contributions Contributions Paid 1 2 3 4 (1) (2) (3) (4) (5) (6) (7) (8) EXPLANATION: This form contains all information regarding contribution recapitulation.

1. Reporting Period Filled with the date, month, and year of the end of the reporting period submitted.
2. Location Code Filled with the district/city location code according to the BPJS Kesehatan application system.
3. Location Name Filled with the district/city location name according to the BPJS Kesehatan application system.
4. Participant Segment Filled with the participant segment of the health insurance program as contained in the Participant Segment Table in Appendix III which is an integral part of this Financial Services Authority Circular.
5. Class Filled with the class of the health insurance program participants.
6. Contribution Receivable Category Filled with the category of health insurance program contribution receivables. No. Category Code
7. Category 1: ≤ 3 months 1
8. Category 2: >3 – 6 months 2
9. Category 3: >6 – 12 months 3
10. Category 4: >12 months 4
11. Total Due Contributions Filled with the total contributions that have become due on the reporting date, including accumulated contributions from previous periods that have not been paid.
12. Contributions Paid Filled with the total contributions paid during the reporting period, including arrears (if any).

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III. CLAIM RECAPITULATION Reporting Period Location Code Location Name Type of Health Facility Class Type of Claim Claim Detail Claim Value Number of Cases Value (1) (2) (3) (4) (5) (6) (7) (8) (9) EXPLANATION: This form contains all information regarding the claim recapitulation of BPJS Kesehatan:

1. Reporting Period Filled with the date, month, and year of the end of the reporting period submitted.
2. Location Code Filled with the district/city location code according to the BPJS Kesehatan application system.
3. Location Name Filled with the district/city location name according to the BPJS Kesehatan application system.
4. Type of Health Facility Filled with the type of health facility of the health insurance program as contained in the Type of Health Facility Table in Appendix III which is an integral part of this Financial Services Authority Circular.
5. Class Filled with the class of the health insurance program participants. No. Class Code
6. Class 1 1
7. Class 2 2
8. Class 3 3
9. Type of Claim Filled with the type of health insurance program claims. No. Type of Claim Code
10. Primary Outpatient Care (RJTP) Capitation 1
11. Non-Capitation Claims 2
12. Primary Inpatient Care (RITP) 3
13. Advanced Outpatient Care (RJTL) Ina CBGs 4
14. Advanced Inpatient Care (RITL) Ina CBGs 5
15. Non-Ina CBGs Claims 6
16. Claim Detail Filled with claim details based on the most frequent claims and highest costs.

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