BPJS Employment and BPJS Health Collaborate to Handle KK/PAK Insurance

JAKARTA - The collaboration of two social security service agencies has entered a new phase. BPJS Employment and BPJS Health have officially implemented the national guarantee of alleged Occupational Accidents (KK) and Work-related Diseases (PAK) through system integration on the e-PLKK Application, in an event held at the Sleman Hospital, Wednesday, December 17.

This program marks the implementation of digital and standardized KK/PAK assurance throughout Indonesia. The integration of e-PLKK BPJS Employment with the BPJS Health system allows membership validation, issuance of Participant Eligibility Letters (SEP), and recording of INA-CBG rates to run automatically and more accurately.

Director of BPJS Employment Services, Roswita Nilakurnia, said this step is a tangible manifestation of the transformation of the Occupational Accident Insurance (JKK) service which is increasingly easy, fast, and oriented towards participants.

"With this integration, workers can obtain fast and reliable services from the initial phase of suspected KK/PAK. This means that every worker who is suspected of having a work accident or a work-related disease can go directly to the hospital that cooperates, it will be checked for eligibility and do not be afraid to be guaranteed," said Roswita, in a written statement, Thursday, December 18.

He added that administrative constraints at the initial stage of the incident affected the speed of the medical handling process. Through the BPJS Employment system which is automatically connected to BPJS Health, workers can now obtain more responsive and transparent service certainty. On the other hand, health facilities also get a more structured and efficient workflow.

As is known, through Government Regulation Number 49 of 2023, the government has determined the strengthening of the mechanism for guaranteeing cases of alleged work accidents and work-related diseases, by entrusting the role of BPJS Employment as the first guarantor in handling the case.

In line with Roswita, Director of Health Service Assurance of BPJS Kesehatan, Lily Kresnowati, emphasized the strategic value of the integration of these two institutions.

"The important thing is our commitment to both (BPJS Employment and BPJS Health), if there are workers who are sick, it must be guaranteed. It's just a matter of whether the guarantee is to BPJS Employment or to BPJS Health. But what is certain is that the hospital or the organizer's faskes will not hesitate, if someone has a work accident or a work-related disease, yes, it will be guaranteed first," said Lily.

He also emphasized that both parties would carry out joint controls, so that accountability for services would be guaranteed in accordance with existing procedures, such as for example in BPJS Employment there are reports from companies, and in BPJS Health there is also a tiered referral procedure.

This activity also received full support from the National Social Security Board (DJSN), with the presence of DJSN members Nikodemus Beriman Purba, Syamsul Hidayat Pasaribu and Hermansyah. For your information, with the Go Livenya feature of KK/PAK presumption on e-PLKK, BPJS Employment participants who experience KK/PAK presumption can obtain immediate health services without waiting for the final conclusion.

The new system provides a number of benefits, including: Direct service according to the class of care and INA-CBG rates. Simplifying the standardized administrative process nationally. Minimizing disputes through automatic data validation of both institutions. More neat and structured digital documentation for health facilities.

BPJS Employment and BPJS Health will continue to conduct periodic monitoring to ensure that the process of guaranteeing the alleged KK/PAK is optimal and can improve the quality of worker protection throughout Indonesia.

On a separate occasion, the Head of the BPJS Employment Jakarta Cilincing Branch Office, Rita Mariana, welcomed this integration as a step forward in worker protection.

"The integration of e-PLKK will make handling work accidents faster and more efficient, so workers don't have to worry about treatment costs when they are at risk at work," said Rita.

This breakthrough, said Rita, provides increasingly comprehensive protection for workers.

"Including assistance so that workers can return to work safely and productively," he concluded.