Coordination of Benefits (CoB) is a mechanism for managing benefits when a person has more than one insurance policy covering the same risk. Its purpose is to prevent double claims and to ensure that the total reimbursement does not exceed the actual cost incurred.
When you have more than one health insurance policy—such as BPJS and a private insurance plan—you might wonder: which one should you use first when filing a claim? This is where the Coordination of Benefits (CoB) becomes important. This scheme determines who pays first and how the remaining costs are handled, helping to avoid duplicate claims that could harm insurance providers.
In this article, Roojai will explain how the CoB system works, its key benefits, and the proper way to file a claim if you have multiple coverages. Let’s break it down clearly and simply.
CoB, or Coordination of Benefits, is a system applied when someone holds more than one health insurance policy for the same medical treatment.
The concept of CoB has gained relevance as more people use BPJS Kesehatan for basic protection while adding private insurance for broader coverage.
This scheme not only clarifies which insurer should pay first but also ensures that claim processing between insurers runs smoothly. CoB is especially useful in situations where one insurer does not fully cover the medical costs—allowing the remainder to be processed by the second insurer.
For hospitals and healthcare providers, CoB ensures clear billing processes. They know which insurer is primary and how to coordinate with the secondary insurer for any unpaid balance.
Without this coordination, claims could overlap, leading to confusion or even potential fraud. CoB makes insurance administration more efficient and transparent.
CoB serves several essential roles, not only simplifying payments but also protecting all parties involved. Here are its main functions:
CoB ensures that two insurance providers don’t pay for the same bill. Once the primary insurer covers its share, the remaining amount can be claimed from the secondary insurer—without duplicate payments.
Without CoB, there's a risk of overpayment or claim misuse. Proper benefit coordination ensures that only legitimate charges are paid, and only up to the policy limits.
CoB not only benefits individuals, but also helps maintain financial stability in the insurance industry. By reducing waste and duplicate payouts, insurers can better allocate resources to serve more policyholders.
Though both involve multiple insurance policies, CoB and double claiming are very different in practice. CoB is a formal process agreed upon by insurers, while double claiming typically refers to submitting the same claim to multiple insurers independently—which may violate policy terms.
Double claim occurs when someone files a single claim to two insurers without coordination, potentially receiving duplicate payouts. This is often considered fraudulent.
In contrast, CoB is legal and transparent. For example, you may use BPJS as your primary insurer for inpatient care. Then, you can submit any remaining costs—such as for higher room classes or branded medication—to your private insurer as a secondary payer. This method is fully compliant with insurance regulations.
Understanding this distinction allows you to fully utilize your protection without breaking the rules or harming the insurers involved.
If you are covered by both BPJS and a private insurance provider, you can legally and efficiently maximize your benefits using the CoB system. Here’s how the process typically works:
Use BPJS first to cover the basic medical services—such as inpatient care or surgeries.
Submit the remaining uncovered costs (e.g., upgraded room, non-generic drugs, additional services) to your private insurer as the secondary provider.
You’ll need to prepare supporting documents such as:
Medical summaries
Itemized hospital bills
Proof of BPJS payments
Claim forms from the private insurer
Also, understand which is considered the primary insurer and which is secondary. Typically, BPJS is the primary, and your private plan is the supplement—but this depends on the insurer’s policy.
The CoB system is commonly used in employee insurance programs. Employers often provide supplemental insurance to enhance BPJS benefits for their workers.
For instance, when an employee is hospitalized, the first claim goes to BPJS. Any excess—such as room upgrades, special medications, or advanced procedures—can then be covered by the employee insurance plan.
Companies usually manage this setup through their HR departments, in cooperation with insurers, making the process easier for employees. This allows staff to get maximum protection without facing high out-of-pocket costs. That’s why employee insurance isn’t just a benefit—it’s a long-term investment in the company’s well-being.
Choosing the right employee insurance isn’t just about medical coverage—it’s about flexibility, especially in supporting Coordination of Benefits with BPJS.
With Roojai, your employees can enjoy dual coverage without the hassle of complex claims—and all within regulatory compliance. Roojai provides comprehensive employee insurance plans that support CoB and start with as few as 3 participants—making it accessible even for SMEs and small businesses.
Explore the right policy and speak with our advisors today at Roojai.co.id!