List of Diseases & Operations Not Covered by BPJS Health Lifestyle – 2 hours ago

Jakarta, CNBC Indonesia – BPJS Health is a national health service system that resembles insurance. This medical service includes outpatient care to surgery.

However, like private insurance, this service only applies to certain categories. This means that not all types of operations can be covered by BPJS Health.

The list of health services covered by BPJS is contained in the Guidelines for Implementing National Health Insurance (JKN) in Minister of Health Regulation (PMK) No. 28 of 2014.

Here are 5 types of operations that are not covered by BPJS Health

1. Operations Due to the Impact of Accidents

2. Cosmetic or Aesthetic Surgery (surgery that is not harmful to health)

3. Operations due to self-injury (operations due to inaccuracy or carelessness that result in injury)

4. Operations at Overseas Hospitals (operations carried out outside the reach of BPJS Health)

5. Operations that do not comply with BPJS Health Procedures (operations that do not complete the appropriate application procedures)

To obtain full protection, participants need to follow applicable procedures. After the procedure is carried out according to the provisions, BPJS Health will cover all costs of surgery and treatment.

  1. The first step, participants are asked to seek treatment at a health facility (puskesmas or clinic) that has been approved by BPJS Health.
  2. Second, if surgery is required, participants will be given a referral letter to the hospital.
  3. The third step, the hospital doctor will examine the patient and arrange a surgery schedule. If the patient is in an emergency situation, treatment will be carried out immediately.

BPJS Health Operational Process Requirements

– BPJS Health Card or Healthy Indonesia Card (KIS).

– Referral letter from first level Puskesmas/Faskes.

– Patient card obtained from the hospital after the patient registers.

In the rules contained in Presidential Regulation number 82 of 2018 concerning Health Insurance, there are at least 21 diseases that are not covered by BPJS Health.

List of 21 Diseases Not Covered by BPJS Health As of November 2023:

1. Diseases in the form of epidemics or extraordinary events.

2. Treatments related to beauty and aesthetics, such as plastic surgery.

3. Straightening teeth like braces.

4. Diseases resulting from criminal acts, such as abuse or sexual violence.

5. Illness or injury resulting from deliberate self-harm or suicide attempt.

6. Diseases due to alcohol consumption or drug dependence.

7. Treatment of barrenness or infertility.

8. Illness or injury resulting from events that cannot be prevented, such as brawls.

9. Health services provided abroad.

10. Treatment and medical procedures that are categorized as trials or experiments.

11. Complementary, alternative and traditional medicine that has not been declared effective based on health technology assessment.

12. Contraceptives.

13. Household health supplies.

14. Health services that do not comply with the provisions of statutory regulations, consisting of referrals at your own request and other health services that do not comply with statutory regulations.

15. Health services in health facilities that do not collaborate with BPJS Health, except in emergency situations.

16. Health services for illnesses or injuries resulting from work accidents or work relations that are guaranteed by the work accident insurance program or are borne by the employer.

17. Health services guaranteed by the mandatory traffic accident insurance program up to the value covered by the traffic accident insurance program according to the participant’s treatment class rights.

18. Certain health services related to the Ministry of Defense, Indonesian National Army (TNI), and Polri.

19. Health services provided within the framework of social service.

20. Services that are already covered under other programs.

21. Other services that are not related to the health insurance benefits provided.

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