{ "success": true, "data": { "id": 1783502, "msgid": "five-operations-no-longer-covered-by-bpjs-kesehatan-from-june-2026-1780553965", "date": "2026-06-04 09:00:06", "title": "Five Operations No Longer Covered by BPJS Kesehatan from June 2026", "author": "", "source": "CNBC", "tags": "", "topic": "Social Policy", "summary": "BPJS Kesehatan, Indonesia's national health insurance system, will cease to cover five types of operations starting in June 2026. These include operations resulting from accidents, cosmetic procedures, self-inflicted injuries, procedures performed abroad, and those not complying with BPJS procedures. Despite this, BPJS Kesehatan still covers 19 types of operations, such as heart surgery and cataract removal, provided patients follow the correct procedures and obtain referrals.", "content": "

BPJS Kesehatan, the national social security agency, provides health\nprotection to the people of Indonesia. Similar to insurance, BPJS\nrequires participants to pay monthly premiums. As long as their\nmembership is active, participants can receive free health services at\nclinics, community health centres (Puskesmas), and hospitals that\ncooperate with BPJS Kesehatan.<\/p>\n

One of the services covered by BPJS Kesehatan is surgery. However,\nthere are several types of surgery that are not covered by BPJS\nKesehatan. What are they?<\/p>\n

Here is a list of operations not covered by BPJS Kesehatan:<\/p>\n

    \n

  1. Operations resulting from accidents<\/p><\/li>\n

  2. Cosmetic or aesthetic surgery (surgery that does not pose a\nhealth risk)<\/p><\/li>\n

  3. Operations resulting from self-inflicted injuries (surgery\nresulting from negligence or carelessness that causes injury)<\/p><\/li>\n

  4. Operations performed in foreign hospitals (surgery performed\noutside the coverage area of BPJS Kesehatan)<\/p><\/li>\n

  5. Operations that do not comply with BPJS Kesehatan procedures\n(surgery that does not follow the correct application\nprocedures)<\/p><\/li>\n<\/ol>\n

    However, according to the guidelines for the implementation of the\nNational Health Insurance (JKN), namely Minister of Health Regulation\n(Permenkes) Number 28 of 2014, there are 19 types of surgery covered by\nBPJS Kesehatan, namely:<\/p>\n

      \n

    1. Heart surgery<\/p><\/li>\n

    2. Caesarean section<\/p><\/li>\n

    3. Cyst surgery<\/p><\/li>\n

    4. Fibroid surgery<\/p><\/li>\n

    5. Tumour surgery<\/p><\/li>\n

    6. Odontectomy surgery<\/p><\/li>\n

    7. Oral surgery<\/p><\/li>\n

    8. Appendicitis surgery<\/p><\/li>\n

    9. Gallstone surgery<\/p><\/li>\n

    10. Eye surgery<\/p><\/li>\n

    11. Vascular surgery<\/p><\/li>\n

    12. Tonsil surgery<\/p><\/li>\n

    13. Cataract surgery<\/p><\/li>\n

    14. Hernia surgery<\/p><\/li>\n

    15. Cancer surgery<\/p><\/li>\n

    16. Lymph node surgery<\/p><\/li>\n

    17. Tooth extraction surgery<\/p><\/li>\n

    18. Knee replacement surgery<\/p><\/li>\n

    19. Thymectomy surgery<\/p><\/li>\n<\/ol>\n

      To obtain BPJS coverage for surgery, patients must seek treatment at\nprimary healthcare facilities, such as community health centres or\nclinics that have been approved by BPJS Kesehatan. If surgery is\nrequired, patients will be given a referral letter to a hospital and\nwill receive a surgery schedule from the doctor in question at the\nhospital. In addition, there are three requirements that must be met and\nobtained by patients to obtain surgery coverage from BPJS Kesehatan,\nnamely a BPJS Kesehatan card or a Healthy Indonesia Card (KIS), a\nreferral letter from a community health centre\/primary healthcare\nfacility, and a patient card from the hospital.<\/p>", "url": "https:\/\/jawawa.id\/newsitem\/five-operations-no-longer-covered-by-bpjs-kesehatan-from-june-2026-1780553965", "image": "" }, "sponsor": "Okusi Associates", "sponsor_url": "https:\/\/okusiassociates.com" }