19 Operations Covered by BPJS Kesehatan as of September 2026
The Health Social Security Administering Body (BPJS Kesehatan) is a programme designed to provide health protection guarantees for participants.
To maintain membership, the public is required to pay contributions regularly every month. Participants who are registered as active can utilise health facilities that have become BPJS Kesehatan partners, ranging from clinics and community health centres (Puskesmas) to hospitals.
One of the services covered by BPJS Kesehatan is surgical procedures. However, there are several types of operations that are not covered by BPJS Kesehatan. What are they?
List of operations not covered by BPJS Kesehatan:
Operations resulting from accidents
Cosmetic or aesthetic surgery (operations that do not endanger health)
Operations resulting from self-inflicted injury (operations due to carelessness or negligence that resulted in wounds)
Operations at overseas hospitals (operations performed outside the reach of BPJS Kesehatan)
Operations that do not comply with BPJS Kesehatan procedures (operations that do not complete the appropriate submission procedures)
Nevertheless, based on the implementation guidelines of the National Health Insurance (JKN), namely Health Ministry Regulation (Permenkes) No. 28 of 2014, there are 19 types of operations covered by BPJS Kesehatan, namely:
Heart surgery
Caesarean section
Cyst surgery
Myoma surgery
Tumour surgery
Odontectomy
Oral surgery
Appendectomy
Gallstone surgery
Eye surgery
Vascular surgery
Tonsillectomy
Cataract surgery
Hernia surgery
Cancer surgery
Lymph node surgery
Pin removal surgery
Knee joint replacement surgery
Thymectomy
To obtain BPJS coverage for surgical procedures, patients must seek treatment at first-level health facilities, such as community health centres or clinics that have been approved by BPJS Kesehatan.
If surgery is required, the patient will be given a referral letter to a hospital and will receive a surgery schedule from the relevant doctor at the hospital.
In addition, there are three requirements that patients must fulfil and obtain to receive surgical coverage from BPJS Kesehatan: a BPJS Kesehatan card or Healthy Indonesia Card (KIS), a referral letter from the community health centre/first-level health facility, and a patient card from the hospital.