5 Operations Not Covered by BPJS Kesehatan as of 21 June 2026: What You Must Know
Not all surgical procedures can be financed by BPJS Kesehatan. Although the National Health Insurance (JKN) programme covers various medical services, several types of operations fall into the exclusion category, meaning participants must bear the treatment costs themselves. Many BPJS Kesehatan participants assume all surgical procedures are automatically covered as long as their membership is active. In fact, there are a number of provisions that limit the types of services that can be financed, including operations performed for specific purposes or those not following applicable procedures. Therefore, it is important for participants to understand the list of surgical procedures not included in the BPJS Kesehatan benefit coverage to avoid obstacles when requiring health services at a hospital.
The list of operations not covered by BPJS Kesehatan as of 21 June 2026 includes: 1. Operations related to the impact of certain accidents. 2. Cosmetic or aesthetic surgery not performed for medical reasons. 3. Operations resulting from self-inflicted injuries or injuries caused by personal negligence. 4. Operations performed at hospitals abroad (outside the reach of BPJS Kesehatan). 5. Operations that do not follow BPJS Kesehatan service procedures and mechanisms.
Nevertheless, based on the National Health Insurance implementation guidelines in Minister of Health Regulation (Permenkes) Number 28 of 2014, there are 19 types of operations that can be covered by BPJS Kesehatan, namely: 1. Heart surgery, 2. Caesarean section, 3. Cyst surgery, 4. Myoma surgery, 5. Tumour surgery, 6. Odontectomy, 7. Oral surgery, 8. Appendectomy, 9. Gallstone surgery, 10. Eye surgery, 11. Vascular surgery, 12. Tonsillectomy, 13. Cataract surgery, 14. Hernia surgery, 15. Cancer surgery, 16. Lymph node surgery, 17. Pin removal surgery, 18. Knee joint replacement surgery, 19. Thymectomy.
To obtain guaranteed surgical costs from BPJS Kesehatan, patients must first undergo an examination at a first-level health facility (FKTP), such as a community health centre or clinic that cooperates with BPJS Kesehatan. If the doctor assesses that the patient requires surgery, the patient will receive a referral letter to a hospital and a surgery schedule according to the specialist doctor’s examination results. Additionally, there are three main documents that participants must possess for surgery to be covered by BPJS Kesehatan: an active BPJS Kesehatan card or Healthy Indonesia Card (KIS), a referral letter from the FKTP, and a patient card from the destination hospital.