5 Surgeries Not Covered by BPJS Kesehatan as of September 2026, Essential Information!

The National Health Insurance (JKN) programme, managed by BPJS Kesehatan, serves as the primary pillar for Indonesians accessing healthcare services. However, not all medical procedures or surgeries are automatically covered by this social security institution.

Many participants mistakenly believe that all types of surgery are fully guaranteed as long as their membership status is active. In reality, there are strict provisions and medical limitations that exclude certain types of operations from the JKN benefit list.

For participants, understanding the list of procedures not included in the service coverage is crucial to avoid financial and administrative obstacles when undergoing treatment in hospitals.

Here is the list of types of surgery not covered by BPJS Kesehatan as of September 2026:

• Surgeries related to the impact of certain accidents.

• Cosmetic or aesthetic surgeries performed purely without medical indication.

• Surgeries resulting from self-harm or injuries caused by personal negligence.

• Surgeries performed in overseas hospitals (outside the jurisdiction of BPJS Kesehatan services).

• Surgeries that do not follow the official procedures, referrals, and service mechanisms of BPJS Kesehatan.

19 Types of Surgery Covered by BPJS Kesehatan

On the other hand, based on the implementation guidelines of the National Health Insurance (JKN) in the Minister of Health Regulation (Permenkes) Number 28 of 2014, there are 19 types of surgical procedures fully guaranteed by BPJS Kesehatan, including:

• Heart surgery

• Caesarean section

• Cyst surgery

• Myoma surgery

• Tumor 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 replacement surgery

• Thymectomy

Claim Submission Procedures and Requirements

To ensure that surgical costs are covered by BPJS Kesehatan, participants must adhere to the tiered treatment flow. Patients must first undergo an initial examination at the First Level Health Facility (FKTP), such as a community health centre (puskesmas), primary clinic, or a partner private practitioner.

If the doctor at the FKTP diagnoses that the patient requires further action, the patient will be provided with an official referral letter to a partner hospital. Subsequently, the surgery schedule will be determined based on the results of the examination by the attending specialist.

Additionally, participants must complete three main administrative documents for the cost coverage to be processed:

• An active BPJS Kesehatan card or the Indonesian Health Card (KIS).

• An official referral letter from the original FKTP.

• A patient card or registration card from the destination referral hospital.