Can You Claim Free Glasses Using BPJS? Here Are the Regulations
Myopia can disrupt daily activities, so sufferers need to use glasses. Unfortunately, the price of glasses is quite expensive, especially if the sufferer experiences several types of myopia at once or requires lenses with large sizes. However, BPJS Kesehatan participants need not worry because participants can obtain assistance for glasses.
The rules regarding glasses assistance are contained in Ministerial Regulation No. 3 of 2023. Referring to that regulation, BPJS participants can undergo free eye examinations at primary or advanced level facilities, then claim glasses at BPJS-partnered opticians.
So, is claiming glasses with BPJS free? See the explanation below!
Rules for Claiming Glasses Using BPJS According to Ministerial Regulation No. 3 of 2023
Ministerial Regulation No. 3 of 2023 regulates health service tariffs in the JKN programme, including tariffs for health aids such as glasses. In this regulation, the tariff for glasses falls into the Non Indonesian-Case Based Groups (Non INA-CBG) tariff category. This tariff group is a tariff group outside the INA-CBG package tariff for certain types of services with a separate claim submission process from the INA-CBG tariff.
The scheme applicable to health aids in this tariff group is the provision of subsidies with a certain amount. Here is the subsidy amount for glasses for each class.
PBI/right to class 3 inpatient care: Rp 165,000
Right to class 2 inpatient care: Rp 220,000
Right to class 1 inpatient care: Rp 330,000
The above amounts are the maximum nominal provided by BPJS Kesehatan. If participants choose glasses with a price less than or equal to that nominal, the glasses claim is considered free. However, if the glasses have a price above that nominal, participants must pay the price difference independently, paid by the employer, or paid with additional health insurance.
In addition to cost provisions, BPJS also applies several other provisions. Here are some glasses claim provisions based on Ministerial Regulation No. 3 of 2023 and BPJS Kesehatan Instagram posts.
Glasses claims are made based on a prescription from an eye specialist doctor who collaborates with BPJS Kesehatan.
Glasses claims only apply to medical indications with a minimum spherical lens size of 0.5 dioptres and/or a minimum cylindrical lens of 0.25 dioptres.
Glasses can be obtained at opticians that collaborate with BPJS Kesehatan.
Glasses claims are provided at the earliest every 2 years.
Claims cannot be made for cases of replacing just the glasses frame or lens glass.
Claims do not apply to cases of additional value (ADD) only.
How to Claim Glasses Using BPJS
The procedure for claiming glasses with BPJS is regulated in BPJS Kesehatan Regulation No. 2 of 2020. Based on that regulation, here are the steps that need to be taken to claim glasses with BPJS.
Visit the primary level health facility for initial examination. If needed, the primary facility will provide a referral to an eye specialist doctor or eye clinic at the advanced referral health facility (FKRTL).
After the examination, the doctor will provide a glasses prescription. Ensure that the prescription has been legalised or verified by the facility. Legalisation can be done at the facility’s counter.
Bring the glasses prescription, BPJS card or proof of membership from the Mobile JKN application, and ID card to an optician that has partnered with BPJS Kesehatan.
Choose glasses according to BPJS provisions.
List of BPJS Partnered Opticians in Jogja
Here are some BPJS partnered opticians in the Jogja area that accept glasses claims with BPJS.
Akur Optik
Address: Jl. KH. Ahmad Dahlan No. 35, Ngupasan, Kec. Gondomanan, Kota Yogyakarta
Optik Candi Putra
Address: Jl. Sumarwi No. 28A, Gadungsari, Wonosari, Kec. Wonosari, Gunungkidul
Optik Wates Baru
Address: Jl. Brigjen Katamso No. 50, Kec. Wates, Kabupaten Kulon Progo
Optik Marlin
Address: Jl. Brigjen Katamso No. 206, Keparakan, Kec. Mergangsan, Kota Yogyakarta
Optik Manding
Address: Jl. Pramuka, Giwangan, Kec. Umbulharjo, Kota Yogyakarta
Optik Arif Bantul
Address: Jl. Bantul KM 10, Badegan, Kec. Bantul, Kabupaten Bantul
Optik Ismail
Address: Jl. Magelang KM 12, Krapyak, Triharjo, Kec. Sleman, Kabupaten Sleman
Optik Makmur Wirobrajan
Address: Jl. RE. Martadinata No. 33, Wirobrajan, Yogyakarta
Kacamata Viral Jogja
Address: Jl. Bantul No. 99, Dongkelan, Panggungharjo, Bantul
In addition to the opticians above, you can also ask for recommendations for other opticians from the facility where you had your eye examination.