Ciamis Resident Shocked by Rp2.6 Million Fine When Child Needed Surgery

For every parent, a child’s health is a non-negotiable priority. However, hopes for smooth medical treatment can sometimes be dashed by a lack of awareness of complex administrative regulations. The experience of Cece Mulyadi, a resident of Ciamis Regency, West Java, serves as a crucial reminder for all JKN-KIS participants about the existence of a ‘Service Fine’ rule that often applies after settling premium arrears. Cece Mulyadi’s child required oral surgery at Dr. Soekardjo Regional General Hospital after being referred from Ciamis Regional General Hospital. Although Cece had fully paid off his outstanding independent BPJS Kesehatan premiums, he was shocked with a service fine bill of Rp2,603,320 when processing the inpatient administration on Tuesday (16/6/2026). This incident caused confusion, as the membership status was considered active again after the arrears were cleared. Many BPJS Kesehatan participants assume that once arrears are settled, all insurance facilities can be used immediately and free of charge. According to regulations, membership status is indeed reactivated immediately for outpatient services. However, a special rule applies to Advanced Inpatient Care (RITL). Based on an explanation from BPJS Kesehatan, the service fine applies if a participant who previously had premium arrears accesses inpatient services within 45 days of their membership being reactivated. This is stipulated in a Presidential Regulation concerning Health Insurance to maintain discipline in premium payments. The fine amount charged to participants, like the family in Ciamis, is not arbitrary. For Non-Wage Earning Worker (PBPU) or independent participants, the applicable formula is used. In Cece Mulyadi’s case, BPJS Kesehatan Tasikmalaya explained that the patient had a history of arrears since April 2025, which were only settled on 5 May 2026. Because the medical procedure was performed before the 45-day period ended (i.e., before 19 June), the service fine was automatically generated by the system. Moch Rizal Idris, Head of Human Resources, General Affairs, and Public Communication at BPJS Kesehatan Tasikmalaya, explained that based on a system check, the patient had a history of premium arrears as an independent JKN-KIS participant. ‘For independent BPJS Kesehatan participants whose membership was temporarily deactivated due to arrears and who have just made a payment, a service fine period of 45 days from the date the arrears are settled applies. The fine is calculated as 5 percent of the initial diagnosis cost (INA-CBGs) multiplied by the number of months in arrears, with a maximum calculation of 12 months. This provision applies to Non-Wage Earning Worker (PBPU) participants,’ he stated.