Effective July, These 5 Operations Are Not Covered by BPJS Kesehatan

Participants in the National Health Insurance (JKN) programme need to understand that not all surgical procedures are covered by BPJS Kesehatan. Generally, operations that are not covered are those not based on medical indications, are cosmetic in nature, or are services excluded under JKN regulations. The following is the list: 1. Operations resulting from the impact of accidents. 2. Cosmetic or aesthetic surgery (operations that are not harmful to health). 3. Operations due to self-inflicted injury (operations resulting from carelessness or negligence that cause injury). 4. Operations at overseas hospitals (operations conducted outside the coverage of BPJS Kesehatan). 5. Operations not in accordance with BPJS Kesehatan procedures (operations that do not complete the appropriate submission procedures). Nevertheless, based on the guidelines for implementing the National Health Insurance (JKN), namely Minister of Health Regulation (Permenkes) Number 28 of 2014, there are 19 types of operations 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 BPJS coverage for surgical procedures, patients must seek treatment at first-level health facilities, such as community health centres or clinics approved by BPJS Kesehatan. If surgery is required, the patient will be given a referral letter to a hospital and 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, namely 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.