Indonesian Political, Business & Finance News

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

| Source: CNBC Translated from Indonesian | Social Policy
Effective July, These 5 Operations Are Not Covered by BPJS Kesehatan
Image: CNBC

Participants of the National Health Insurance (JKN) programme need to understand that not all surgical procedures are covered by BPJS Kesehatan.

In general, surgeries that are not covered are those that are not based on medical indications, are cosmetic in nature, or fall under services excluded by JKN regulations. The list includes:

  1. Surgery resulting from the impact of accidents.

  2. Cosmetic or aesthetic surgery (surgeries that do not pose a threat to health).

  3. Surgery resulting from self-harm (surgery due to carelessness or negligence that results in injury).

  4. Surgery performed in overseas hospitals (surgeries conducted outside the scope of BPJS Kesehatan).

  5. Surgery that does not follow BPJS Kesehatan procedures (surgeries that do not complete the appropriate application process).

Nevertheless, based on the implementation guidelines of the National Health Insurance (JKN), specifically the Minister of Health Regulation (Permenkes) Number 28 of 2014, there are 19 types of surgeries 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 replacement surgery

  19. Thymectomy

To obtain BPJS coverage for surgical procedures, patients must seek treatment at a primary healthcare facility (faskes), such as a community health centre (puskesmas) or a clinic approved by BPJS Kesehatan. If surgery is required, patients will be provided with a referral letter to a hospital and will receive an operation schedule from the relevant doctor at the hospital.

Furthermore, there are three requirements that patients must fulfil to obtain surgical coverage from BPJS Kesehatan: a BPJS Kesehatan card or the Indonesian Health Card (KIS), a referral letter from a Puskesmas or primary healthcare facility, and a patient card from the hospital.

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