Five Operations No Longer Covered by BPJS Kesehatan from June 2026

BPJS Kesehatan, the national social security agency, provides health protection to the people of Indonesia. Similar to insurance, BPJS requires participants to pay monthly premiums. As long as their membership is active, participants can receive free health services at clinics, community health centres (Puskesmas), and hospitals that cooperate with BPJS Kesehatan.

One of the services covered by BPJS Kesehatan is surgery. However, there are several types of surgery that are not covered by BPJS Kesehatan. What are they?

Here is a list of operations not covered by BPJS Kesehatan:

1. Operations resulting from accidents

2. Cosmetic or aesthetic surgery (surgery that does not pose a health risk)

3. Operations resulting from self-inflicted injuries (surgery resulting from negligence or carelessness that causes injury)

4. Operations performed in foreign hospitals (surgery performed outside the coverage area of BPJS Kesehatan)

5. Operations that do not comply with BPJS Kesehatan procedures (surgery that does not follow the correct application procedures)

However, according to the guidelines for the implementation of the National Health Insurance (JKN), namely Minister of Health Regulation (Permenkes) Number 28 of 2014, there are 19 types of surgery covered by BPJS Kesehatan, namely:

1. Heart surgery

2. Caesarean section

3. Cyst surgery

4. Fibroid surgery

5. Tumour surgery

6. Odontectomy surgery

7. Oral surgery

8. Appendicitis surgery

9. Gallstone surgery

10. Eye surgery

11. Vascular surgery

12. Tonsil surgery

13. Cataract surgery

14. Hernia surgery

15. Cancer surgery

16. Lymph node surgery

17. Tooth extraction surgery

18. Knee replacement surgery

19. Thymectomy surgery

To obtain BPJS coverage for surgery, patients must seek treatment at primary healthcare facilities, such as community health centres or clinics that have been approved by BPJS Kesehatan. If surgery is required, patients will be given a referral letter to a hospital and will receive a surgery schedule from the doctor in question at the hospital. In addition, there are three requirements that must be met and obtained by patients to obtain surgery coverage from BPJS Kesehatan, namely a BPJS Kesehatan card or a Healthy Indonesia Card (KIS), a referral letter from a community health centre/primary healthcare facility, and a patient card from the hospital.