List of 21 Illnesses Not Covered by BPJS Kesehatan
The public is requested to understand the scope of healthcare services that are guaranteed or not guaranteed under the BPJS Kesehatan programme. BPJS Kesehatan is a government programme that must be followed by all Indonesian citizens. Through BPJS Kesehatan, the community can receive medical treatment free of charge. Similar to general insurance, there are monthly BPJS Kesehatan premiums that must be paid by the public according to their chosen membership class.
Despite being a health insurance programme, not all diseases are covered by BPJS Kesehatan. This is stipulated in Presidential Regulation Number 82 of 2018 concerning Health Assurance. For instance, BPJS Kesehatan does not cover services that are not considered basic healthcare or are not part of medical treatment, such as aesthetic services.
Understanding the benefits of healthcare services is vital for participants to avoid errors when accessing services at health facilities. By knowing the coverage provisions, the public can prepare necessary documents, follow service procedures, and ensure that the type of service required complies with applicable regulations.
Information regarding healthcare services is also related to the need for public education. BPJS Kesehatan participants are advised to re-verify service provisions through official channels or by directly asking healthcare facility officers before undergoing certain medical procedures. In healthcare services, not all actions or conditions are automatically covered. Therefore, the public needs to understand the limits of benefits, referral procedures, and applicable administrative requirements.
Ignorance regarding coverage provisions can lead to confusion when patients require services. Clear education is expected to help participants make more accurate decisions when seeking medical treatment. Those requiring further information regarding BPJS Kesehatan services should confirm directly with the relevant healthcare facilities. Confirmation is particularly necessary if the required service involves special procedures, referrals, or follow-up examinations.
By taking these steps, participants can obtain explanations regarding service flows, administrative completeness, and potential costs that may need to be prepared. Complete information regarding the list of diseases or services not covered must refer to the latest applicable regulations and official explanations from the relevant parties.
Other services that have no connection to the provided health insurance benefits are also excluded. Indonesian citizens need to be aware that certain conditions fall outside the scope of coverage. Furthermore, the Minister of Health, Budi Gunadi Sadikin, has emphasised that there are no plans to increase BPJS Kesehatan premium rates, despite a potential deficit of up to Rp2 trillion per month.