List of 21 Illnesses Not Covered by BPJS Kesehatan

The public is being asked to understand the scope of health services that are covered and those that are not under the BPJS Kesehatan programme. BPJS Kesehatan is a government programme that must be participated in by all Indonesian citizens. With BPJS Kesehatan, the public can receive free medical treatment without any charge. Like general insurance, there are BPJS Kesehatan contributions that must be paid by the public every month according to the chosen class. Although it is a free health insurance, not all illnesses can be covered by BPJS Kesehatan. This is stipulated in Presidential Regulation Number 82 of 2018 concerning Health Insurance. For example, BPJS Kesehatan does not cover services that are not basic health or are not included in medical treatment, such as aesthetic services. Understanding the benefits of health services is important for participants to avoid mistakes when accessing services at health facilities. By knowing the coverage provisions, the public can prepare documents, follow the service flow, and ensure the type of service needed complies with applicable regulations. Information regarding health services is also related to the need for public education. BPJS Kesehatan participants are advised to re-confirm service provisions through official channels or directly ask health facility officers before undergoing certain medical procedures. In health services, not all actions or conditions are automatically included in the coverage. Therefore, the public needs to understand the limits of benefits, referral procedures, and applicable administrative requirements. Ignorance of coverage provisions can cause confusion when patients need services. Clear education is expected to help participants make more appropriate decisions when seeking treatment. Members of the public who need further information regarding BPJS Kesehatan services should confirm directly with the relevant health facilities. Confirmation is especially necessary if the required service involves special procedures, referrals, or follow-up examinations. By taking this step, participants can obtain explanations regarding the service flow, administrative completeness, and possible costs that need to be prepared. Complete information regarding the list of illnesses or services not covered must refer to the latest applicable provisions and official explanations from the relevant parties. Other services unrelated to the health insurance benefits provided are also not covered. Indonesian citizens and residents of Bali need to know that as of June-July 2025, there are 21 illnesses not covered by BPJS Kesehatan.