The cost of health care is quite high, and many Indonesians rely largely on BPJS Health for treatment.
BPJS Health does not, however, cover all medical bills. The general people should be aware of this in order to avoid being disappointed when the hospital informs them that their medical bills will not be repaid.
“Diseases not covered by BPJS” and “Diseases covered by BPJS” were not clearly mentioned by the government. However, just like conventional health insurance, there are a number of diseases that are not covered by this sort of social insurance.
According to Presidential Regulation 82 of 2018 on Health Insurance, there are at least 21 ailments that BPJS Health does not cover.
The following is a list of 21 diseases for which BPJS does not provide coverage:
- Diseases that occur in epidemics or as a result of unusual events.
- Beauty and cosmetic treatments, such as plastic surgery.
- Teeth alignment, such as stirrup.
- Diseases brought on by criminal acts like sexual assault or violence.
- Intentional self-harm or suicide attempts result in illness or injury.
- Illness caused by alcoholism or drug addiction.
- Infertility or infertility treatment.
- Illness or injury caused by unavoidable circumstances, such as brawls.
- Health-care services provided in another country
- Treatments and medical procedures classified as tests or experiments.
- Complementary, alternative, and traditional medicine that has not been determined to be effective by a health technology assessment.
- Contraceptive procedures.
- Household medical supplies.
- Health services that are not in compliance with the law, such as self-referrals and other health services those are not in compliance with the laws and regulations.
- Except in an emergency, health services at health facilities that do not interact with BPJS Kesehatan.
- Health services for illness or injury resulting from work accidents or work connections, are covered by a work accident insurance programme or are paid for by the employer.
- Health services, up to the value covered by the mandatory traffic accident insurance programme according to the participant’s class rights, are guaranteed by the mandatory traffic accident insurance programme.
- Health services provided by the Ministry of Defense, the Indonesian National Armed Forces (TNI), and the National Police in Indonesia.
- Health care provided as part of social service.
- Services that are already covered by other programmes.
- Services that are unrelated to the health insurance coverage.
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