5 Facts You Need to Know about BPJS Health

The national social security system in force in Indonesia is currently run by the Social Security Administration Agency (BPJS). Through the Healthy Indonesia National Card-Health Insurance Program (JKN-KIS) organized by the Health BPJS, the country wants to ensure that all Indonesians are protected by comprehensive, fair and equitable health insurance. BPJS Health is a system that must be followed by all Indonesian citizens and foreign nationals who have been in Indonesia for a minimum period of 6 months. The government has set a target of achievement so that all Indonesian citizens have a health BPJS by 2019. This is in accordance with article 14 of Law Number 24 Year 2011. Contributions are paid according to the level of benefits obtained. Special contribution assistance programs are also provided for the poor. Nevertheless, there are still many complaints from BPJS Health users. Complaints received by the Indonesian Consumers Foundation (YLKI) regarding BPJS Health include hospital refusal of BPJS patients, procedural difficulties, incomplete treatment, inadequate doctor services, long queues at BPJS recipient health facilities such as the emergency department in the hospital, and not paid

Facts about BPJS Health

To get the maximum BPJS services, here are some facts about BPJS Health that need to be known:

• Unlike private insurance which generally has restrictions and conditions for several types of diseases, BPJS Health is designed to cover all types of diseases. BPJS Health will cover BPJS members from all age levels and all severity of illness. The amount of premium paid is not based on age, medical history, or level of illness, but based on the health facilities enjoyed. This facility is divided into classes I to class III.
• BPJS Health adheres to a tiered referral pattern, so that patients cannot freely go to the desired hospital or health facility. First, patients must go to a first-level health facility, which is a puskesmas, clinic, or private practice doctor who works closely with BPJS. Then, if the health facility is not able to treat, it will be referred to a higher health facility or hospital class.
• The limitations of hospitals or health facilities in collaboration with BPJS, make BPJS Health patients often have to queue to get services. Even so, now more and more doctors and hospitals are serving BPJS Health participants.
• Medical expenses and laboratory examinations are also included in the BPJS Health service. Patients do not need to pay anymore for these services, as long as they remain in accordance with applicable BPJS health procedures or regulations. BPJS will not cover the cost of supporting examinations at the request of the patient himself without indication or not according to the diagnosis of the disease provided by the doctor.
• Withdrawal of fees to BPJS patients applies if the participant asks for facilities higher than the right that should have been obtained. For example, when a patient requests a class of care that is higher than the right he has. For this reason, patients need to inform BPJS Health and hospital staff if they are being treated when they want to use a higher grade of premium paid to BPJS.

It is important to learn the procedures for obtaining optimal services from the Health BPJS. In addition, do not forget to meet the obligation to pay premiums every month so that there are no obstacles when seeking treatment.