List of medical services covered by BPJs and those that are not

JKN-KIS is one of the compulsory health insurance for Indonesian citizens which is managed by the government through BPJS Kesehatan. However, not all residents use and register themselves for various reasons. One of them is due to the lack of information about this one health product. To increase your knowledge and information about the JKN-KIS program, here are various facilities and services that are covered by BPJS Kesehatan and those that are not covered.

What services are covered by BPJS Kesehatan?

If you are registered as a member of BPJS Kesehatan, you will get various facilities that can be used for life. The following are various health services covered by BPJS Kesehatan.

1. First level health services

First level health services finance public health services which include:

• Health service administration costs.
• Promotional and preventive services such as personal health education, routine immunization, family planning (counseling, vasectomy, or tubectomy), and health screening to detect disease risks and prevent further effects of disease.
• Medical examination, treatment and consultation.
• Non-specialized (general) medical procedures, whether surgery or not.
• Medicines and consumable medical materials services.
• Blood transfusions according to medical needs.
• Investigation through first level laboratory diagnosis.
• First-degree hospitalization as recommended by the doctor.

2. Advanced level referral health services

Advanced level referral health services, including outpatient and inpatient health services. The following are referral level services that are covered by BPJS Health, namely:

• Health service administration costs.
• Examination, treatment, and consultation with specialists and subspecialists.
• Medical actions that require both surgical and non-surgical specialists in accordance with a doctor's referral.
• Medicines and consumable medical materials (for example, intravenous fluids).
• Supporting services that require a certain advanced diagnosis as recommended by a doctor.
• Medical rehabilitation.
• Blood services, such as providing blood bags.
• Clinical forensic medicine or post mortem services to diagnose and seek evidence of criminal acts from patients who have been injured due to certain crimes.
• Providing body care services for patients who die after being hospitalized at a health facility in collaboration with BPJS Kesehatan. However, the services guaranteed do not include the casket and hearse.
• Treatment in the usual inpatient room.
• Inpatient care in an intensive care unit such as the ICU.

3. Childbirth

Births that are covered by BPJS Kesehatan in health facilities at the first level and at the advanced level are deliveries up to a third child, regardless of whether the child is born alive or dead.

4. Ambulance

The ambulance facility is the responsibility of BPJS Kesehatan and is only provided for referral patients from one health facility to another which aims to save the patient's life.

Source: MedApplications

List of services not covered by BPJS Kesehatan

Indeed, there are many services that are covered by BPJS Kesehatan, even for life. However, not all health services are covered and guaranteed by BPJS Kesehatan. The following is a list of services that are not covered by BPJS Kesehatan, referring to the service manual for BPJS Kesehatan participants.

• Health services that are carried out without going through the applicable procedures.
• Health services provided in health facilities that do not cooperate with BPJS Kesehatan, except in emergencies.
• Health services that have been guaranteed by the work accident insurance program until the cost reaches a maximum agreement.
• Health services that have been guaranteed by the mandatory traffic accident insurance program until the cost reaches a maximum agreement.
• Health services carried out abroad.
• Health services for aesthetic purposes or to enhance one's appearance, such as plastic surgery or teeth whitening.
• Health services to deal with infertility (fertility problems) such as IVF.
• Medical services for aligning teeth (orthodontist).
• Illness and health problems due to dependence on drugs or alcohol.
• Health problems resulting from deliberate self-harm or self-harming hobbies.
• Additional, alternative, and traditional treatments such as acupuncture, shin she, chiropractic and various other types of treatment that have not been declared effective based on assessment of health technology.
• Medication and medical measures are categorized as experiments (experiments).
• Payment for contraceptives, cosmetics, baby food and milk.
• Household health supplies.
• Health services due to disasters and extraordinary events or outbreaks that are attacking.
• Other service costs that are not related to the health insurance benefits provided.
• Individual claims.

By knowing what facilities are covered by BPJS Kesehatan and which you have to bear on your own, you can prepare protection against all possibilities.