Contents:
- What are the services covered by BPJS Kesehatan?
- 1. First level health services
- 2. Advanced level referral health services
- 3. Childbirth
- 4. Ambulance
- List of services not covered by BPJS Kesehatan
JKN-KIS is one of the mandatory health insurance for Indonesian citizens managed by the government through BPJS Kesehatan. However, not all residents use and register themselves for various reasons. One of them is because of the lack of information about this one health product. To increase your knowledge and information about the JKN-KIS program, here are the various facilities and services that are borne by the BPJS Health and those that are not covered.
What are the services covered by BPJS Kesehatan?
If you are registered as a member of the BPJS Kesehatan, you will get various facilities that can be used for life. The following are various health services borne by BPJS Kesehatan.
1. First level health services
First level health services finance public health services which include:
- Health service administration costs.
- Promotive and preventive services such as individual health counseling, routine immunization, family planning (counseling, vasectomy, or tubectomy), and health screening to detect the risk of disease and prevent further effects of the disease.
- Medical examination, treatment and consultation.
- Non-specialist medical procedures (general), whether they require surgery or not.
- Drug services and medical materials are used up.
- Blood transfusion according to medical needs.
- Investigation through first-level laboratory diagnosis.
- First level hospitalization in accordance with the doctor's recommendation.
2. Advanced level referral health services
Advanced referral health services, including outpatient and inpatient health services. The following are referral level services that are the responsibility of the Health BPJS, namely:
- Health service administration costs.
- Examination, treatment, and consultation to specialist doctors and subspecialists.
- Medical action that requires a specialist doctor both surgical and non-surgical in accordance with a doctor's referral.
- Drug services and consumable medical materials (eg intravenous fluids).
- Support services that require certain further diagnoses according to the doctor's recommendations.
- Medical rehabilitation.
- Blood services, such as providing blood bags.
- Clinical forensic or post-mortem medical services to diagnose and seek evidence of criminal offenses from patients who have suffered injuries due to certain crimes.
- Providing services for the management of bodies in patients who die after hospitalization in health facilities in collaboration with BPJS health. However, guaranteed services do not include caskets and hearses.
- Regular inpatient care.
- Inpatient care in intensive spaces such as ICU.
3. Childbirth
Childbirth borne by BPJS Health at first and advanced level health facilities is delivery to the third child, without seeing children born or alive.
4. Ambulance
The ambulance facility is borne by BPJS Kesehatan and is only given to referral patients from one health facility to another health facility that aims to save the lives of patients.
List of services not covered by BPJS Kesehatan
Indeed, there are many services borne 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 not covered by BPJS Kesehatan, referring to the service manual for BPJS Health participants.
- Health services carried out without going through applicable procedures.
- Health services carried out in health facilities that do not work with BPJS Kesehatan, except in emergencies.
- Health services that have been guaranteed by the work accident insurance program to the extent of the costs reach a maximum agreement.
- Health services that have been guaranteed by the mandatory traffic accident guarantee program to the extent of the cost of reaching a maximum agreement.
- Health services carried out abroad.
- Health services with aesthetic goals or beautify your appearance such as plastic surgery or whitening teeth.
- Health services to treat infertility (fertility problems) such as IVF.
- Health services to flatten teeth (orthodontist).
- Diseases and health problems due to drug or alcohol dependence.
- Health problems due to intentionally hurting yourself or as a result of hobbies that endanger yourself.
- Additional, alternative, and traditional treatments such as acupuncture, shin she, chiropractic and various other types of treatment that have not been declared effective are based on health technology assessments.
- Medical treatment and actions are categorized as experiments (experiments).
- Payments for contraception, 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 borne by BPJS Health and which you have to deal with yourself, you can prepare protection against all possibilities.
