Contents:
- What can the BPJS pay for diabetes?
- What diabetes medications are covered by BPJS?
- What is the procedure for examining diabetes with BPJS?
- Then, what about diabetes treatment with private insurance?
If not treated properly, diabetes can increase mortality in a country. Diabetes has even become one of the chronic diseases with the largest mortality rate in Indonesia. The number of Indonesians diagnosed with diabetes from year to year has always skyrocketed. Riskesdas data reported that total diabetes cases by the end of 2013 doubled compared to 2007.
So, it is not surprising if diabetes treatment is included in the BPJS program as a government effort to control the malignancy of the disease in Indonesia. Some private insurance companies also claim to treat diabetes policy holders. Let's find out what is funded by insurance for diabetes.
What can the BPJS pay for diabetes?
In accordance with Permenkes 28/2014,BPJS insurance covers all types of diseases.Reported on the Indonesian Health Insurance page, the financing of treatment of major killer diseases (one of which is diabetes) is borne entirely by BPJS. That is, all funding for the treatment of diabetes in Indonesia is free if you are officially registered as a BPJS participant and follow the applicable claim rules.
These include daily diabetes medication prescriptions, purchasing insulin and refills, hospitalization, to diabetes gymnastics classes and nutrition education for dietary arrangements in your FASKES area.
What diabetes medications are covered by BPJS?
Diabetes medications that must be taken for life and prediabetes drugs will be borne by BPJS. However, this facility is limited to certain types of drugs.
Diabetes drugs that are funded in diabetes mellitus are drugs that are in the National Formulary List (Fornas). Fornas is a reference in giving medicines to BPJS participants. Medicines that enter the National Medicines are the most effective, safe, and affordable prices.
If you use drugs outside of this list, then you have to pay for it yourself with personal money. But other costs outside of this drug, such as the cost of consulting a doctor, will still be paid by the BPJS.
In Fornas there is also the maximum amount of medicine that can be prescribed. For example, the diabetes drug metformin 850 mg can be given a maximum of 60 tablets per month. That means, if more than this amount of metformin drug is given in a month, then you will have to pay the remaining excess drug price.
What is the procedure for examining diabetes with BPJS?
For the examination, the stages will be the same as examination of disease in general. First you need to go first to the puskesmas as a level 1 health facility to get a basic physical examination. Afterwards if health facility 1 assesses your condition needs to be addressed further, then a referral letter will be made for treatment to level 2 health facilities.
If the lifetime of your referral letter has expired but you still need further treatment, repeat again from the first step, which is going to health facility 1 to renew the referral letter. So on.
Make sure your BPJS contribution is not in arrears so that the bureaucracy is smooth during treatment.
Then, what about diabetes treatment with private insurance?
The terms and conditions of each insurance company for diabetes can vary. Basically, insurance claims for diabetes will depend on the agreement of the policy alias contract that you have made with the insurance agent at the beginning of the registration.
If the policy contract approves insurance to pay for your diabetes treatment, then don't worry. All diabetes medications and other diabetes checks will be supported by the insurance.
However, some insurance companies have a starting point not to finance cases of diabetes complications or certain diseases caused by diabetes.
