Important to Know: List of Services and Diseases Not Covered by BPJS Kesehatan
For Indonesian citizens who are BPJS Kesehatan participants, it is important to understand the limitations of the services provided. Not all types of medical treatment or hospital services can be covered by this national health insurance program. The rules regarding this are clearly stated in Presidential Regulation (Perpres) Number 82 of 2018 concerning Health Insurance.
Based on these regulations, there are 21 categories of diseases and medical services that are not guaranteed by BPJS Kesehatan. Some of these include health services performed without following applicable procedures, services aimed at aesthetics or beauty, and alternative treatments that have not been medically recognized by the government.
In addition, services to address fertility issues, such as in vitro fertilization (IVF), as well as treatment for drug or alcohol dependency are also not included in the insurance coverage. Likewise, health services that are already covered by work accident insurance programs or other insurance will not be covered again by BPJS Kesehatan to avoid overlapping financing.
The government's step in establishing these rules aims to ensure that social security funds are used effectively and appropriately. With clear limitations, it is hoped that the national health system can continue to run sustainably for all Indonesian people.
For participants who wish to know the complete list of these 21 categories, it is recommended to access official information through the official BPJS Kesehatan website or application. Understanding one's rights and obligations as a participant will help the public in obtaining the right health services when needed.