Overview and Benefits of BPJS Healthcare

BPJS Healthcare (Badan Penyelenggara Jaminan Sosial or Social Insurance Administration Organization) is a state-owned corporation which provides national healthcare insurance for Indonesian citizens. This public service is responsible for protecting the healthcare rights of all Indonesians, by ensuring them access to medical facilities.

The BPJS Healthcare program has been officially established in the country since 2014. Every citizen of Indonesia should have this national insurance, especially when considering how expensive medical treatment can cost. This is in addition to all the other social and economic issues that come with being ill. The obligation to become a member of BPJS Healthcare was introduced in the Presidential Regulation Number 12 of 2013 regarding Healthcare Benefits.

With BPJS Healthcare, citizens receive the guarantee of being able to use a wide range of health facilities continuously, and without worry. The main benefits of using BPJS Healthcare are:

1. First-evel Health Facility (Fasilitas Kesehatan/FasKes), or non-specialist health service, which covers:

- Health improvement services and disease prevention. For example, health screening, immunization, family planning and chronic disease management programs.

- Medical treatment services by general practitioners and dentists, including;

• Registration and administration
• Medical examination, consultations and treatment
• Non-specialist medical procedures: operative and non-operative
• Drug and medicinal services
• Blood transfusions according to medical needs
• First stage laboratory diagnostic tests
• First-degree hospitalization as medically needed
• Obstetric and newborn care
• Ambulance services between health facilities

2. Advanced health referral services that include:

- For outpatients

• Service administration
• Medical examinations, consultations, and treatment by specialists and sub-specialists
• Specialist procedures as medically required
• Laboratory, radiology, and other diagnostic support services
• Drug and medicinal services
• Implantable medical device services
• Advanced diagnostic support services as medically required
• Rehabilitation
• Blood services
• Medical devices
• Family Planning services; limited to vasectomy and tubectomy
• Clinical forensic services

- Hospitalizations

• Non-intensive care
• Intensive care in the ICU
• Other health services as determined by the minister
• Funeral services for patients who die in hospital

3. Emergency Services

4. Ambulance Services

The Differences between BPJS Healthcare and JKN or other health insurance programs

People often find it difficult to distinguish between BPJS Healthcare fromJKN (Jaminan Kesehatan Nasionalor National Healthcare Insurance). Many people consider the two insurance schemes to be the same while they are actually not.

JKN is a social insurance program with an insurance system set by the government of Indonesia for its citizens. This national program is set forth in Act Number 40 of 2004 regarding National Social Insurance System (Sistem Jaminan Sosial Nasional/SJSN).

On the other hand, BPJS is a corporation that runs JKN program, which merged the three previous programs:ASKES (the health insurance scheme for civil servant and the army), JAMSOSTEK (the social security program for private workers), and JAMKESMAS (the health insurance scheme for the poor).

In spite of being an insurance program, the BPJS Healthcare scheme is different to what is offered by private health insurance providers. The main difference is, on the insurance itself, BPJS Healthcare doesn’t apply as strict a limit as a private insurance does. Some of the other differences are:

1. The premium for BPJS Healthcare is very affordable and is categorized based on the services’ class. The monthly premium for BPJS Healthcare ranges betweenIDR25,500 – 80,000. Most private insurance providers will charge for monthly premium as low as hundreds of thousands to millions of rupiahs.
2. BPJS Healthcare provides health insurance services to anyone, without age limitation. Most private insurance providers only issue insurance services during the pre-retirement age. When someone passes the age limit set by the scheme, the amount of insurance coverage will be decreased or reduced to nothing at all.
3. In providing their health services, BPJS Healthcare doesn’t look into a patient’s medical history. This means any person who has a long-term sickness (preexisting condition) will still be allowed to be a member and receive the same health insurance treatment. Most private insurance providers won’t cover a patient with preexisting conditions. Even if they do, there will be a lot of requirements and procedures to go through.
4. The health facility system from BPJS needs to be initiated from the first level, which is Puskesmas (the appointed local health clinic), nearby clinic, or family doctor. If the service from the first level is not enough, patients will be given a referral letter to receive advance treatment in an affiliated hospital. In an emergency situation, a patient can receive treatment in the emergency unit of any hospitals, without having to goto the first-level facility. Meanwhile, most private insurance providers are more direct, where the patient has the ability to choose which partner hospitals to go to, and receive treatment without having to get a referral.

How to Register for BPJS Healthcare

To become a member and be able to receive BPJS Healthcare treatment, you have to register yourself collectively or individually. The following are the steps to join BPJS Healthcare:

1. Future members can choose one of the following registration methods:

a. Via BPJS office branches, found in each municipality

b. Via mobile customer service

c. Via any other regional/local offices

d. Via bank, Payment Point Online Banking (PPOB), and other partners

e. Via BPJS Healthcare Center at 1500-400, the mobile JKN application, and BPJS Healthcare official website

2. Future members should fill out the form for Member Data (Data Isian Peserta) and compile the supporting documents (main supporting documents are a copy of ID card and family card).

3. Within the form, choose your desired class treatment and your first FasKes place, and provide valid contact information. Especially for class treatment I and II, future members need to fill out an authorization letter that facilitates a debit payment for monthly payments.

4. After being validated, future members will receive a virtual account number, which will later be used to pay the premium.

5. Process the premium payment between 14 – 30 days after the registration date. You will receive payment receipt and a document to print your card. You will either receive this document via SMS or email.

6. Wait a maximum of 7 working days to receive your BPJS Healthcare card. You can also print and collect your card at the nearest BPJS offices by showing your initial payment receipt.

BPJS Healthcare Premium

Your monthly premium amount for BPJS Healthcare is determined by Presidential Regulation Number 10 of 2016. The amount of the premium depends on the class selected by members.

Class 1

The premium for Class 1 is IDR 80,000 per person per month. BPJS Healthcare will cover any cost related to inpatient treatment for patients staying on Class 1 room in their referral hospital.

Class 2

The premium for Class 2 is IDR 51,000 per person per month. BPJS Health will cover any cost related to inpatient treatment for patients staying in a Class 2 room in their referral hospital.

Class 3

This class is the one with the most affordable premium. The premium for Class 3 is IDR 25,500 per person per month. BPJS Health will cover any cost related to inpatient treatment for patients staying on Class 3 room in their referral hospital.

In terms of receiving health treatment, members from Classes 2 and 3 are permitted to ask for an inpatient room upgrade, as long as they are willing to pay the remaining cost.

BPJS Healthcare members must pay their premium at the latest by the 10th day of a calendar month. Any delay in payment will cause member status to be temporarily frozen until all the late payments are paid.

BPJS Healthcare Premium Payment on Traveloka

Currently, Traveloka provides a number of bill payment features, including BPJS Healthcare. This feature allows Traveloka users to do online transactions on the website or mobile application. With this feature, BPJS Healthcare members can stop worrying about forgetting to pay their bills.

Paying your monthly BPJS Healthcare premium on Traveloka is very easy, with very affordable administration fee. All you have to do is visit Traveloka website or open your Traveloka App, and on the menu, select “Bill Payment” and click ‘BPJS Kesehatan’. Continue by filling out the necessary information, and follow the payment process as guided by Traveloka website/app.

Becoming a member of BPJS Healthcare is a must and made obligatory by the government of Indonesia. If you are not registered as one, register yourself online immediately to get your membership quickly and easily. For more information about registering for BPJS Healthcare, visit BPJS Online Registration page.