BPJS is a government-run health insurance program in Indonesia
BPJS (Social Security Agency for Health) is a government health insurance program in Indonesia, or in other words, social health care. The BPJS insurance program was originally designed to ensure access to essential quality health care services, as well as essential medicines and vaccines, for all. If you are in Indonesia on a work visa, having a BPJS (in this case BPJS Ketenagakerjaan) is a mandatory requirement. BPJS Kesehatan health insurance can also be issued if you have KITAS.
There are two types of BPJS: BPJS Kesehatan (health insurance) and BPJS Ketenagakerjaan (social insurance). BPJS Kesehatan is obtained by individuals and provides the insured with health protection. Having BPJS Ketengakerjaan is necessary if you work for a company, both local and foreign, or are the owner of a company. In this case, you are required to register your employees (foreign and local) under the BPJS insurance program. To apply for both types of insurance, you must stay in Indonesia for at least 6 months. This rule is compulsory. They can also ask you to prove how long you have been in Indonesia.
BPJS Ketengakerjaan (BPJS Employment)
Provided by the employer to protect its employees. The Social Security package aims to maintain a decent basic standard of living when participants experience loss or reduction in income due to work-related injury, old age, retirement or death.
If you live in Indonesia and work as a freelancer, you can also register as an independent member of BPJS Insurance. In this case, you will make the monthly contribution yourself.
If you officially take a job in Indonesia, your employer is required to provide you with BPJS Ketengakerjaan insurance. The company will register you and a social security card will be issued. Once again, this is a mandatory requirement under Indonesian law!
What does it cover?
Basic BPJS Ketengakerjaan protection includes protection against accidents at work by compensating for damage received and treatment provided, pension protection upon reaching retirement age, protection upon termination of employment with the company (especially if you have worked in the same company for 10 years or more ) and protection in case of death. If an employee dies while working for the company, payments will be made to his family.
Payment
Both the employer and the employee, i.e. cardholder, must make monthly payments under the social insurance program. The payment amount depends on what type of protection is preferred and the employee’s salary. Debits occur from your bank account automatically every month.
It is important to understand that BPJS Ketengakerjaan is not a complete insurance product, especially when it comes to health insurance. Therefore, you can always opt for additional health insurance from an independent company if you prefer better coverage. Indonesian law does not prohibit this in any way.
BPJS Kesehatan (BPJS HEALTH)
This type of insurance can be arranged independently if you have KITAS. If you are the owner of an investor KITAS, then you can also include up to five close relatives in your insurance. They must have long-term visas to Indonesia.
Altogether, BPJS Kesehatan is a very decent insurance policy and, probably, the best price/value combination in the Indonesian insurance segment today. Some people acquire KITAS just to be able to take advantage of this insurance. You will, of course, make the monthly payments yourself. But they are very affordable (from 35 to 150 thousand rupees per month depending on the class) compared to any other private Indonesian or international insurance. At the same time, this policy covers all basic health protection needs.
Insurance classes
There are three classes of BPJS Kesehatan insurance. All of them cover medical examination, treatment and consultation, administrative services, pre-medical and medical procedures and surgeries, some dental and oral health services. They differ only in conditions during hospitalization. It is up to you to decide which class to choose. But! Be very careful when choosing a category at the stage of applying for insurance. After receiving a BPJS insurance card, changing it in the future will be very difficult and time-consuming. Reissue may take up to several months. After activation, the contribution amount will be automatically deducted from your bank account every month.
So, as noted above, there are no significant differences in medical services for BPJS class 1, 2 and 3 participants. All participants will receive the same treatment in accordance with applicable procedures. However, the difference appears when undergoing inpatient treatment. Room amenities vary depending on the insurance class.
Class 1: Monthly premium will be 150 thousand IDR per month. In case of hospitalization, you are entitled to a ward for 2-4 patients. You can also apply to move to the VIP lounge if it is available. However, be prepared to pay additional costs beyond BPJS’s responsibility.
Class 2: Contribution of 100 thousand IDR per month. Inpatient treatment in a ward for 3-5 patients. Like Class 1 patients, BPJS Class 2 patients can also apply to be transferred to a VIP or Class 1 ward if they are willing to pay costs beyond the BPJS coverage.
Class 3: You will need to pay only 35 thousand IDR per month. Your treatment will take place in a ward for 4-6 patients. However, you can apply to move to 2nd and 1st class wards, if available.
What BPJS Kesehatan does not cover
No doubt, BPJS is a very good health insurance that covers a wide range of medical services for a minimal financial investment. Nevertheless, no single insurance will cover everything.
List of conditions that are not covered by BPJS Health:
Diseases in the form of epidemics or emergency events.
Procedures related to beauty and aesthetics, such as plastic surgery.
Orthodontic Services.
Diseases resulting from criminal acts such as abuse or sexual assault.
Illnesses or injuries resulting from willful self-harm or attempted suicide.
Illnesses resulting from alcohol or drug use.
Infertility treatment.
Illnesses or injuries resulting from events that cannot be prevented, such as fights.
Medical services provided abroad.
Treatments and medical procedures that fall under the category of trials or experiments.
Complementary, alternative and traditional medicine that has not been recognized as effective by health technology assessments.
Contraception.
Household health products.
Other medical services that do not comply with legal regulations.
Medical services in medical institutions that do not cooperate with BPJS Health, except in emergency situations.
Medical services for illnesses or injuries resulting from work-related or employment-related accidents that are guaranteed by a work-related accident insurance program or covered by the employer. In this case, you must be insured under the BPJS Ketengakerjan program.
Medical services exceeding the limits of the amount covered by the accident insurance plan, in accordance with the entitlement of the member’s class of treatment.
Services that are already covered by other programs.
Other services not related to health insurance benefits provided.
Among the numerous advantages, BPJS Kesehatan insurance has its shortcomings too. Let’s recall the most significant ones. 1.It’s only valid in Indonesia. If you go on holiday or back to your country, you would need to purchase an extra health care policy abroad. 2.Long waiting process. Quite often the waiting process in hospitals that work with BPJS Kesehatan takes a long time. This is not always the case but it’s good to keep it in mind too.
When applying for BPJS you will be assigned to a specific local clinic (puskesmas kesehatan). After that, it will no longer be possible to change it. With the exception of accidents, you will be treated in this clinic in the future. An exception will also be made if the treatment provided in this hospital does not help you, or it is not technically equipped to treat your condition. If this is the case, the doctor will write you a referral to another hospital that is able to provide the necessary treatment.
It also should be mentioned that BPJS not only covers the treatment of actual diseases and accidents, but also the screening of potential diseases. Disease screening is a series of tests to detect the presence or possibility of a particular disease or condition in a person, even if he or she does not have any symptoms. Disease screening is important because it can help detect diseases early, before they become more serious and more difficult to treat. BPJS Kesehatan covers several types of disease screening, including cancer, cardiovascular disease and infectious diseases. And they are usually free for insurance plan participants.
