BPJS Kesehatan is Indonesia’s most widely recognized health insurance program, operating under the Jaminan Kesehatan Nasional (JKN) initiative. This government-run scheme aims to provide accessible and affordable healthcare for all residents in Indonesia, including foreign nationals living in the country long-term.

Who Can Register for BPJS Kesehatan?

BPJS Kesehatan is open to all Indonesian residents, grouped into different participant categories:

1. Wage-Receiving Employees (Pekerja Penerima Upah / PPU)

This group includes:

1. Government employees such as civil servants, military (TNI), and police (Polri)
2. Private sector workers
3. Employees of state-owned or region-owned enterprises

Premiums are jointly paid by the employer and employee.

2. Non-Wage Recipients (Pekerja Bukan Penerima Upah / PBPU)

Includes self-employed individuals such as:

1. Freelancers
2. Entrepreneurs
3. Informal sector workers

Participants in this category pay the full premium on their own.

3. Non-Workers (Bukan Pekerja)

Applies to individuals who are not actively employed, such as:

1. Investors
2. Pensioners
3. Property owners

4. Contribution Assistance Recipients (Penerima Bantuan Iuran / PBI)

These are low-income individuals or families identified by the Ministry of Social Affairs. Their premiums are fully subsidized by the government.

5. Foreign Residents in Indonesia

Foreigners are eligible if they:

1. Reside in Indonesia for at least six months
2. Hold a valid work permit or are self-employed

Those with a KITAS (Limited Stay Permit Card) can also register.

Healthcare Coverage with BPJS Kesehatan

BPJS offers comprehensive medical services divided into two main categories:

Outpatient Services (Rawat Jalan)

1. Primary Care (Faskes 1): Includes clinics or government health centers (Puskesmas) where patients receive general treatment.
2. Referral Services: If specialized treatment is needed, patients are referred to hospitals or higher-level facilities.

Inpatient Services (Rawat Inap)

Covers hospitalization for further medical treatment, including surgery and specialized care.

BPJS Membership Classes and Premium Rates

BPJS Kesehatan offers three membership classes, each providing different levels of hospital accommodations:

Class I

• Monthly Premium: IDR 150,000

• Shared ward for 2–4 patients

• Option to upgrade to VIP room at additional cost

Class II

• Monthly Premium: IDR 100,000

• Shared ward with slightly more patients than Class I

• Upgrade options available

Class III

• Monthly Premium: IDR 42,000

   ◦ IDR 35,000 paid by the member

   ◦ IDR 7,000 subsidized by the government

• Basic shared room with 4–6 patients

• Upgrade possible to higher classes with personal expense

Note: The government is planning to implement a standard inpatient service model called Kelas Rawat Inap Standar (KRIS) by 2025, which will eventually replace the current tiered system.

BPJS Contribution Rates for Employees

For employees, healthcare contributions are shared:

1. Employer: 4% of salary (max IDR 480,000)
2. Employee: 1% of salary (max IDR 120,000)

The contribution is calculated up to a maximum monthly wage of IDR 12 million and covers up to five family members (employee, spouse, and three children).

Key Benefits of BPJS Kesehatan

Affordable Coverage

Tiered pricing ensures accessibility for various income levels.

Nationwide Access

Accepted at most public health facilities and many private ones across Indonesia.

Preventive Healthcare

Includes immunizations, routine check-ups, and maternal health services.

Inclusive Enrollment

Open to all ages and health conditions, including those with pre-existing illnesses.

Cashless System

No upfront payment is required if administrative procedures and referrals are followed.

Services Covered by BPJS Kesehatan

BPJS provides broad coverage, including:

1. Outpatient Care: General consultations, diagnostic tests, and referrals
2. Inpatient Care: Hospital stays, surgeries, lab work, and medications
3. Emergency Treatment: Immediate coverage without referral in urgent situations
4. Maternal Care: Prenatal check-ups, childbirth (normal and C-section), newborn care
5. Chronic and Serious Conditions: Dialysis, chemotherapy, major surgeries, and disease management
6. Mental Health Services: Includes consultations, medications, and inpatient care for psychiatric conditions

What BPJS Kesehatan Does Not Cover

Some services fall outside BPJS coverage, such as:

1. Cosmetic procedures (e.g., plastic surgery for beauty enhancement)
2. Fertility treatments (e.g., IVF)
3. Alternative therapies (e.g., acupuncture not prescribed by a doctor)
4. Treatment at non-affiliated clinics or hospitals
5. Injuries from criminal acts, substance abuse, or self-harm
6. Elective upgrades (e.g., premium rooms not medically required)

Things to Consider

While BPJS Kesehatan offers significant benefits, there are a few limitations to be aware of:

1. Domestic-Only Coverage: BPJS is valid only within Indonesia. Travelers or expatriates should consider additional international health insurance.
2. Waiting Times: Public hospitals with BPJS services can have long queues, particularly in urban areas.

How to Use BPJS Kesehatan

Visit Your Registered Primary Care Facility (Faskes 1)

Start your treatment at the clinic or Puskesmas listed on your BPJS card.

Get a Referral When Needed

Your primary care provider will refer you to a hospital or specialist for advanced treatment.

Use Emergency Services Directly

In emergencies, you can go to any ER. If deemed an emergency, services will be covered without prior referral.

Conclusion

BPJS Kesehatan is a powerful health insurance solution for residents in Indonesia, offering broad access to medical services at an affordable price. Whether you're employed, self-employed, retired, or a foreign resident, BPJS ensures you and your family have a safety net when health issues arise.