The National Health Insurance (JKN) program managed by BPJS Kesehatan has provided broad protection for the Indonesian public. However, complaints emerging on social media regarding hospital bills that JKN participants had to pay highlight the importance of a deep understanding of applicable health insurance provisions.
Head of Public Relations at BPJS Kesehatan, Rizzky Anugerah, explained that payment issues often occur due to inactive membership status or unpaid contributions. Under Presidential Regulation No. 59 of 2024, participants who reactivate their membership while undergoing inpatient care will be subject to a service fine. This fine is set at 5 percent of the estimated treatment cost multiplied by the number of unpaid months, with a maximum fine capped at Rp20 million.
Furthermore, Rizzky emphasized that BPJS Kesehatan continues to cover thousands of disease diagnoses, including long-term care such as dialysis, cancer treatment, and therapies for patients with diabetes and hemophilia. However, a number of services are indeed not covered by BPJS Kesehatan because they are managed by other agencies or are of a specific nature.
Uncovered services include cosmetic procedures such as aesthetic plastic surgery and dental braces. In addition, healthcare services received abroad, clinically unproven alternative treatments, and work-related injuries already covered by BPJamsostek, Taspen, or ASABRI are also not covered by BPJS Kesehatan.
Other institutions, such as the National Narcotics Board (BNN), are responsible for substance dependency disorders, while cases of violence victims are handled by LPSK. The provisions regarding these exclusions are not new rules, but have been regulated in stages since Law No. 40 of 2004 up to the latest regulatory updates. BPJS Kesehatan continues to urge the public to pay their contributions regularly so that the sustainability of this social security program is maintained for all Indonesian people.
