What is BPJS?
BPJS stands for Badan Penyelenggara Jaminan Sosial (Social Insurance Administration Organization). BPJS adminsters the Indonesian national health insurance Jaminan Kesehatan Nasional or JKN for short.
There are two versions of BPJS: BPJS Kesehatan (the successor of PT Askes) and BPJS Ketanagakerjaan (the successor of Jamsostek). The first administers JKN for non-employees/self employed/informal workers, and the latter for employees. Both are government insurance companies formed by the law Undang-Undang no. 24 tahun 2011.
Eligibility
Individual participation is mandatory for all Indonesian residents, including expats on ITAS/P by January 2019. Meanwhile, employers must enroll their employees by January 2016. Expat employees who are working at least 6 months (and their dependent family members) must be registered by their employer.
How to register
Employers must register their employees and dependent family members. For non-employees registration may be done online. You will need to provide the following:
- KK (kartu keluarga)
- KTP (kartu tanda penduduk)
- NPWP
- Photo 3×4 cm (2)
- Phone number
- Bank account number to pay premium from.
You will still need to go to the local BPJS office to pick up the card. Since 2016, you have to enroll everyone on the same KK at the same time.
Premium for Non-employees/Self-employed/non-formal workers
As per the newest regulation Presidential Decree No 19 / 2016, the premiums are:
- Class I : Rp 80,000
- Class II : Rp 51,000
- Class III : Rp 25,500
Per person, per month, due on the 10th of each month. For employees the premium is 5% of monthly salary, up to a salary cap of Rp 8 million. In the private sector, the employer is responsible for 4% and the employee is responsible for 1%. Meanwhile, for public sector employees the split is 3% and 2%. This covers the employee, their spouse and up to 4 dependent children. Dependent children are unmarried children up to 21 years old, or 25 years old if attending university. You can add parents or children beyond the first 4 for 1% of monthly salary per person. Employees with monthly salary of Rp 4 million or less are eligible for Class II facilities. Meanwhile, those with higher salary will be eligible for Class I facilities.
There is a bit of unfairness in the case that both husband and wife are working as employees. In that case both have to pay the premium. Yet, the coverage of one should cover the other.
Note on taxes: The employer contribution is considered as taxable income (penghasilan kena pajak). Similarly, employees can not deduct their contribution from taxable income.
In Indonesia, hospitals have different levels of room comfort. They range from wards with 10 or more beds, to private luxury rooms the size of small apartments. The medical service itself is supposed to be equal regardless of room comfort. Therefore, classes in BPJS refer to the comfort of the room only. Typically, Class I will have 2-3 beds per room, Class II will have 3-5 beds, and Class III 5 or more beds.
You can upgrade to a higher class by paying the difference out of pocket. You can even upgrade to classes higher than Class I (VIP, VVIP etc). Be aware that the difference could be high, so it is best to ask for an estimate first. You can also change your class (and payment) with BPJS once every 12 months.
Coverage
There are no exclusions due to preexisting conditions or age, nor are there coverage limits. However, the program does not cover:
- Healthcare obtained outside the BPJS procedure
- Healthcare obtained at facilities not participating with BPJS
- Care obtained abroad
- Cosmetic procedures
- Infertility treatments
- Orthodontics
- Medical issues from drug or alcohol abuse
- Self inflicted injuries or due to dangerous activities
- Alternative medicine
- Experimental medicine
- Contraception, cosmetics, baby food and milk.
- Medical care due to natural disasters, epidemics, special occurrences or state of emergencies.
- Other care not related to the treatment of covered medical issue.
Penalties
If premiums are overdue for over 1 month, the coverage becomes inactive on the 10th of the following month. Therefore, you have to pay any outstanding premiums to reactivate. Within 45 days of reactivating coverage, any in-patient treatment will incur a penalty. The penalty is 2.5% x treatment cost x number of months inactive. This is up to a maximum of 12 months or Rp 30 million, whichever is lower.