BPJS HEALTH

PT Askes (Persero) also created the General Public Health Insurance Program (PJKMU), which is intended for people who have not been covered by Jamkesmas, Askes Sosial, or private insurance. Until then, there were more than 200 districts / cities or 6.4 million people who had become PJKMU participants. PJKMU is a Regional Health Insurance (Jamkesda) whose management is handed over to PT Askes (Persero).

The step towards universal health coverage is even more evident with the official operation of BPJS Kesehatan on January 1, 2014, as a transformation from PT Askes (Persero). This began in 2004 when the government issued Law Number 40 of 2004 concerning the National Social Security System (SJSN) and then in 2011 the government established Law Number 24 of 2011 concerning the Social Security Administering Agency (BPJS) and appointed PT Askes (Persero) as organizers of social security programs in the health sector, so that PT Askes (Persero) was changed to BPJS Health.

Through the Healthy Indonesia National Card-Health Insurance Program (JKN-KIS) organized by BPJS Health, the country is present in our midst to ensure that the entire population of Indonesia is protected by comprehensive, fair and equitable health insurance.

The national social security system that applies in Indonesia is currently run by the Social Security Organizing Agency (BPJS). Through the Healthy Indonesia National Card-Health Insurance Program (JKN-KIS) organized by BPJS Health, the state wants to ensure that all Indonesian citizens are protected by comprehensive, fair and equitable health insurance.

BPJS Health is a system that must be followed by all Indonesian citizens and foreign nationals who have been in Indonesia for a minimum period of 6 months. The government has set a target of achieving so that all Indonesian citizens have a health BPJS in 2019. This is in accordance with article 14 of the Law No. 24 of 2011. Contributions are paid according to the level of benefits obtained. A special contribution assistance program for the poor is also provided. However, there are still many complaints from BPJS Health users.

Complaints that were received by the Indonesian Consumers Foundation (YLKI) regarding BPJS Health included hospital refusal of BPJS patients, difficulties in procedures, incomplete treatment, not maximal medical services, long lines at BPJS recipient health facilities such as emergency units in the hospital, and not paid.

To get maximum BPJS service, here are some facts about Health BPJS that need to be known:

 

Unlike private insurance which generally has limitations and conditions for certain types of diseases, BPJS Health is designed to cover all types of diseases. BPJS Health will cover BPJS members from all ages and all the severity of the disease suffered.

The premium paid is not based on age, medical history, or the level of illness suffered, but based on health facilities enjoyed. This facility is divided into class I to class III.

BPJS Health adheres to a tiered referral pattern, so patients cannot be free to go to a hospital or desired health facility. First, patients must seek treatment at first-level health facilities, namely health centers, clinics, or individual practice doctors who work with BPJS. Then, if the health facility is unable to treat, it will be referred to a higher health facility or a hospital class.

The limitations of hospitals or health facilities in collaboration with BPJS make BPJS Health patients often have to queue to get services. Nevertheless, there are now more doctors and hospitals serving BPJS Health participants.

Medical expenses and laboratory examinations are also included in the BPJS Health service. The patient does not need to pay for the service again, provided that it remains in accordance with the applicable health BPJS procedures or conditions. BPJS will not cover the costs of the investigation at the request of the patient himself without indication or not according to the diagnosis of the disease given by the doctor.

Withdrawal of fees for BPJS patients applies if participants ask for facilities higher than the rights that should be obtained. For example, when a patient asks for a treatment class higher than his right. For this reason, patients need to notify BPJS Health and hospital staff if they want to use a class higher than the premium paid to BPJS.

It is important to learn about the procedure for obtaining optimal service from BPJS Kesehatan. In addition, do not forget to fulfill the obligation to pay premiums every month so that there are no obstacles during treatment.

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