Jakarta, CNBC Indonesia – Not all operations can be covered by BPJS Health. In fact, a number of operations cannot use the national guarantee system.
For information, to receive surgery, patients need to seek treatment at a first-level health facility (faskes). You can go to a health center or clinic approved by BPJS Health.
If surgery is necessary, a referral letter to the hospital will be given. Later you will get an operation schedule from the doctor at the hospital.
Patients also need to meet the requirements to be operated on using BPJS Health. Starting from the BPJS Health Card or Healthy Indonesia Card (KIS), referral letters from primary health centers/faskes, and patient cards from hospitals.
Based on the guidelines for implementing National Health Insurance (JKN), namely Minister of Health Regulation (Permenkes) Number 28 of 2014, there are 19 types of operations covered by BPJS Health. Here’s the list:
1. Heart Surgery
2. Caesarean section
3. Cyst surgery
4. Myoma surgery
5. Tumor surgery
6. Odontectomy surgery
7. Oral Surgery
8. Appendectomy
9. Gallstone Surgery
10. Eye Surgery
11. Vascular Surgery Operations
12. Tonsillectomy
13. Cataract Surgery
14. Hernia surgery
15. Cancer Surgery
16. Lymph Node Surgery
17. Pen Removal Operation
18. Knee Joint Replacement Surgery
19. Thymectomy operation
Operations that are not covered by BPJS Health
Meanwhile, there are several types of operations that are not covered by BPJS Health. Some of them include accidents or self-injury, here is the complete information:
1. Operations Due to the Impact of Accidents
2. Cosmetic or Aesthetic Surgery (surgery that is not harmful to health)
3. Operations due to self-injury (operations due to inaccuracy or carelessness that result in injury)
4. Operations at Overseas Hospitals (operations carried out outside the reach of BPJS Health)
5. Operations that do not comply with BPJS Health Procedures (operations that do not complete the appropriate application procedures)
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