BPJS penalties and exclusions on first time sign up

Gogrilla

New Member
Joined
Dec 19, 2020
Messages
3
Hi all,

My Indonesian wife has not been employed, and not been registered with BPJS. I am now wondering if and under which conditions she could register with BPJS.
The best I found until now is this very good article from @dafluff : https://www.expatindo.org/summary-jkn-and-bpjs/

It seems to indicate:
  1. She still can
  2. There will be no exclusions due to pre-existing conditions
  3. She must pay outstanding premiums to reactivate (not mentioned how much)
  4. There will be no penalty if first treatment is more than 45 days after (re)activing
  5. There will be max penalty of 30 juta if ifrst treatment is earlier than 45 days after (re)activating
The article is from 2017 though. So I wondering:
  • Does anyone know whether or has information on if this information is (still) valid?
  • Does anyone know where to find current information / laws on this topic?
Any help or information would be greatly appreciated!

Cheers...
 

dafluff

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Cager
Joined
Jul 13, 2016
Messages
3,994
Hi all,

My Indonesian wife has not been employed, and not been registered with BPJS. I am now wondering if and under which conditions she could register with BPJS.
The best I found until now is this very good article from @dafluff : https://www.expatindo.org/summary-jkn-and-bpjs/

It seems to indicate:
  1. She still can
  2. There will be no exclusions due to pre-existing conditions
  3. She must pay outstanding premiums to reactivate (not mentioned how much)
  4. There will be no penalty if first treatment is more than 45 days after (re)activing
  5. There will be max penalty of 30 juta if ifrst treatment is earlier than 45 days after (re)activating
The article is from 2017 though. So I wondering:
  • Does anyone know whether or has information on if this information is (still) valid?
  • Does anyone know where to find current information / laws on this topic?
Any help or information would be greatly appreciated!

Cheers...

Hi @Gogrilla, welcome to the forum.

1. Yes
2. Yes
3. Capped at 24 months premiums.
4. Yes
5. Yes, but only for in-patient care.
 

Gogrilla

New Member
Joined
Dec 19, 2020
Messages
3
Hi @Gogrilla, welcome to the forum.

1. Yes
2. Yes
3. Capped at 24 months premiums.
4. Yes
5. Yes, but only for in-patient care.
Hi @dafluff ,

Thanks you SO much for your reply, this really helps a lot :)
I do have some questions still, hoping you are any other member could help out more:

Ad 5: Does that mean out-patient care is excluded form BPJS, or rather excluded from that penalty rule?

Further: My wife had been told by BPJS representative that she could only join with exclusions. As this apparently is not true, would there be any description of applicable admissions rules, coverage, penalties etc on some (BPJS) website? So that we can convice BPJS admin when trying again?

I have tried to find such information of course but my bahasa is lacking.
Also, I have found a set of applicable laws, have Google translated them and am reading them, but I would not normally expect such detail to be present in laws.

Cheers :)
 

dafluff

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Moderator
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Messages
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Hi @dafluff ,

Thanks you SO much for your reply, this really helps a lot :)
I do have some questions still, hoping you are any other member could help out more:

Ad 5: Does that mean out-patient care is excluded form BPJS, or rather excluded from that penalty rule?

Further: My wife had been told by BPJS representative that she could only join with exclusions. As this apparently is not true, would there be any description of applicable admissions rules, coverage, penalties etc on some (BPJS) website? So that we can convice BPJS admin when trying again?

I have tried to find such information of course but my bahasa is lacking.
Also, I have found a set of applicable laws, have Google translated them and am reading them, but I would not normally expect such detail to be present in laws.

Cheers :)

Only in-patient treatments will be penalized, out-patient care is available as normal, after rejoining BPJS and paying outstanding premium (max 24 months).

Not sure what you/BPJS rep. means regarding exclusions? There is no mechanism by which they can exclude coverage for pre-existing conditions. As long as your wife re-activates the BPJS, she's good to go. What exactly are they proposing to exclude?
 

Gogrilla

New Member
Joined
Dec 19, 2020
Messages
3
Only in-patient treatments will be penalized, out-patient care is available as normal, after rejoining BPJS and paying outstanding premium (max 24 months).

Not sure what you/BPJS rep. means regarding exclusions? There is no mechanism by which they can exclude coverage for pre-existing conditions. As long as your wife re-activates the BPJS, she's good to go. What exactly are they proposing to exclude?
"Only in-patient ... premium (max 24 months)."
Thanks again for the clarification. :)

Exclusions: She has kidney issues. These seem to be intermittent, and a real cause and diagnosis is still missing. It seems probably though that she might need dialysis with some regualrity.
It was said any kidney treatment plus dialysis would be exlcuded.
And so I was hoping that on some official site, perhaps BPJS's own site, it is clearly stated that exclusions are a no-go, and can use that to help them understand.

At any rate, by what you stated, it seems she can just register, they must accept that. And then if and when needed in the future, she can go to the BPJS-joined faskes / doctor / hospital and have treatment, right?

EDIT
I do read now in Undang-Undang Nomor 24 Tahun 2011, Bab 5, Pasal 17, Paragraph (2) the following:
"(2) Sanksi administratif sebagaimana dimaksud pada ayat (1) dapat berupa:
a.teguran tertulis;
b.denda; dan/atau
c.tidak mendapat pelayanan publik tertentu.
(4) Pengenaan sanksi sebagaimana dimaksud pada ayat (2) huruf c dilakukan oleh Pemerintah atau pemerintah daerahatas permintaan BPJS.
(5) Ketentuan lebih lanjut mengenai tata cara pengenaan sanksi administratif diatur dengan Peraturan Pemerintah.
"
Does that perhaps give BPJS a legal opening to indeed exclude normally covered services? Or does this mean something else?
 
Last edited:

dafluff

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Messages
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"Only in-patient ... premium (max 24 months)."
Thanks again for the clarification. :)

Exclusions: She has kidney issues. These seem to be intermittent, and a real cause and diagnosis is still missing. It seems probably though that she might need dialysis with some regualrity.
It was said any kidney treatment plus dialysis would be exlcuded.
And so I was hoping that on some official site, perhaps BPJS's own site, it is clearly stated that exclusions are a no-go, and can use that to help them understand.

At any rate, by what you stated, it seems she can just register, they must accept that. And then if and when needed in the future, she can go to the BPJS-joined faskes / doctor / hospital and have treatment, right?

EDIT
I do read now in Undang-Undang Nomor 24 Tahun 2011, Bab 5, Pasal 17, Paragraph (2) the following:
"(2) Sanksi administratif sebagaimana dimaksud pada ayat (1) dapat berupa:
a.teguran tertulis;
b.denda; dan/atau
c.tidak mendapat pelayanan publik tertentu.
(4) Pengenaan sanksi sebagaimana dimaksud pada ayat (2) huruf c dilakukan oleh Pemerintah atau pemerintah daerahatas permintaan BPJS.
(5) Ketentuan lebih lanjut mengenai tata cara pengenaan sanksi administratif diatur dengan Peraturan Pemerintah.
"
Does that perhaps give BPJS a legal opening to indeed exclude normally covered services? Or does this mean something else?

I am not sure what the BPJS rep is on about, a treatment is either covered or not covered. Whether pre-existing or not. Dialysis is covered. As long as the doctors prescribe it she will get it.

The article you quoted defines sanctions for employers who do not register their employees for BPJS. This article is irrelevant to the patient.
 

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