BPJS and JKN: The Indonesian National Health Insurance System

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 the national health insurance program (JKN). The latter is a worker’s compensation and pension program. This article deals with BPJS Kesehatan, and the national health insurance only.

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 for 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)
Email
Phone number
Bank account number to pay the 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.

Click to see the complete list of local BPJS offices.

BPJS Card or Kartu Indonesia Sehat?

Both these cards signify participation in the BPJS insurance program. As such, they are functionally equal. You do not have to exchange one for the other. Initially, Kartu Indonesia Sehat (Indonesian Health Card) was a campaign promise of President Joko Widodo. The KIS was given to people whose BPJS insurance was state-subsidized. However, now KIS is issued to all new BPJS participants.

Premium for Non-employees/Self-employed/non-formal workers

Updated Oct 31, 2019: As per the newest regulation Presidential Decree No 75 / 2019, the premiums are:

Class I	Rp 160,000
Class II	Rp 110,000
Class III	Rp 42,000

Per person, per month, due on the 10th of each month.

Premium for Employees

For employees, the premium is 5% of monthly salary, up to a salary cap of Rp 12 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 the monthly salary per person. Employees with a monthly salary of Rp 4 million or less are eligible for Class II facilities. Meanwhile, those with a 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 contributions from taxable income.

Classes?

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.

Obtaining Care

As with many national healthcare systems, you must first seek care from an authorized primary care facility (FasKes 1). The primary care facility will recommend a more specialized care facility if needed. The exception is for medical emergencies.

A full list of FasKes 1 by area can be obtained by following this: LINK

Bring your BPJS/KIS card, copies passport/KTP, KK, and referral letters from FasKes 1 if they refer you to a specialized care facility.

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 issues.

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, capped at 24 months.

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 24 months or Rp 30 million, whichever is lower.

BPJS Android App

In July of 2017, BPJS has released an Android app. You can download this free app via the Google Play store.

Among other things, the app can act as a virtual BPJS card. It can also lists the location of your care facility and check the status of your payments.

Other notes

Need more help? BPJS has a 24-hour hotline at 1500400 (Indonesian)

You can pay the premium via ATM, Internet Banking, or at the teller at Bank Mandiri, BNI, and BRI. Also, you can also set up auto-debit at those banks. Finally, other places you can pay include Alfamart and Indomaret, the Post Office, and your local BPJS office.

Don’t forget your household staff. BPJS Kesehatan is an ideal insurance product for them. It is customary to pay for the healthcare costs of your staff. Hence it is fair that you kick in for the premium.

FasKes 1s are typically small community clinics (Puskesmas), or general practitioners. English may not be spoken here. You may want to bring someone to help translate if needed.

Expat employees used to be able to opt-out of Jamsostek (the predecessor of BPJS Ketenagakerjaan) if they have equal or better coverage. This is no longer the case with BPJS. Participation is mandatory even if they have other insurance.