BPJS Kesehatan coverage excludes specific surgical procedures

BPJS Kesehatan provides various medical services through affiliated clinics, community health centers, and hospitals. However, certain surgical procedures are not covered by the program.

Exclusions from coverage include surgeries resulting from accidents, cosmetic or aesthetic procedures that do not pose a health risk, surgeries resulting from self-harm or negligence, procedures performed at hospitals abroad, and those that do not follow established BPJS Kesehatan protocols.

Under Ministry of Health Regulation Number 28 of 2014, covered procedures include heart surgery, C-sections, cyst and tumor removals, appendectomies, gallbladder surgery, eye surgeries, hernia repairs, and cancer treatments, among others. To access these benefits, patients must first visit a primary healthcare facility for a referral to a hospital.