BPJS Kesehatan outlines JKN service procedures and coverage exclusions

BPJS Kesehatan has outlined key requirements for participants to ensure smooth access to the National Health Insurance (JKN) program. Binti Lukluah, Head of the Surabaya Branch, emphasized that maintaining an active membership status is the primary requirement. For non-wage earners, this involves paying monthly premiums by the 10th of each month. To prevent lapses, the agency offers an autodebit feature, though participants are advised to monitor their accounts for potential failures due to insufficient funds or network issues.

Additionally, participants must follow the tiered service flow, as the program does not allow direct hospital access without following established medical referral procedures. Statuses can be checked via the Mobile JKN application, WhatsApp (PANDAWA), or the Care Center.

Under Presidential Regulation Number 82 of 2018, certain medical services and conditions are excluded from BPJS Kesehatan coverage. These 21 categories include aesthetic or cosmetic treatments, dental braces, medical care resulting from criminal acts, self-inflicted injuries, and treatments related to alcohol or drug addiction. Other exclusions involve infertility treatments, experimental medical procedures, traditional or alternative medicine not deemed effective, and healthcare services obtained abroad.