engglish

1. New Health Insurance in
Indonesia
By
Bayu Aditya
Azhari Maulana
Budi Ariwibowo
Prima Maharani
Lisa Dwipayoma
Rama Dani Putra

2. Introduction
• Choosing good health insurance in Indonesia
somehow becomes dilemma for insurance
applicant. Knowledge about insurance become
one of factor which make it happened. This is also
caused by many features that given by insurance
company which makes many consumers become
confused. With increasing health insurance
needed in Indonesia, make many companies
compete to produce insurance product which suit
with consumer needed.

3. Cont…
• Besides insurance companies, our government
also has a program which helps all Indonesian
people to increase their social and health.
Government policy on the National Health
Insurance (JKN) and The National Social
Security Agency (BPJS) needs to be known and
understood by all the people of Indonesia. It is
necessary dissemination of information
through dissemination to all stakeholders
interests and the public at large

4. History
• The right standard of living for the health, well being
and have family is human right and recognized by all
nations in the world, including Indonesia. Recognition
that listed in the Declaration of the United Nations
1948 on Human Rights. Article 25 Paragraph (1)
Declaration states, every person is entitled to get good
living for the health and welfare himself and his family
including food, clothing, housing and medical care and
also social services required and the right to security in
the event of unemployment, illness, disability, widow /
widower, old age or Other circumstances that lead to a
shortage living, which is out of his control.

5. • Under the Declaration, after World War II some
countries take the initiative to develop social security,
include health insurance for all residents (Universal
Healt Coverage). In the trial 58th 2005 in Geneva,
World Health Assembly (WHA) underlines the need for
the development of the system ensure the availability
of health financing community access to health
services and provide protection to them against
financial risk. 58th WHA passed a resolution stating,
sustainable health financing through Universal Health
Coverage held through an insurance mechanism social
health. WHA also advised the WHO to encourage
state-member states to evaluate the impact system
changes health financing to health care when they
move towards Universal Health Coverage.

6. • In Indonesia, the Pancasila state philosophy
and the basic precepts-especially 5
also recognizes civil rights to get health. This
right is also enshrined in the Constitution and
Section 45 of Article 28 H 34, and is set in the
Law. 23/1992 which is then replaced by Law
36/2009 on Health. in Law 36/2009 affirmed
that every person has the same rights in
gaining access to resources in the health
sector and obtain health care safety, quality,
and affordable.

7. • In 2004, issued Law 40 of the National Social Security
System (Navigation). Law 40/2004 tell that social security
mandatory for all residents including the National Health
Insurance (JKN) through The National Social Security
Agency (BPJS).
•
Law No.. 24 of 2011 also establishes, Social Security
The National will be held by BPJS, consisting of BPJS of
Health and BPJS of employment. Special for National Health
Insurance (JKN) will be hosted by the implementation of
BPJS of health starting at January 1, 2014. Operationally,
the implementation poured JKN Government Regulation
and Regulation of the President, among others:
Government Regulation No.101 of 2012 on Aid Recipients
Contribution (PBI); Presidential Regulation. 12 Year 2013
concerning Guarantee Health, and JKN Roadmap (Roadmap
National Health Insurance).

8. • To supports the implementation, the Ministry
of Health giving priority to the health
insurance reform health. The Ministry of
Health is working on a regulation form of
regulation, which would be a legal umbrella
for regulate, among others, health care,
health services level First, health care
referrals and advanced levels. Regulation
Ministers will also set the type and price
ceilings medical device and drug services
medical consumables and materials for
participants Warranty National Health.

9. What is BPJS?
• BPJS is a law department which have made for
hold social security program. BPJS consist of
BPJS of health and BPJS of employment.
• Health social security orginizing department (
BPJS of health) is law department which have
made for health security program. This
department start the operation at January 1st
2014.

10. What kind of social security are in
BPJS?
•
•
•
•
•
Health security
Work accident security
Old age security
Pension security
Dying security

11. Who become BPJS of health
participant?
• All Indonesian people have to become BPJS
participant which organize by BPJS including
foreigner who have work in Indonesian at
least 6 months and have paid premi.

12. How many group are BPJS of health
participant consist of ?
• There are 2 group of participant, they are:
1. Premi recipient (PBI) health security
2. Non premi recipient ( Non PBI) health security

13. Premi recipient (PBI) health security
• PBI is indigent and poor people, with
participant establishment who have been set
by law.

14. Non premi recipient ( Non PBI) health
security
•
•
Non PBI consist of
Employee salary recipient and family, such as
–
–
–
–
–
–
•
Civil employee
Indonesian Army
Indonesian Policeman
Goverment official
Private employee
All employee who doesn’t include to a to e which receive salary
Non Employee and family, such as
– Investor
– Employer
– Pension recipient, consist of
•
•
•
•
Civil employee who receive pension salary
Army and policeman who receive pension salary
Widow, fatherless and motherless from pesion salary recipient
Goverment official who receive pension salary
– Veteran
– Heroes

15. What are Right and Duty of
participant ?
• Right of participant
1. Get member card as valid evidence to get health
care.
2. To get benefit and information about right and
duty also procedure about health care
3. Get health care in health facility which work all
with BPJS
4. Told lamentation , critic, and suggest by spoken
or written to BPJS office.

16. • Duty of participant
1. Apply her/himself as participant and also pay the
premi which the cost have been set by law
2. Report participant data modification, including
marry, divorce, dying, move and change facility
class.
3. Keep the member card from broke, lost, or be
used by other people who doesn’t have right on
it
4. Obey all rule and procedure about health care.

17. What kind of service health care are
in warranty?
• a. Primary health care, ie non-health care specialist
include:
1) Administrative services
2) preventive and promotive services
3) examination, treatment, and medical consultation
4) non-specialist medical measures, both operative and
non-operative
• 5) Drugs and medical materials consumables services
6) Blood transfusion in accordance with medical needs
7) 1st level Laboratory diagnostic investigations and
8) Hospitalization first level according to the indication.

18. • b. Advanced level referral health services, ie services
health include:
1) Outpatient which includes:
• a) Administrative services
b) Examination, treatment and specialist consultations
by specialists and subspecialty
c) act in accordance with a medical specialist, medical
indications
d) Drugs and medical materials consumables services
e) implantable medical devices
f) Support diagnostic in accordance medical indications
g) Medical Rehabilitation
h) Blood Services
i) The services of forensic medicine
j) Corpse services in health facilities.

19. • 2) Hospitalization which includes:
• a) non-intensive inpatient treatment
b) inpatient care in intensive care.
c) other health services determined by the
Minister

20. What services are not covered?
• 1.Health services are done without going through the
procedure as stipulated in applicable regulations.
2. Health services in health facilities do not in collaboration
with the Health BPJS, except for emergency cases.
3. Health services has been secured by security programs
workplace accidents to disease or injury due to accidents
employment or employment relationship.
4. Health services performed abroad
• 5. Health services for cosmetic purposes and / or aesthetic.
6. Services to overcome infertility (Getting Descendants).
7. Leveling dental services (orthodontics).
8. Health disorders / diseases caused by drug addiction and
/ or alcohol.

21. 9. Health problems from accidentally hurting yourself, or as
a result of hobbies are a danger to themselves.
10. Complementary medicine, alternative and traditional,
including acupuncture, shin she, chiropractic, which has not
been declared effective based health technology
assessment (Health Technology Assessment / HTA).
11. Medicine and medical treatment which including
experiment (experiment).
12. Contraceptives, cosmetics, baby food, and milk.
13. Household health supplies.
14. Health care programs that are already guaranteed in
the accident traffic in accordance with the provisions of the
legislation.
15. Catastrophic health services, extraordinary events /
outbreaks.
16. Cost of other services that are not related to benefits
provided health insurance.