The following services are covered by the BPJS health insurance scheme:
1. Health services in clinics or health centers
First level health services (according to the class you choose) include:
- Free administration fee for health services.
- Get promotive and preventive services. For example, such as consultations, routine immunizations, about family planning programs and health checks to see if there is a risk of disease and its prevention.
- Receive medical examination, treatment and consultation.
- General medical treatment, surgery or not.
- Medicines and medical materials
- Blood transfusions according to medical needs.
- First-level laboratory diagnostic examination.
- Inpatient facilities according to the BPJS Kesehatan class given a doctor’s referral.
2. If you are referred to a hospital
- Administrative costs for health services.
- Examination, treatment, and consultations with specialists and sub-specialists.
- Medical procedures that require a specialist, both surgical and non-surgical, according to a doctor’s recommendation.
- Medicines and consumable medical supplies (e.g. intravenous fluids).
- Supporting services that require certain advanced diagnoses according to doctor’s recommendations.
- Medical rehabilitation.
- Blood services, such as provision of blood bags.
- Clinical forensic medical services or post-mortem examinations to diagnose and seek evidence of crime from patients who have been injured as a result of certain criminal acts.
- Providing corpse management services to patients who died after being hospitalized at health facilities in collaboration with BPJS Kesehatan. However, the service covered does not include caskets and hearses.
- Treatment in the usual inpatient room.
- Hospitalization in intensive care units such as the ICU.
3. Childbirth
Labour or birth covered by BPJS Health in first-level and advanced-level health facilities only applies up to the third child, regardless of whether the child is born alive or dead.
4. Ambulance
The ambulance facility is the responsibility of BPJS Health and is only provided for referral patients from one health facility to another with the aim of saving the patient’s life.
