Jakarta, CNBC Indonesia – BPJS Kesehatan is a public legal entity that guarantees costs for most diseases. Effective since 2014, the law stipulates that in fact every Indonesian citizen is required to become a member of BPJS Kesehatan.
Just like insurance, to become a BPJS Kesehatan participant, participants pay a fee every month. As long as the membership status is active, participants can get free health services at cooperating clinics and hospitals.
Even so, there are a number of health services that cannot be covered by BPJS. And this service is related to accidents that befall BPJS Health participants.
Types of accidents that are not covered by BPJS Kesehatan:
1. Single accident due to own negligence
A single traffic accident is an accident that occurs in only one motorized vehicle without involving other road users and drivers. Usually these accidents occur due to negligence of the driver.
BPJS Health will not cover accidents due to negligence, such as consuming alcohol or drugs while driving.
Apart from that, accidents due to driving at high speed in the context of committing crimes such as robbery, committing acts of violence or sexuality are also not covered by BPJS Kesehatan.
Accidents that occur because the driver tries to end his life and there are clashes between groups are not covered by BPJS Kesehatan because they are included in the category of intentional ones.
2. The double accident that Jasa Raharja has borne
Multiple traffic accidents are accidents that occur between two or more drivers. Multiple accidents can also occur between drivers and pedestrians or other road users.
BPJS Health will not cover multiple accident victims that have been covered by Jasa Raharja.
Jasa Raharja itself is the executor of the traffic accident insurance program by providing insurance benefits to victims of multiple accidents of up to 20 million rupiah. If health services for accident victims are still under 20 million rupiah, Jasa Raharja will bear the full costs. However, if it is more than that, BPJS Kesehatan will bear the difference less than the Jasa Raharja ceiling limit.
3. Multiple accidents of public transport passengers
Jasa Raharja has also covered multiple accidents for passengers on public transportation so that BPJS Kesehatan does not cover this type of accident.
4. Work Accident
Referring to the Service Handbook for Participants of the National Health Insurance for Healthy Indonesia Cards (JKN-KIS), it is stated that BPJS Health does not guarantee health services for diseases or injuries resulting from work accidents or work relationships that have been guaranteed by the work accident insurance program or are the responsibility of the employer. .
The work accident insurance program is carried out by BPJS Employment, not BPJS Health. Therefore, work accidents are accidents that are not covered by BPJS Kesehatan.
Those are the four types of accidents that are not covered by BPJS Kesehatan. It should be remembered that apart from these four types of accidents, the JKN-KIS program can fund them. However, a certificate of accident is required for BPJS Health from the police to benefit from medical expenses.
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