For many foreigners living in Indonesia, the question of accessing affordable healthcare often arises. The good news? Those who have resided in the country for at least six months are eligible to join BPJS Kesehatan — Indonesia’s national health insurance scheme. But before you rush to register, there’s something important to know: not all surgeries are covered.
Under Indonesian Law No. 24 of 2011, foreign nationals who stay in Indonesia for at least half a year — typically for work — can enroll in the JKN (National Health Insurance) program. This provides them with the same healthcare protection as Indonesian citizens. Yet, both locals and expats must be aware that BPJS Kesehatan only covers specific surgical procedures.
To get coverage for surgery through BPJS, a few steps must be followed. Patients must first visit a primary-level healthcare facility — such as a puskesmas (community clinic) or an approved private clinic — to get a diagnosis. If surgery is deemed necessary, the facility will issue a referral letter. With this referral, patients are directed to a hospital where the doctor schedules the surgery.
Besides the referral, there are three required documents to ensure BPJS will cover the procedure: the BPJS Kesehatan card or Indonesia Health Card (KIS), the referral from a first-level health provider, and a patient card issued by the hospital.
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Still, not every type of surgery is eligible for BPJS coverage. There are several categories that are explicitly excluded, including procedures that might surprise some.
Among surgeries not covered by BPJS Kesehatan are:
- Operations due to accidents or injuries from external trauma
- Cosmetic or aesthetic surgeries that are non-essential for health
- Procedures needed after self-inflicted injuries or negligence
- Surgeries performed abroad, outside BPJS jurisdiction
- Surgeries that bypass official BPJS procedures or referrals
Despite these exclusions, there is a wide range of procedures that are covered. The Ministry of Health Regulation (Permenkes) No. 28 of 2014 outlines 19 surgeries that are fully eligible under the BPJS scheme.
These include:
- Heart surgery
- Cesarean section
- Cyst removal
- Myoma (fibroid) removal
- Tumor surgery
- Odontectomy (tooth extraction surgery)
- Oral surgery
- Appendectomy (appendix removal)
- Gallstone removal
- Eye surgery
- Vascular surgery
- Tonsillectomy
- Cataract surgery
- Hernia repair
- Cancer-related surgeries
- Lymph node surgery
- Removal of orthopedic implants (pen removal)
- Knee joint replacement
- Thymectomy (removal of the thymus gland)
This balance between inclusions and exclusions is designed to prioritize health needs while maintaining sustainable insurance operations. So while BPJS Kesehatan opens the door to essential healthcare for foreigners in Indonesia, understanding the fine print is key.
With the proper documents and procedures, expats and locals alike can access a range of life-saving surgeries under this national program — as long as they stay within the system’s rules.
