These Are The Rules And Types Of Accidents Guaranteed By BPJS Kesehatan

BPJS Health Service. (Doc: BPJS Kesehatan)

JAKARTA BPJS Kesehatan emphasized that not all traffic accidents are automatically guaranteed by the National Health Insurance (JKN) program. Determination of the guarantor of the cost of treating victims depends on the type of accident and applicable regulations.

Based on Presidential Regulation Number 59 of 2024 Article 52, BPJS Kesehatan does not bear the traffic accidents that occur when traveling from house to place of work or vice versa.

The case is categorized as a work accident and is the responsibility of the agency or guarantor agency for work accidents such as BP Jamsostek, Taspen, ASABRI, or employers.

"BPJS Kesehatan bears the cost of health services for active JKN participants who have single traffic accidents, meaning that they do not involve other vehicles," said Head of Public Relations of BPJS Kesehatan, Rizzky Anugerah in a written statement, Saturday, August 9.

Rizzky added that accidents involving other vehicles (dual accidents) are the responsibility of Jasa Raharja based on the police report, with a maximum cost limit of Rp. 20 million. If the maintenance costs exceed this limit, the guarantee will be continued by BPJS Kesehatan or other agencies in accordance with applicable regulations.

"BPJS Kesehatan tidak menjamin kecelakaan tunggal yang disebabkan oleh tindakan yang membahayakan diri seperti balapan liar atau tindakan membahayakan diri lainnya," ucapnya.

Rizzky said, when someone has a traffic accident and is taken to a health facility to get help, the victim's family or guardian is advised to immediately take care of the police report.

Chronologically, the cause of traffic accidents, scene of events, and other related information, according to Rizzky, is important to decide which agency has the authority to guarantee victims of traffic accidents. "This police report is important to take care of immediately because it is the basis for guaranteeing traffic accident patients," he said.

Rizzky said that most people often think that the underwriters are only BPJS Kesehatan or Jasa Raharja. In fact, there are other agencies that also play a role, such as BPJS Ketenagakerjaan (BPJamsostek), PT Taspen (Persero), PT ASABRI (Persero), employers, and other guarantors.