Accidents That Are Not Borne BPJS Health: You Must Read!

BPJS Unmitigated Accident (Benzoix-Freepik Image)

YOGYAKARTA - Almost a variety of health problems have been borne by BPJS and even accidents. But there are, some accidents that are not borne by BPJS! Anything? Let's look at it until it's finished.

This is because the guarantor for JKN participants (National Health Insurance) who experience accidents has been regulated in the Finance Minister Regulation Number 141/PMK/02/2018 regarding coordination between guarantee organizers in providing health service benefits.

Assistant Deputy for Public Communication and Public Relations of BPJS Kesehatan, Rizzky Anugerah, said that there are various guarantor institutions that bear participants who have had accidents.

The guarantee is determined based on the alleged accident case up to the type of collateral membership that is owned.

"If it is suspected that including accidents, then traffic and participants are registered with the Health Insurance, PT Jasa Raharja will be the first guarantor to guarantee treatment, as well as BPJS Kesehatan as the second guarantor," he said, Saturday (18/5/2024).

Quoted from various sources, Friday (1/3/2024), there are 4 types of accidents that are not covered by BPJS Kesehatan.

Although President Joko Widodo has signed Presidential Regulation No. 59 of 2024 concerning Health Insurance, Rizzky emphasized that there are no changes in the record.

"There is no change with the issuance of Presidential Decree 59/2024," he said.

Then, what accidents are not borne by BPJS Kesehatan? Here's the list.

I. Work Accident

Participants who experience work accidents, the treatment is not borne by BPJS Kesehatan.

The work accident in question is that participants experienced a disaster during a work expedition. BPJS Kesehatan does not bear the type of accident because it has been borne by BPJS Ketenagakerjaan. Treatment is carried out through the BPJS Ketenagakerjaan Work Accident Security (JKK) program. However, there are only a few types of accidents that are borne, namely:

Accident on the way: an accident experienced by participants when leaving or returning to work.

Diseases due to work: protection for workers who are susceptible to certain diseases due to work, such as working in high-pollution places or high chemical liquids.

Kecelakaan di lokasi kerja: kecelakaan yang berlangsung di lapangan buat profesional berisiko tinggi, seperti di area perembangan minyak atau pembangunan bangunan bangunan berbelis.

II. Single Accident Due To Negligence

Participants' care is also not borne by BPJS Kesehatan if they experience a single accident due to negligence. Muttaqien stated that BPJS Kesehatan covered health costs in traffic accidents if the accident was single and not for the negligence of participants.

Accidents due to negligence are interpreted as because they consume drugs or liquor while driving a vehicle. On the other hand, BPJS Kesehatan does not bear the accident because participants drive vehicles at high speed to rob, commit violence, or sexuality.

The accident was caused by participants being involved in group disputes or wanting to end their lives categorized as BPJS Kesehatan as intentional.

III. Accident for Public Transportation Passengers

BPJS Kesehatan tidak mengangkut jenis kecelakaan buat penumpang transportasi umum.

The type of accident is not covered by BPJS Kesehatan because it has been borne by Jasa Raharja.

IV. Double Accident

Member of the National Social Security Council (DJSN) Muttaqien narrated, BPJS Kesehatan also did not bear the type of dual accident or accident that linked 2 motorists or more.

The type of accident will be borne by Jasa Raharja up to IDR 20,000,000.

BPJS will bear the care of participants who have had multiple accidents if health financing is still needed at the hospital.

Requirements For Accidents Borne BPJS Kesehatan

Rizzky explained that BPJS Kesehatan could bear the care of participants in its capacity as the second guarantor. However, participants are required to prepare several files, namely police reports and active JKN participating cards. Check out how to take care of accidents to be borne by BPJS Kesehatan:

The first thing that must be done is that the families of participants who are traffic accident victims can make a police report at the nearest police station based on complaints from the families of participants who are suspected of having a traffic accident and/or work accident.

A copy of the police report was brought by the participant's family to the health facility to attach it to the claim document. In the near future BPJS Kesehatan will carry out a bridging information system with the Integrated Road Safety Management System (IRSMS) application belonging to the Korlantas Polri so that copies of the police report can be obtained online.

Later, the health facility will coordinate with field officers PT Jasa Raharja and BPJS Kesehatan according to the requirements, based on the police report.

PT Jasa Raharja and BPJS Kesehatan will continue the process of verifying claims according to applicable conditions after the issuance of a police report from the Police.

In addition, for more complete refrension, you can read: Categories of Health Services and Types of Diseases that are not Borne BPJS.

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