Presidential Regulation Number 19 Year 2016

Original Language Title: Peraturan Presiden Nomor 19 Tahun 2016

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Back COUNTRY SHEET REPUBLIC of INDONESIA No. 42, 2016 KESRA. Social. Health Coverage. Implementation of REGULATORY changes.. The PRESIDENT of the REPUBLIC of INDONESIA number 19 YEAR 2016 ABOUT SECOND AMENDMENT OVER the PRESIDENTIAL REGULATION No. 12 2013 of HEALTH COVERAGE with the GRACE of GOD ALMIGHTY the PRESIDENT of the Republic of INDONESIA, Considering: a. that some provisions in the regulations of the President no. 12 2013 of health coverage as amended by regulation of the President Number 111 2013 about changes to the presidential Regulation No. 12 2013 of health coverage need to be tailored to the needs of the Organization of the national health coverage;
b. that based on considerations as referred to in letter a, the need to establish the presidential regulation on changes in Both top presidential Regulation No. 12 2013 of health coverage;

Remember: 1. Article 4 paragraph (1) of the Constitution of the Republic of Indonesia in 1945;
2. Act No. 40 of 2004 on National Social Security Systems (State Gazette of the Republic of Indonesia Number 150 in 2004, an additional Sheet of the Republic of Indonesia Number 4456);
3. Law Number 24 year 2011 about social security governing body (State Gazette of the Republic of Indonesia Number 116 in 2011, an additional Sheet of the Republic of Indonesia Number 5256);
4. Presidential Regulation No. 12 2013 of health coverage (State Gazette of the Republic of Indonesia by 2013 the number 29) as amended by regulation of the President Number 111 2013 about changes to the presidential Regulation No. 12 2013 of health coverage (State Gazette of the Republic of Indonesia by 2013 the number 255);
Decide: define: PRESIDENTIAL REGULATION on CHANGES in BOTH TOP PRESIDENTIAL REGULATION No. 12 2013 ABOUT health coverage.
Article I some provisions in the regulations of the President no. 12 2013 of health coverage (State Gazette of the Republic of Indonesia by 2013 the number 29) as amended by regulation of the President Number 111 2013 about changes to the presidential Regulation No. 12 2013 of health coverage (State Gazette of the Republic of Indonesia by 2013 the number 255), amended as follows: 1. In between number 2 and number 3 of article 1 was inserted one (1) number Figure 14a, i.e., so that article 1 reads as follows: article 1 in regulation this President is: 1. Health coverage is a guarantee in the form of health protection in order for participants to benefit health care and protection in the meet the needs of basic health care that is given to any person who has paid dues or contributions paid by the Government.

2. the governing body of the health social security hereinafter abbreviated BPJS health is a legal entity formed to organise Health assurance program.

3. Recipient defined contribution health coverage hereinafter called PBI health coverage is poor and people cannot afford health coverage program as participants.

4. the participant is any person, including aliens who worked the shortest 6 (six) months in Indonesia, which has paid your dues.

5. Benefits are avail social security rights of participants and/or members of his family.

6. A worker is any person who works with receive a salary, wage, or remuneration in other forms.

7. Wage Workers are any persons who work on employer by receiving salary or wages.

8. Workers Not Wage is everyone working or trying to top his own risk.

9. the Employer is an individual person, a businessman, a legal entity or other entity that employs labor, or organizers of the State that employs civil servants by paying a salary, wage, or remuneration in other forms.

10. The salary or wages of the Workers rights is accepted and expressed in the form of money as a reward from the Employer to the worker and are paid according to a work agreement, agreement, or other regulations, including allowances for workers and their families for a job and/or services that has been or will be carried out.

11. Termination of the working relationship which further shortened LAYOFF is the termination of the working relationship due to a specific thing that results in the termination of the rights and obligations between workers/labour and Employer based on the provisions of the legislation.

12. Permanent Total Disability is a disability that results in the inability of a person to do the job.

13. Contribution health coverage is the amount of money that is paid regularly by participant, Employer and/or Government programs for health coverage.

14. Health facilities health care facilities are used to organize the efforts of individual health service, good promotif, preventive, curative, rehabilitative or undertaken by the Government, local governments, and/or the community.

14A. Deception (Fraud) in the implementation of national health Assurance Program on National Social Security Systems hereinafter called Deception (Fraud) is the action that was done on purpose, to get financial gain from national health assurance program in National Social Security Systems through the fraudulent deeds that do not comply with the provisions.

15. State officials is the leadership and members of State institutions as stipulated in the Constitution of the Republic of Indonesia in 1945 and State officials specified by law.

16. Government employees Non public servants are employees not fixed, Honorary officers, a special staff, and other employees who are paid by the State Budget revenues and Expenditures or budget revenues and Shopping area.

17. Member of the Indonesia national army which is hereinafter referred to as member of the TNI personnel/Warrior is a tool of the State in the field of defence are doing their job in matra under the command of the Chief of staff of the combined forces, or under the direction of the Commander of the TNI.

18. Members of the State police of the Republic of Indonesia which is hereinafter referred to as members of the national police is a civil servant in the State police of the Republic of Indonesia that carries out the functions of the police.

19. A Veteran is a Veteran of the Republic of Indonesia as stipulated in Act No. 15-year Veteran of the Republic of Indonesia about 2012.

20. Pioneer of Independence was a pioneer of Independence referred to in Act No. 5 Prps in 1964 about the Award/Alimony to Pioneer the movement National/independence.

21. The Central Government that the Government is hereinafter referred to as the President of the Republic of Indonesia that holds the powers of the Government of the Republic of Indonesia as stipulated in the Constitution of the Republic of Indonesia in 1945.

22. Local Government is the Governor, Governor, or mayor, and other areas as the organizer of local governance.

23. The Minister is the Minister who organized a Government Affairs in the field of health.

2. The provisions of paragraph (2) of article 4 amended so that article 4 reads as follows: article 4 (1) Participants are not the PBI health coverage as stipulated in article 2 letter b is a Participant that does not belong to the poor and the people are not capable of: a. Wage Workers and their family members;

b. Workers rather than Wage and their family members; and c. not Workers and their family members.

(2) Wage workers as referred to in paragraph (1) letter a consists of: a. the civil servant;

b. TNI members;

c. members of the national police;

d. State officials;

e. the Chairman and a member of the Regional House of representatives;

f. Government employees non public servants;

g. private sector employees; and h. the Workers not included in the letter a to letter g who receive wages.

(3) Workers Not Wage as stipulated in paragraph (1) letter b consists of: a. a worker outside the working relationship or self-employed; and b. the Workers not included in the letter a that is not a wage.

(4) Not the Workers referred to in paragraph (2) Letter c consists of: a. investors;

b. the Employer;

c. the recipients;

d. a Veteran;

e. pioneer of Independence;

f. widow, widower, or orphans of Veterans or the pioneer Independence; and g. instead of workers who are not included in letters a to e with the letters that are able to pay your dues.

(5) The recipient of a pension referred to in subsection (4) the letter c consists of: a. the civil servant who quit with pension rights;

b. members of the Indonesian armed forces and members of the national police who stopped the pension rights;

c. State officials who quit with pension rights;

d. the widow, widower, or children orphaned from the recipient of a pension referred to in letter a, letter b, letter c, and who got the rights to a pension;

e. pension recipients other than referred to in letter a, letter b, and the letter c; and f. widow, widower, or children orphaned from the recipient of a pension referred to in letter e that got the right of retirement.

(6) The worker referred to in subsection (1) letter a and letter b including foreigners working in Indonesia the shortest 6 (six) months.

(7) Health coverage for workers that Indonesia citizen working abroad are governed by the provisions of its own legislation.

3. The provisions of paragraph (1) of article 5 amended so that article 5 reads as follows: article 5 (1) Wage Workers and members of their families referred to in article 4 paragraph (1) letter a include a Wage Worker, wife/husband, children, stepchildren of a legitimate marriage, and adopted son, at most 5 (five) persons.

(2) Children, stepchildren of a legitimate marriage, and adopted children are legitimate as referred to in paragraph (1), the criteria: 1. not or have never been married or had no income of her own; and


2. hasn't aged 21 (twenty one) years old or have not been aged 25 (twenty-five) years who still continue their formal education.

(3) Participants not PBI health coverage can include other family members.

(4) Other family members referred to in subsection (3) includes a child to four (4) and so on, fathers, mothers, and in-laws.

4. The provisions of article 11 is amended to read as follows: article 11 (1) Employer as dimaksuid in article 6 paragraph (3) and subsection (4) is required to register himself and his workers as participants health coverage to Health by paying dues BPJS.

(2) In the event the Employer significantly real-not Health Workers to register the BPJS, workers concerned shall have the right to register himself as a participant in health coverage.

(3) Registration by the worker referred to in subsection (2) is done by attaching a document proving the status of employment practices.

(4) Workers who registered himself as a participant in health coverage referred to in subsection (2), the contributions are paid in accordance with the provisions of this Regulation of the President.

(5) In the event that the worker has not been registered on the BPJS health, an employer is obligated to take responsibility at a time when Workers need health services in accordance with the benefits provided by the BPJS health.

(6) Employer in addition to the organizers of the country in violation of the provisions referred to in subsection (5) are the administrative sanction in the form of: a. a written reprimand;

b. a fine; and/or c. got no specific public services.

(7) The imposition of an administrative sanction procedures as referred to in paragraph (6) was carried out in accordance with the provisions of the legislation.

(8) Every worker is not a Wage as stipulated in article 6 paragraph (2) Letter c is obligated to register himself and the members of his family are singly or in groups as participants health coverage on the BPJS Health by paying dues.

(9) Everyone is not a Worker referred to in article 6 paragraph (2) Letter c is obligated to register himself and the members of his family are singly or in groups as participants health coverage to Health by paying dues BPJS.

5. The provisions of subsection (2) amended article 12, and between paragraph (2) and paragraph (3) is inserted 1 (one) verse, namely paragraph (2a) so the article 12 reads as follows: article 12 (1) each person who has been registered on the BPJS Health reserves the right to obtain the identity of the participants.

(2) The identity of the Participants referred to in subsection (1) in the form of Cards Healthy Indonesia which at least contains the names and identification numbers of participants are integrated with the Population identification numbers (NIK), except for new-born babies of mothers registered as PBI.

(2a) Healthy Indonesia card as referred to in paragraph (2) provided to Participants gradually.

(3) Identity number of the participants referred to in subsection (2) is the sole identification numbers that apply to all social security programs.

6. The provisions of paragraph (3) of article 4 amended so that article 16 reads as follows: article 16 (1) Dues health coverage for participants PBI health coverage is paid by the Government.

(1a) Defined contribution health coverage for the population that is registered by the local governments paid for by local governments.

(2) Defined contribution health coverage for Workers Wage paid by the Employer and workers.

(3) Defined contribution health coverage for Workers is not the recipient of the wages and Workers not paid by the Entrant participant or any other party on behalf of the participants.

(3a) The provisions referred to in subsection (3) does not apply to: a. the recipients referred to in article 4 paragraph (2) letter a up to d; and b. veterans and Independence Pioneers.

(4) Deleted.

7. The provisions of article 16A is amended to read as follows: article 16A (1) defined contribution health coverage for participants as well as population Health Guarantee PBI are registered by the local authorities of Rp RP 23,000 (twenty three thousand rupiah) per person per month.

(2) Terms of quantity defined contribution health coverage referred to in subsection (1) comes into force on January 1, 2016.

8. The provisions of subsection (1) and paragraph (3) subparagraph b of article 16B amended so that Article 16B reads as follows: article 16B (1) Tuition for Healthcare Workers Wage of civil servants, members of the INDONESIAN ARMED FORCES, members of the national police, State officials, and members of PARLIAMENT, as well as government employees Non public servants a 5% (five percent) of salary or Wages per month.

(2) Contribution referred to in subsection (1) and paragraph (2) is paid with the following conditions: a. 3% (three percent) paid by the Employer; and b. 2% (two percent) is paid by participants.

(3) Obligations of the Employer in paying dues as referred to in paragraph (2) letter a, implemented by: a. the Government Contribution to health coverage for Central civil servants, members of the INDONESIAN ARMED FORCES, members of the national police, State officials, and Government employees Non public servants Center; and b. local authorities to Levy health coverage for the regional head and Deputy Head of the region, the President and members of PARLIAMENT, civil servants and Government employees, Area of Non public servants area.

9. The provisions of article 16 d is amended to read as follows: article 16 d Limit the highest Salary or Wages per month which is used as the basis for the calculation of the magnitude of Dues health coverage for Workers Wage as stipulated in article 16 c of the non government employees and civil servants as stipulated in article 16B subsection (1) Rp RP 8.000.000 (eight million dollars).

10. The provisions of article 16F is amended to read as follows: article 16F (1) defined contribution health coverage for Workers is not the recipient of the wages and the participants not Workers: a. Rp 30.000,00 (thirty thousand rupiah) per person per month with the benefits of the services in Class III treatment rooms.

b. Rp RP 51.000 (fifty-one thousand rupiah) per person per month with the benefits of the services in class II treatment rooms.

c. Rp 80,000.00 (eighty thousand rupiah) per person per month with the benefits of service in a maintenance room class I.

(2) Terms of quantity defined contribution health coverage referred to in subsection (1) comes into force on April 1, 2016.

11. The provisions of article 16 h added one paragraph, namely, subsection (4), so the Article 16 h reads as follows: article 16 h (1) defined contribution health coverage for other family members are paid by the participants.

(2) A quantity defined contribution health coverage for the rest of the family as referred to in paragraph (1) set of 1% (one percent) of the salary or wages of Participants Workers Wage per person per month.

(3) A quantity defined contribution health coverage for other family members referred to in subsection (1) for participants of workers instead of Wage and Worker Participants not set according to selected Benefits refer to the provisions as referred to in article 16F.

(4) Payment of Dues health coverage for the rest of the family as referred to in paragraph (2) beginning with the granting of a power of Attorney from the worker to the Employer to do additional Dues deductions health coverage and deposit to the BPJS health.

12. The provisions of paragraph (3) and subsection (4) amended article 17 the provisions of subsection (5) and paragraph (6) is deleted, so that article 17 reads as follows: article 17 (1) an employer is obligated to charge dues of Workers, pay dues which becomes his responsibility, and deposit the dues to the BPJS Health no later than the 10th of each month.

(2) For the local government Employer, the remittance of dues to the BPJS Health referred to in subsection (1) is carried out through the State Treasury's account no later than the 10th of each month.

(3) In the event of the 10th as referred to in paragraph (1) falls on a holiday then the dues payable on the next working day.

(4) The provisions concerning the forwarding of the local government Employer contribution from the account of the State Treasury to the BPJS Health arranged with regulation of the Minister of finance.

(5) Deleted.

(6) Deleted.

(7) Further provisions concerning the procedures for the payment of Dues for Healthcare Workers Wage is regulated by regulation BPJS Health after coordinating with ministries/related agencies.

13. The provisions of paragraph (1) of article 17A is amended, the provisions of subsection (3) and paragraph (4) was deleted, so the Article 17A reads as follows: article 17A (1) participants are Not Wage Workers and participants are not the Workers referred to in Article 16F is obligated to pay dues to the BPJS Health health coverage no later than the 10th of each month.

(2) Dues can be paid health coverage for more than 1 (one) month is done at the beginning.

(3) Deleted.

(4) Deleted.

(5) BPJS health must develop a mechanism for the withdrawal of the dues that are effective and efficient for participants Not Wage Workers and participants is not a Worker referred to in subsection (1).

(6) Further provisions concerning the procedures for the payment of Dues health coverage for Workers is not a Wage Worker and participant is not governed by regulation BPJS Health after coordinating with ministries/related agencies.

14. Between Article 17A and article 17B is inserted 1 (one) article, namely Article 17A. 1 to read as follows: article 17A. 1 (1) in the event of a delay in payment of the Dues health coverage more than 1 (one) month from the date of 10 as stipulated in article 5 clause (1) and paragraph (2) and in article 17A, paragraph (1) guarantee Participants laid off temporarily.

(2) Participants guarantee suspension as referred to in paragraph (1) terminates active membership status and back when Participants: a. pay dues months delinquent at most for 12 (twelve) months; and b.b. pay dues on the month when the participants want to end suspension bail.


(3) Within 45 (forty five) days from the active membership status back as referred to in paragraph (2), a participant referred to in subsection (1) is obliged to pay a fine to the BPJS Health for each inpatient health services acquired.

(4) The fines referred to in subsection (3) of 2.5% (two comma five per cent) of the cost of health care for delinquent each month with provisions: a. number of months delinquent at most 12 (twelve) months; and b. the highest fines big Rp RP 30,000,000 (thirty million dollars).

(5) Wage Workers for participants, payment of dues as referred to in paragraph (2) and fines referred to in subsection (3) are borne by the Employer.

(6) The terms of payment of the levy referred to in subsection (2) and fines referred to in subsection (3) excluded for participants who are not capable as evidenced by the certificate of the authorized agencies.

(7) Suspension provisions guaranteeing participants and the imposition of a penalty referred to in subsection (1) until subsection (7) comes into force on July 1, 2016.

(8) Further provisions regarding the payment of the levy referred to in subsection (2) and a fine referred to in paragraph (3) subject to the regulations of the BPJS health.

3. The provisions of paragraph (1) letter b, paragraph (3), subsection (4), and subsection (5) of article 21 amended and between paragraphs (4) and paragraph (5) is inserted 1 (one) verse, namely subsection (4a), so the Article 21 reads as follows: article 21 (1) promotif services and preventive Benefits include the granting of services: a. individual health counselling;

b. routine immunization;

c. family planning; and d. the health screening.

(2) (Individual health Counselling referred to in subsection (1) letter a covering at least guidance regarding management of disease risk factors and behaviors to live clean and healthy.

(3) Routine immunization Services (as referred to in paragraph (1) letter b include the granting of this type of routine immunizations in accordance with the provisions of the legislation.

(4) (Family planning services as referred to in paragraph (2) Letter c include counseling, contraceptive services including vasectomy and tubektomi, working in conjunction with the national population and family planning.

(4a) Provisions on the fulfilment of the needs of contraceptive drugs and tools for Healthcare participants in the health facility governed by regulation the head of the Agency's National population and family planning.

(5) Vaccines for routine immunization as well as contraceptive drugs and instruments referred to in paragraph (3) and paragraph (4) provided by the Government and/or regional Governments in accordance with the provisions of the legislation.

(6) Health screening service referred to in subsection (1) the letter d is granted selectively aimed at detecting the risk of disease and prevent further impact from the risk of certain diseases.

(7) Provisions on the procedures for the granting of sickness health screening services, and health screening service time as referred to in paragraph (6) subject to the regulations of the Minister.

16. The provisions of article 22 is modified to read as follows: article 22 (1) guaranteed health services consists of: a. first-level health services, including health services, including specialised non which includes: 1. administrative services;

2. promotif and preventive services;

3. inspection, treatment, and medical consultation;

4. actions, including specialised medical, both operative and non operative;

5. service of medicines and medical consumables materials;

6. examination of laboratory diagnostic support level pratama; 7. the first level of inpatient care in accordance with medical indications.

b. health service reference advanced level, including health services which include: 1. administrative services;

2. the examination, treatment, and medical consultation basis;

3. inspection, treatment, and consultation, including specialised;

4. actions, including specialised medical, surgical or non surgical either in accordance with medical indications;

5. service of medicines and medical consumables materials;

6. advanced diagnostic support services in accordance with medical indications;

7. medical rehabilitation;

8pelayanan blood;

9pelayanan forensic medicine clinic;

10pelayanan bodies in patients died at health facilities;

11pelayanan family planning;

When 12perawatan the non-intensive; and when 13perawatan in the intensive room.

(2) Health service referred to in subsection (1) letter b figure 2 applies only to health care in the emergency unit.

(3) Health service referred to in subsection (1) letter b Figure 11, not including the family planning services that have been funded by the Government.

(4) In terms of required, in addition to health services as referred to in paragraph (1) a participant is also entitled to a service in the form of health equipment.

(5) Health equipment as referred to in paragraph (4) including wellness tools.

17. Between section 22 and section 23 pasted one article, namely Article 22A to read as follows: article 22A the Minister may establish other health services guaranteed health technology assessment based on (health technology assessment) taking into account the adequacy of dues after coordinating with the Minister who organized a government financial affairs.

18. The provisions of the letter b and the letter c of article 23 is amended so that Section 23 reads as follows: article 23 accommodation Benefits as stipulated in article 20 paragraph (5) in the form of inpatient services as follows: a. class III treatment rooms for: 1. the participants of the PBI health coverage as well as a population that is registered by the local authorities; 2. participants of the workers and not the recipient of the wages and the participants not workers who pay dues to the benefits of the services in class III treatment rooms.

b. class II treatment rooms for: 1. Civil servants and retired civil servant the spaces I and the II room with members of his family;

2. the members of the Indonesian armed forces and the recipient of the retiring Members of the INDONESIAN civil servants equivalent to the space I and the II room with members of his family;

3. Members of the national police and the national police Members recipients of equal civil servant of Group I and group spaces spaces II along with members of his family;

4. Participants other than Wage Workers figure 1 to figure 3 Non Government employees and civil servants with Salary or Wages up to an additional Rp 2,000 (four million dollars); 5. the participant and Not Wage Workers and participants are not workers who pay dues to the benefits service at class II treatment rooms.

c. maintenance room class I for: 1. State officials and their family members;

2. the Chairman and members of the DPRD, along with members of his family;

3. Civil servants and retired civil servant of Group III and the room space IV along with members of his family;

4. the members of the Indonesian armed forces and the recipient of the retiring Members of the INDONESIAN civil servants are equivalent classes of spaces III and IV space along with the members of his family;

5. Members of the national police and the national police Members recipients of equal civil servant of Group III and the room space IV along with members of his family;

6. Veterans and Independence Pioneers along with their family members;

7. a widow, widower, or orphans of Veterans or the pioneer Independence;

8. Participants other than Wage Workers number 1 to number 5 Non Government employees and civil servants with Salary or wages of an additional Rp 2,000 (four million dollars) to Rp RP 8.000.000 (eight million dollars); 9. participants of the workers and not the recipient of the wages and the participants not workers who pay dues to the benefit of service in a maintenance room class I.

19. The provisions of article 24 is amended to read as follows: article 24 (1) Participants who want a higher class of debt can follow additional health insurance.

(2) The difference between the cost of that is guaranteed by the BPJS Health and costs over a higher class of debt can be paid by: a. the participant concerned;

b. the Employer; or c. an extra health insurance.

(3) The provisions referred to in paragraph (1) excluded for: URa.PBI health coverage; and b. the Participant registered by the local authorities as referred to in article 6A.

(4) The difference in payments by the Employer as referred to in paragraph (2) letter b does not include for participants who are registered by the local authorities.

20. The provision of article 25 is amended to read as follows: article 25 (1) are not guaranteed health services include the following: a. medical services which are carried out without going through the procedures stipulated in the regulations;

b. health services conducted at health facilities that do not cooperate with the BPJS health care, except in emergencies;

c. health services guaranteed by a work accident assurance program against diseases or injuries due to accidents or working relationship;

d. health services guaranteed by the traffic accident assurance program that is compulsory up to the value of the guarantee program covered by a traffic accident;

e. health services performed abroad;

f. health service for the purpose of aesthetic;

g. the Ministry to overcome infertility;

h. service of leveling gear (ortodonsi);

i. health disorders/diseases caused by drug addiction and/or alcoholism;

j. health disorders due to intentionally hurt yourself, or due to do hobbies that endanger yourself;

k. treatment of complementary, alternative and traditional, that has not been stated effective based on health technology assessment (health technology assessment);

b. treatment and medical actions are categorized as experimental (experimental);

d. drug and contraceptive tools, cosmetics, baby food, and milk;

n. health household supplies;

o. health services due to the disaster during emergency, extraordinary events/outbreaks;


p. health services at Genesis no expected preventable (preventable adverse events); and q. others which no relationship with Healthcare Benefits provided.

(2) Health problems due to intentionally hurt yourself, or due to do hobbies that endanger yourself as referred to in paragraph (1) Letter j, treatment and medical actions are categorized as experimental (experimental) as referred to in paragraph (1) the letter l, and unexpected events that can be prevented (preventable adverse events) as referred to in paragraph (1) letter p is assigned by the Minister.

21. The provision of article 27 is amended to read as follows: article 27 BPJS health and additional health insurance program organizers can do the coordination in providing Benefits to participants of the health coverage that has the right to protection of health insurance programs.

22. The provisions of article 27A is amended to read as follows: section 27A (1) BPJS Health do work closely with organizers of the social security program in the field of work accident and traffic accidents.

(2) Provisions on the procedures for cooperation as referred to in subsection (1) is subject to the agreement of cooperation between the Health program organiser BPJS and social security in the field of work accident and traffic accidents.

23. Article 27B were deleted.

24. Article 28 is deleted.

25. Between paragraph (2) and paragraph (3) of article 29 inserted three paragraphs, namely subsection (2a), (2b), and subsection (2 c), so that Article 29 reads as follows: article 29 (1) for the first time each participant registered by the BPJS Health at one first-level health facilities established by the BPJS Health after Health Department recommendations of kabupaten/kota.

(2) In the shortest period of 3 (three) months of the next Participant has the right to choose the first level health facilities.

(2a) For the sake of equity, BPJS Health can do the transfer of participants from a first-level health facilities to other first-level health facilities that are still in the same area.

(2b) Transfer of participants as mentioned in subsection (2a) is carried out taking into account the recommendations of the district/city health office after coordinating with Health Facilities, associations and professional organizations.

(2 c) In terms of participants moved as referred to in subsection (2a) an objection, then the participants can ask for is moved to the first level health facilities it wants.

(3) Participants must obtain health services at the first level health facilities place registered participants.

(4) In certain circumstances, a provision referred to in subsection (3) does not apply to participants who: a. are outside the territory of the first level health facilities place registered participants; or b. in the circumstances of medical kegawatdaruratan.

(5) In terms of Participants require advanced level health services, first rate medical facilities should refer to the health facility nearest advanced level reference in accordance with the reference system which is set out in the provisions of the legislation.

(6) Further provisions regarding health services first rate and health service reference advanced level set by regulation of the Minister.

26. The provisions of paragraph (3) of article 32 amended so that Article 32 reads as follows: article 32 (1) of the Ministry of health, medicine, medical materials and consumables for Healthcare Participants in the health facility based on the list and the price of drugs, health equipment, medical materials and consumables that are assigned by the Minister.

(2) Before the specified by the Minister, the list and price of drugs, health equipment, medical materials and consumables as referred to in paragraph (1) are arranged in a transparent and accountable by the National Committee.

(3) The National Committee as referred to in paragraph (2) is composed of elements of the Ministry of health, the food and drug Supervisory Agency, the National population and family planning, Health, BPJS association profession, College, and experts.

(4) A list of drugs, health equipment, medical consumables material referred to in subsection (1) the national and Formularium poured in the compendium of Health Tools.

27. Between Article 32 and article 33 pasted one article, namely Article 32A to read as follows: section 32A (1) the Government and the local government is responsible for the availability of the drug, health equipment, medical materials and consumables in organizing Health assurance program.

(2) Medicine, health, medical materials and consumables used in the health service which is a government program is provided by the Government and/or regional Governments in accordance with the provisions of the legislation.

28. In between paragraphs (4) and paragraph (5) of article 36 is inserted 1 (one) verse, namely subsection (4a), so the Article 36 reads as follows: article 36 (1) Health Service Providers include all health facilities are established close cooperation with the BPJS health.

(2) Government-owned health facilities and local government which meets the requirements of compulsory works closely with health BPJS

(3) Privately-owned health facilities who meet the requirements can be established close cooperation with the BPJS health.

(4) The cooperation referred to in paragraph (2) and paragraph (3) was implemented by making a written agreement.

(4a) In the framework of the implementation of cooperation with health facilities, Health BPJS coordinate with health service district/city.

(5) The requirements referred to in subsection (2) and paragraph (3) subject to the regulations of the Minister.

29. Among Article 36 and article 37 pasted one article, namely Article 36A to read as follows: section 36A (1) health facilities who work with Health cost prohibited BPJS medical services to participants during the course Participants benefit health services in accordance with its rights.

(2) In the event of the grant of the Ministry of emergency, good health facilities which cooperate or not cooperate with BPJS Health healthcare cost prohibited to participants.

(3) The cost of medical services as referred to in paragraph (1) and paragraph (2) covered by the BPJS Health in accordance with the provisions of the legislation.

30. The provisions of article 38 is amended to read as follows: article 38 (1) compulsory health BPJS pay health facilities over the services provided to Participants at least: a. the 15th of every month for first-level health facilities that use pre-payment efforts based on kapitasi;

b. 15 (fifteen) working days since the document claims outside of kapitasi accepted for first-level health facilities and health facilities; and c. 15 (fifteen) working days since the document claims accepted for advanced level referral health facilities.

(2) BPJS Health obliged to pay indemnity to health facilities of 1% (one percent) of the amount to be paid for each 1 (one) month of delay.

(3) In terms of the 15 (fifteen) per month as referred to in paragraph (1) letter a fall on a holiday, payment is made on the next working day.

31. Between Article 38 and article 39 pasted one article, namely Article 38A to read as follows: article 38A (1) the filing of the document claim of financing health care by health facilities to the BPJS Health given a period of at least 2 (two) years since health services are completed in order.

(2) In that case the filing timeframe claims documents referred to in subsection (1) is exceeded, the claim cannot be filed again.

(3) Excluded from the provisions referred to in paragraph (1) and paragraph (2), a claim for health care financing with long treatments or cannot be determined.

32. Between paragraph (1) and paragraph (2) of article 39 are inserted one (1) subsection i.e. subsection (1a), subsection (4) amended and added one (1) subsection i.e., subsection (5), so that Article 39 reads as follows: article 39 (1) BPJS Health health facilities to make payment to the first level in pre-kapitasi based on efforts over the number of participants enrolled in the first-level health facilities.

(1a) In terms of first-level health facilities as referred to in paragraph (1) is a first-level health facilities to the Central Government, payment mechanisms, including the use and was, following the provisions of the legislation in the field of finances of the State.

(2) In terms of first-level health facilities in an area does not allow payment based on kapitasi as referred to in paragraph (1), the health authority given BPJS to make payments with other more successful mechanism of action.

(3) BPJS Health health facilities to make the payment reference is an advanced level based on how the Indonesian Case Based Groups (INA-CBG ’ s).

(4) Quantity kapitasi and non-kapitasi as well as the Indonesian Case Based Groups (INA-CBG ’ s) and non Indonesian Case Based Groups (non INA-CBG ’ s) reviewed at least every two years by the Minister.

(5) The Minister in the review of quantity kapitasi and non-kapitasi as well as the Indonesian Case Based Groups (INA-CBG ’ s) and non Indonesian Case Based Groups (non INA-CBG ’ s) referred to in subsection (4) is carried out by taking into account the adequacy and sustainability of program dues up to 2 (two) years performed together with Health, BPJS DJSN, and Minister of Government Affairs which hosts in finance.

33. Between Article 39 and article 40 pasted one article, namely Article 39A to read as follows: article 39A


(1) For the purposes of the payment of the cost of health care, Health BPJS may request medical record medical record summary form participants to health facilities in accordance with the provisions of the legislation.

(2) Summary of the medical record referred to in subsection (1) at least contains the identity of the patient, diagnosis, treatment and inspection history and the invoiced costs.

34. The provisions of paragraph (4) of article 40 is deleted, so that article 40 reads as follows: article 40 (1) Emergency Services conducted by healthcare facilities that do not have a partnership with Health BPJS paid in reimbursement costs.

(2) A fee as referred to in paragraph (1) be charged directly by the health facility to the BPJS health.

(3) BPJS Health giving payments to health facilities as referred to in paragraph (2) is equivalent to the rates in force in the region.

(4) Deleted.

(5) Further provisions concerning the assessment of the kegawatdaruratan and replacement procedures emergency service charge is set by regulation BPJS health.

35. The provision of article 43A is amended to read as follows: article 43A (1) develop technical Health BPJS operasionalisasi healthcare systems, systems of quality control services, and health care payment system to improve efficiency and effectiveness.

(2) The development referred to in subsection (1) is carried out in the framework of the Organization of the health coverage program.

(3) In carrying out the development referred to in subsection (1), coordinating with ministries of health of the BPJS/related agencies.

36. The provisions of paragraph (2) of article 45 amended so that Article 45 reads as follows: article 45 (1) in the event that a participant is not satisfied against the Healthcare services provided by health facilities who work with Health, BPJS participants can convey the complaint to a Health Facility and/or Health BPJS.

(2) In terms of participants and/or health facilities do not get good service from the BPJS health, can deliver the complaint to the head of the health service district/city, head of the provincial health Office, and/or the Minister.

(3) The submission of a complaint referred to in subsection (1) and paragraph (2) should gain handling and solving adequately and in a short time and given feedback to deliver.

(4) The submission of a complaint as referred to in paragraph (3) was carried out in accordance with the provisions of the legislation.

37. Between paragraph (1) and paragraph (2) of article 46 inserted 1 (one) verse, namely paragraph (1a), the provisions of paragraph (3) are amended so that Section 46 reads as follows: article 46 (1) Dispute between: a. participants with healthcare facilities;

b. participants with BPJS Health;

c. the BPJS health facilities; or d. the BPJS Health with Health Facilities Association, completed by way of a discussion by the parties to the dispute.

(1a) Dispute resolution conversationally referred to in subsection (1) involves the head of the Provincial Health Office, head of Department of health district/city, and/or Supervisory hospitals.

(2) In the event the dispute cannot be solved conversationally, disputes are resolved by way of mediation or through the courts.

(3) Resolution of disputes by way of mediation or through the Court referred to in subsection (2) is conducted in accordance with the provisions of the legislation.

38. Among the XI CHAPTER and chapter XII inserted three chapters, namely CHAPTER XIA, XIB, CHAPTER and chapter XIC, and of Article 46 and article 47 was inserted four (4) article, namely Article 46A, article 46B, article 46C, and article 46D to read as follows: Chapter XIA PREVENTION of FRAUD (FRAUD) in the IMPLEMENTATION of HEALTH ASSURANCE PROGRAM Article 46A (1) BPJS Health , district/city health Office, and the advanced level reference health facility that works closely with the Health System should build BPJS prevention of Fraud (Fraud) in the implementation of the program of health coverage.

(2) Deception (Fraud) in the implementation of the health security program can be done by participants, officers of the BPJS health, health care givers, as well as a provider of drug and health equipment.

(3) The system of prevention of Fraud (Fraud) as referred to in paragraph (1) is carried out through: a. the preparation of policies and guidelines on the prevention of Fraud (Fraud);

b. development of a culture of prevention of Fraud (Fraud);

c. health services development oriented to quality control and cost control; and d. the establishment of teams of the prevention of Fraud (Fraud).

(4) The system of prevention of Fraud (Fraud) as referred to in paragraph (2) be done systemically, structured, and comprehensive by engaging the entire human resources in Health, BPJS health facility, district/city health Office, and other stakeholders.

(5) Further provisions concerning the system of prevention of Fraud (Fraud) is controlled by a regulation of the Minister.
CHAPTER XIB SUPERVISION Article 46B (1) the Minister, head of the provincial health Office, and head of Department of health district/city to conduct surveillance against Providence Health assurance program in accordance with their respective authority.

(2) Implementation of the supervision referred to in subsection (1) may involve Supervisory hospitals, Hospital Board of Trustees, the society/Association perumahsakitan, and/or professional organizations in accordance with their needs.

(3) Implementation of the supervision referred to in subsection (1) is carried out coordinated with relevant agencies in accordance with the provisions of the legislation.
Article 46C Superintendent Employment at institutions responsible in the field of employment can perform checks against an employer who violates the provisions referred to in article 6 paragraph (3) which is carried out in accordance with the provisions of the legislation.
TRANSITIONAL PROVISIONS Article XIC CHAPTER 46D Card membership which had been owned by the Participant before this presidential Regulation enacted, stated remains valid throughout has not been replaced with Healthy Indonesia in accordance with the Card in this presidential Regulation.
Article II this presidential regulation comes into force on the date of promulgation.

In order to make everyone aware of it, ordered the enactment of regulations this President with its placement in the State Gazette of the Republic of Indonesia.

Established in Jakarta on 29 February 2016 PRESIDENT Republic of INDONESIA, ttd JOKO WIDODO Enacted in Jakarta on March 1st, 1999 the MINISTER of LAW and HUMAN RIGHTS Republic of INDONESIA, ttd YASONNA h. LAOLY fnFooter ();

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