pension; d.Veteran; e. Pioneer of Independence; f.widow, duda, or orphaned child of Veterans or Independence Pioneers; and g.not Workers which is not included in the letter a up to the letter e which is able to pay dues. (5) The retired recipient as referred to in paragraph (4) of the letter c consists of: a. A civil servant who stops with the right of retirement; b. Member of the Indonesian Armed Forces and members of the Polri who quit with the pension rights; c. State officials who cease with the right of retirement; d.widow, widowed, or orphaned child of a retired recipient as referred to in letters a, letter b, and letter c that gets a pension; e.recipients retire other than as referred to in letters a, letter b, and letter c; and f.widow, duda, or child Orphaned from a retired recipient as referred to in the letter e who got the pension rights. (6) Workers as referred to in paragraph (1) letter a and letter b including foreign nationals working in Indonesia at least 6 (six) months. (7) The Health Guarantee for the Workers of Indonesian citizens working abroad is governed by the provisions of its own laws.
3 The provisions of paragraph (1) Section 5 are amended, so that Article 5 reads as follows: Section 5 (1) of the person of the Upah Recipient and his family members as referred to in Article 4 of the paragraph (1) of the letter a includes the Workers of the Upah, the lawful istri/husband, the child. The birth, the stepson of the lawful marriage, and the legitimate adopted son, at most 5 (five) people. (2) The biological child, step-child of a lawful marriage, and a valid adopted son as referred to in verse (1), with the criterion: 1.neither or never married nor has his own income; and 2.not in the age of 21 (twenty-one) years or not 25 (twenty-five) years old that still continues to be a formal education. (3) Participants instead of PBI Health Guarantee can include other family members. (4) Other members of the family as referred to in verse (3) include children to 4 (four) and so on, father, mother, and in-laws.
4 The provisions of Section 11 are amended so that it reads as follows: Section 11 (1) Terms of Use in Section 6 of the paragraph (3) and paragraph (4) shall register itself and its Works as a Health Warranty Participant to the BPJS by paying dues. (2) In the event of a real Worklight does not register its Work to the BPJS Health, the worker in question is entitled to register itself as a Health Guarantee Participant. (3) The Registration by the Worker as referred to in paragraph (2) is done by attaching a document that proves its status of order. (4) The worker who lists himself as a Health Guarantee Participant as referred to in paragraph (2), its dues are paid according to the provisions in this Presidential Regulation. (5) In terms of the Workers not listed on BPJS Healthcare, the Compulsory Workforce is responsible at the time when its work requires health care according to the benefits provided by BPJS Health. (6) Work other than state organizer who violates the provisions as referred to in paragraph (5) is subject to administrative sanction: a.tereprimand written; b.denda; and/or c.does not receive a specific public service. (7) The order of the administrative sanction as referred to in paragraph (6) is exercised in accordance with the provisions of the laws. (8) Each worker is not an Upah Recipient as referred to in Article 6 of the paragraph (3) the letter c is required to register itself and its family members individually or in a group as Health Guarantee Participants at BPJS Health by paying Iuran. (9) Each person is not a worker as referred to in Article 6 of the paragraph (3) the letter c is required to register itself and its family members individually or in a group as Health Warranty Participant to the BPJS Health by paying dues.
5 The paragraph (2) of section 12 is changed, and between verses (2) and paragraph (3) is inserted 1 (one) paragraph, (2) the paragraph (2a) so that Article 12 reads as follows: Section 12 (1) Each Participant has been registered with the BPJS Health is entitled to the Participant ID. (2) The identity of the Participant as referred to in verse (1) of the least-contained Indonesian Card containing the name and identity number of the Participants integrated with the Occupation Identity Number (NIK), except for the newborn from the mother of the person who is the one who is the most important person in the country Registered as a PBI. (2a) The Indonesian card Sehat as referred to in verse (2) is given to the Participant gradually. (3) The participant's identity number as referred to in the paragraph (2) is the sole identity number that applies to all social security programs.
6.Terms of paragraph (3) Section 16 is amended, so Section 16 reads as follows: Section 16 (1) The Health Guarantee section for Health Guarantee PBI Participants is paid by the Government. (1a) The Health Guarantee for residents registered by the Local Government is paid for by the Local Government. (2) The Health Guarantee for the Upah Recipient Workers is paid by the Giver and Workers. (3) The Health Guarantee for the Workers ' Participants is not an Upah Recipient and the Participant is not paid by the Participant or any other party in the name of the Participant. (3a) The provisions referred to in paragraph (3) do not apply to: a.recipients are retired as referred to in Section 4 of the paragraph (5) of the letters a up to the letter d; and b. Veteran and the Provision of Independence. (4) Deleted.
The provisions of Section 16A are amended so that it reads as follows: Section 16A (1) The Health Guarantee for Health Guarantee PBI Participants as well as the residents registered by the Regional Government of Rp23,000.00 (twenty-three thousand rupiah) per people per month. (2) The provisions of the Warranty Quantity as referred to in paragraph (1) are effective on 1 January 2016.
The provisions of paragraph (1) and paragraph (3) of the letter b Section 16B are amended, so that Article 16B reads as follows: Article 16B (1) The Health Guarantee for an Upah Participant Who Consists Of A Civil Servant, A Member Of The Army, A Member Of The Police, State officials, leaders and members of the DPRD, as well as non-State Government employees of 5% (five percent) of Gaji or Upah per month. (2) The Iuran as referred to in paragraph (1) and paragraph (2) are paid with the following terms: a.3% (three percent) is paid by the Workforce; and b.2% (two percent) is paid by the Participant. (3) The Obligation Obligation in pay of dues as referred to in paragraph (2) letter a, executed by: a. Government for Warranty Health for the Central Civil Service, Member of the Indonesian Armed Forces, Member of Police, State Officials, and the Government Employee Non-Central Public Employees; and b. Local Government for Health Guarantee for regional heads and regional deputies, leaders and members of the DPRD, Regional Civil Servers, and Non-State Government Employees.
9.Terms of Section 16D amended so that it reads as follows: Section 16D The highest limit of Gaji or Wages per month are used as the basis of the calcus: Section 4 (1) Participant of the Health Guarantee as referred to in Article 2 of the letter b is an Participant that is not a poor facir and one cannot be able to It consists of: A, a worker of the Upah and a member of his family; b. the worker is not the recipient of the Upah and his family members; and the c.not Worker and his family members. (2) Licensee's (2) Licensee's use of the Cloud Service is subject to the terms of the following: g.private employees; and h. Workers that are not included in the letter a up to the letter g that received Upah. (3) The worker is not an Up-recipient as it is referred to in paragraph (1) the letter b consists of: a. a worker outside of a working relationship or an independent worker; and b. A worker who is not included in a letter that is not a recipient of the Upah. (4) Not the Worker as referred to in paragraph (1) the letter c consists of: a.investor; b. Workday; c.recipient of theonsumable; 6.examination of pretrial laboratory diagnostic support; and first-degree hospitalization in accordance with medical indications. b.advanced degree referral health services, covering health services covering: 1.administration of services; 2.examination, treatment, and basic medical consultancy; 3.examination, treatment, and specialistic consultations; 4.action medical specialistic, both surgical and non surgical according to medical indications; 5.services of drug and medical materials consumable; 6.ministry of advanced diagnostic support in accordance with medical indications; 7.rehabilitation of medical; 8service of blood; 9service of medical care Clinic forensics; 10services on patients who died at the facility. Health; 11service of family planning; 12nursing non-intensive care; and 13nursing in intensive care. (2) The health service as referred to in paragraph (1) the letter b 2 only applies to the health care service of the emergency unit. (3) The health ministry as referred to in verse (1) the letter b of the number 11, excluding the service of the Family Planning which has been financed by the government. (4) In terms of need, in addition to health care as referred to in verse (1) Participants are also entitled to a health care tool. (5) The health tool as referred to in paragraph (4) includes a health aid tool.
17.In between Article 22 and Article 23 of the following 1 (one) section, Article 22A thus reads as follows: Article 22A Minister may establish another health care secured based on health technology assessment (health technology) assessment) by taking into account the adequate of the iuran after coordinating with the minister organizing government affairs in the financial field.
18.The terms of the letter b and the letter c Section 23 are amended, so that Article 23 reads as follows: Section 23 of the accommodation benefits as referred to in Section 20 of the paragraph (5) of the hospitalization services are as follows: {class III care} III: 1.Participants of Health Guarantee as well as residents registered by the Local Government; and 2.Participant Non-Recipients and Participants are not employees who pay their dues for the benefit of service in the Class III care room. (B.room) Class II for: 1.Pegawai The civil servant and the recipient of the pension of the civil servants of the room I and the class of room II and his family members; with the members of the army, and the retired military members of the Indonesian Civil Service, the equivalent of the civil servants of the class. Room I and the room of room II and his family members; the three members of the Polri and the members of the retired Polri who are the equivalent of the civil servants of the room I and the room II and their family members; 4.Participant of the Recipient other than the number of members of the family. 1 to 3 and Non-Civil Servants Employees with Gaji or Upah up to Rp4,000.000.00 (four million rupiah); and 5.Participant Workers Not Upah Recipients and Participants are not workers who pay dues for the benefit of service in the Class II care room. The C.kroom of the classroom I for: 1.Officials of State and his family members; the founding of the House of Representatives and the members of his family; the members of the House of Civil Affairs and the members of the family; the members of the Civil Service and the IV of the room, and the members of the And his family, and his family, and the retired members of the Indonesian Civil Service, and the IV room, and the members of the family, and the members of the family, and the members of the house of Polri, who were members of the civil servants, who were members of the same group. Room III and room IV along with members of his family; 6,Veterans and Pioneers. Independence and its members of the family; 7.widow, widower, or orphaned child of Veterans or Pioneered Independence; 8.Participants of the Recipient Workers in addition to the number 1 to the number 5 and non-civil servants of the Government with Gaji or Upah in the United States. over Rp4,000.000.00 (four million rupiah) up to Rp8.000.00 (eight million rupiah); and 9.Participants of Workers Not Upah Recipients and Participants non-workers paying dues for the benefit of service in the classroom nursing room I.
19.Conditions Article 24 is amended so that it reads as follows: Article 24 (1) Of the participants who wish A class that's higher than the right can follow additional health insurance. (2) The difference between the cost guaranteed by BPJS Health at the higher cost of the class of the right may be paid by: a. Participants are concerned; b. Workday; or c.insurance of additional health. (3) The provisions referred to in paragraph (1) are excluded: a.PBI of Health Guarantee; and b. Participants registered by the Regional Government as referred to in Section 6A. (4) The payment of the difference by the Workforce as referred to in paragraph (2) the letter b is not included for the Participant registered by the Local Government.
The provisions of Section 25 are amended so as follows: Article 25 (1) of the Service Non-guaranteed health services include: health services performed without going through procedures as set in regulations; health care services performed at Health Facilities that do not cooperate with BPJS Health, except in the state of emergency; c.ministry of health guaranteed by accident warranty program work against illness or injury due to a work accident or a working relationship; health care is guaranteed by a mandatory traffic accident guarantee program to the value incurred by the traffic accident guarantee program; Health services performed abroad; f.health care for aesthetic purposes; g.ministry to address infertility; h.service leveling teeth (orthodontions); i.d. of health/disease due to drug and/or alcohol dependence; Health care disorder caused intentionally self-harm, or effect. doing self-harm hobbies; complementary, alternative and traditional treatments, which have not been declared effective based on health technology assessment (health technology assessment); l.treatment and medical actions that categorised as an experiment (experiment); m.tool and contraceptive drug, cosmetics, baby food, and milk; n.Supply of household health; o.ministry of health as a result of emergency response times, external events/wabah; p.ministry health on unexpected events that can be prevented (preventable adverse events); and other services that are not related to the Health Guarantee Benefits provided. (2) The health disorder of intentionally self-harm, or as a result of self-harm and self-harm as referred to in verse (1) j, treatment and medical actions categorized as experiments (experiments) as well as referred to in paragraph (1) of the letter l, and the preventable adverse events as referred to in paragraph (1) the letter p is specified by the Minister.
The provisions of Article 27 are amended so that it reads as follows: Article 27 BPJS Health and organizers of additional health insurance programs can conduct coordination in providing benefits to Health Security Participants who have the right to the protection of additional health insurance programs.
22.provisions Section 27A is amended so that it reads as follows: Article 27A (1) BPJS Health performs cooperation with the organizers of the social security program in the field of work accidents and traffic accidents. (2) The provisions of the manner of cooperation as referred to in paragraph (1) are set forth in a cooperat time of health screening services as referred to in paragraph (6) are governed by the Regulation of Ministers.
16.provisions Article 22 is amended so that it reads As follows: Article 22 (1) The secured health care consists of: the first-degree health ministry, covering non-specialistic health services that includes: 1.administration of ministry; 2.m promotional and preventative services; 3.examination, treatment, and medical consultation; 4.A non-specialistic medical treatment, either operative and non operative; 5.services of drug and medical materials cion agreement between BPJS Health and the organizers of the social security program in the field of work accidents and traffic accidents.
23.Article 27B removed.
24.Article 28 removed.
25.Between verses (2) and paragraph (3) of Section 29 are inserted three (three) verses, paragraph (2a), paragraph (2b), and paragraph (2c), so Article 29 reads as follows: Article 29 (1) For the first time each Participant is registered by BPJS Health on one The first-level Health Facility set by BPJS Health after receiving the local district/local health service recommendations. (2) In the shortest term of 3 (3) the following month the Participant has the right to select the desired first level Health Facility. (2a) For the benefit of the structuring, BPJS Health can conduct the transfer of participants from a first-level Health Facility to another first-level Health Facility still in the same region. (2b) The participant 's beauty as referred to in verse (2a) is done by considering the recommendation of the county/city health service after coordinating with the Association of Health Facilities, and the profession' s organization. (2c) In the event the participants are moved as referred to in the paragraph (2a) objection, then the participant can request to be transferred to the first level Health Facility it wants. (3) Participants must obtain health services at the first-level Health Facility where the Participant is registered. (4) In certain circumstances, the provisions referred to in paragraph (3) do not apply to the participants who: a.be outside the first-level Health Facility area of the registered Participant; or b.in the state of medical gawatation. (5) In the case of the participant requires advanced health care, the first level Health Facility must refer to the nearest advanced referral Health Facility in accordance with the referral system set up in regulatory provisions It's (6) Further provisions concerning first-level health care and advanced level referral health services are governed by the Regulation of Ministers.
26.Conditions The paragraph (3) of Article 32 is amended, so Article 32 reads as follows: Section 32 (1) Drug service, health care, and medical materials are used for Health Guarantee participants in Health Facilities guidelines on lists and prices of drugs, health tools, and medical materials are used to be established by the Minister. (2) Before it is set by the Minister, the list and price of medicine, the health tool, and the medical materials are used up as referred to in verse (1) are drafted transparently and accountable by the National Committee. (3) The National Committee as referred to in paragraph (2) consists of the elements of the Ministry of Health, the Food and Drug Administration, the National Occupation and Family Planning Agency, the BPJS Health, the profession association, the college, and the expert power. (4) List of medicines, health tools, medical materials consumes as referred to in paragraph (1) is poured in the National Formularium and the Compendium of Health Tools.
27.Between Section 32 and Section 33 is inserted 1 (one) section, namely Section 32A so that reads as follows: Article 32A (1) The Government and the Regional Government are responsible for the availability of drugs, health tools, and the medical materials are used in the hosting of the Health Guarantee program. (2) Drug, health care, and consumable medical materials used in health care which are government programs are provided by the Government and/or the Local Government in accordance with the provisions of the laws.
28.Among verses (4) and paragraph (5) of Article 36 are inserted 1 (one) verses, i.e., paragraph (4a), so Article 36 reads as follows: Article 36 (1) Host of health services includes all Health Facilities that are in partnership with BPJS Healthcare. (2) Government-owned Health Facility and Local Government that meets the mandatory requirement of cooperating with BPJS Health. (3) Private property facilities that meet the requirements can establish cooperation with BPJS Health. (4) The cooperation as referred to in paragraph (2) and paragraph (3) is exercised by making a written agreement. (4a) In the course of implementation of cooperation with the Health Facility, BPJS Health is coordinating with the county/city health service. (5) Requirements as referred to in paragraph (2) and paragraph (3) are governed by the Regulation of the Minister.
29.Between Section 36 and Section 37 is inserted 1 (one) section, i.e. Section 36A thus reads as follows: Section 36A (1) Health Facility Cooperating with BPJS Health is prohibited from attracting health care costs to Participants during the Participant's benefit of health care according to its rights. (2) In terms of granting emergency services, the Health Facilities both working together or who are not cooperating with BPJS Health are prohibited from attracting health care costs to Participants. (3) The cost of health care as referred to in paragraph (1) and paragraph (2) is borne by BPJS Health in accordance with the provisions of the laws.
30.The provisions of Article 38 are amended so that it reads as follows: Article 38 (1) BPJS Health is required to pay the Health Facility for services given to the slowest participant: a.date 15 each month running for the Health Facility the first level to use the pre-attempted payment method based on the capitation; b.15 (fifteen) of the working day since the document claims outside the capitation is complete for the first-level Health Facility and other Health Facilities; and c.15 (five The working day since the claim document is fully accepted for the referral health facility. Advanced level. (2) The BPJS Health is required to pay damages to a Health Facility of 1% (one percent) of the amount payable for each 1 (one) delay month. (3) In terms of date 15 (fifteen) each month run as referred to paragraph (1) the letter a fall on the day off, the payment is made on the next working day.
31.In between Article 38 and Section 39 is inserted 1 (one) section, Article 38A thus reads as follows: Article 38A (1) The submission of claims document financing of healthcare by the Health Facility to BPJS Health is given the term the slowest 2 (two) year since the health service was completed given. (2) In the case of the term submission of the claim document as referred to in paragraph (1) exceeded, the claim cannot be refiled. (3) Excluded from the provisions as referred to in paragraph (1) and paragraph (2), for claims of financing of health care with long or indeterminable treatment times.
32.Between paragraph (1) and paragraph (2) Section 39 is inserted 1 (1) the paragraph (1), paragraph (4) is changed, and is added 1 (one) the paragraph (5), so that Article 39 reads as follows: Section 39 (1) The BPJS Health makes the payment to the The first-level Health Facility is pre-attempted based on the capitation of the number of Participants enrolled in the first-level Health Facility. (1a) In terms of the first level Health Facility as referred to in paragraph (1) is the Central Government ' s first-level Health Facility, the payment mechanism, including use and accountability, follows the regulatory provisions laws in the financial field of the country. (2) In terms of the first level Health Facility in an area does not allow payment based on the capitation as referred to in paragraph (1), BPJS Health is granted the authority to make payments with other more mechanisms. It worked. (3) BPJS Health makes payment to advanced referral Health Facility based on the way Indonesian Case Based Groups (INA-CBG ' s). (4) The capitation and non-capitation and the Indonesian Case Based Groups (INA-CBG 's) and non Indonesian Case Based Groups (non INA-CBG' s) are reviewed at least once every 2 (two) years by the Minister. (5) The Minister in reviewing the quantity of capitation and non-capitation as well as Indonesian Case Based Groups (INA-CBG 's) and non Indonesian Case Based Groups (non INA-CBG' s) as referred to in paragraph (4) are performed by taki