874, No. 201421

Hb check, blood group check, celup test

glucoprotein urine, immunization, supplemental iron and acid supplements

folate, and counselling, as well as converting to a doctor at

trimester First or as early as possible.

2) A standard ANC check was given in package form

at least 4 (four) times the examination.

3) The PNC/neonatus check was appropriate in

the form of a package of minimum 3 (three) mother visits and 3 (three) times

baby visits.

4) obstetrics services and neonatal performed by midwife

or doctor, according to her competency and authority.

e. Health tool service

The health tool service type and price plaphone are set by

Minister. Guaranteed health care tools services include:

NO ALAT

HEALTH PROVISIONS

1 Kacamata 1. Given the quickest 2 (two) years

once

2. Minimal medical indication:

-Sferis 0.5D

-Silindris 0.25D

-

2 The hearing aids were given the fastest 5 (five) years

once over medical indications

3 Protesa motion 1 tools. Protesa means the device is:

a. Fake legs

b. Fake hand

2. Given the quickest 5 (five) years

once over medical indications

4 Protesa gear was given the quickest 2 (two) year once

over medical indications for the same tooth

5 Korset bones

back

Dimed quickest 2 (two) year once

top medical indication

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2014, No. 874 22

NO ALAT

HEALTH PROVISIONS

6 Collar neck Given the quickest 2 (two) years

above medical indication

7 Kruk Being given the quickest 5 (five) years

once over medical indication

2. Benefits that are not guaranteed in the JKN program include:

a. Health services performed without going through the procedure

as set out in the applicable regulations;

b. Health care services conducted at the Health Facility which is not

working with BPJS Health, except in circumstances

emergency;

c. Health services that have been guaranteed by warranty program

work accident against illness or injury by accident

work or a working relationship;

d. Health services that have been guaranteed by the program guarantee

a traffic accident that is mandatory until the value

is borne by the traffic accident guarantee program;

e. health care services performed abroad;

f. Health care services for aesthetic purposes;

g. Service to address infertility;

h. The service leveled the teeth (orthodonsi);

i. Health disorders caused intentionally hurting themselves, or as a result of

doing a self-harm hobby;

j. Complementary, alternative and traditional treatment, including

non-medical acupuncture, shin she, chiropractic, that has not been stated

effective based on health technology assessment (health technology

assessment);

k. Treatment and medical actions are categorized as experiments

(experiment);

l. Contraceptive tools, cosmetics, baby food, and milk;

m. Household health provisions;

n. Health services due to disaster during emergency response times,

outside events/wabah;

o. Health care costs on unexpected events that can

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874, No. 201423

prevented (preventable adverse events);. The intended preventable

adverse events is an injury related to

errors/omission of medical attention including errors

therapy and diagnosis, inability of tools and others as

except complication of related diseases.

p. Other service fees that no relation to the Benefits

Health guarantee are provided.

D. Drug Services, Drug Supplies and Drug Use

1. Drug Services

a. Drug Service for JKN Participants at FKTP is performed by pharmacists in

pharmacy installation of the pratama/pharmacy clinic in Puskesmas/pharmacy

under the laws.

In terms of Puskesmas has not yet had a pharmacist then the ministry

the drug can be done by a pharmacist technical power with

coaching the pharmacist of the County/City Health Service.

b. Drug service for JKN Participants at FKRTL is performed by pharmacists in

primary hospital pharmacy installation/pharmacy /pharmacy as per provisions

legislation.

c. Drug service for JKN participants in health facilities refers

on the list of drugs listed in Fornas and drug prices that

is listed in the drug e-catalog.

d. The drug has been using the mechanism e-purchasing based on e-

catalog or if there is an operational constraint to be done

manually.

e. In terms of the type of the drug not available in the National Formularium and

the price is not in the e-catalog, then its absence can

use the other procurement mechanism according to

laws (Presidential Regulation Number 70

of the Second Amendment to the Presidential Regulation

No. 54 of 2010 On the Procurement of Government Goods/Services).

In terms of the faskes experience the availability of the drug availability as

listed in the e-catalog then it can contact the Directorate

The Public Drug Bina with an email address: e_katalog@kemkes.go.id or

081281753081 and (021) 5214872.

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2014, No. 874 24

Any drug availability constraint report should be accompanied with

information:

a. name, supply and drug force

b. the name of the drug factory and the name of the drug distributor

c. place of occurrence (name and address of city/county and propinsi,

depo farmasi/pharmacy/pharmacy installation of the diesan hospital

medicine)

d. drug order date

e. confirm results with local distributor

f. other related things

2. Drug provision

Drug treatment at health facilities is implemented with reference

to the Fornas and drug prices listed in the e-catalogue of drugs.

The drug procure in e-cataloging uses an e-purchasing mechanism,

or if there is a manually done operational constraint.

In terms of the type of the drug not available in Fornas and its price is not

contained in the e-catalog, then it can be used

the procurement mechanism that others in accordance with the

applicable laws.

3. Use of Drug Beyond the National Formularium

On the implementation of health care, the use of the drugs adjusted

with the treatment standards and in accordance with applicable provisions.

If in the granting of health care, patient requires

a drug that has not been listed in the national Formularium, then this can

be provided with the following conditions:

a. Drug use outside of the national Formularium in FKTP can

be used if appropriate with medical indications and in acamination Pap Smear

7) Special for the case with Positive IVA checks can

perform Krio Therapy services.

d. Benefits of bidness Service and Neonatal in JKN:

1) ANC examination of physical examination, high measurement

body and body weight, blood pressure check, measurement

upper arm circumference, high examination of the uteri fundus,

examination of the fetal heart rate, fetus position checking,

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2014, No. 874 28

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874, No. 201429

BAB V

FUNDING

A. General provisions

1. Health Guarantee is a amount of money paid

regularly by Participant, Workforce, and/or Government for the program

National Health Guarantee.

2. The Kapitation Fund is a paid monthly payment magnate

in advance to FKTP by BPJS Health based on the number of participants

registered without taking into account the type and number of services

the health provided.

3. The management of the Kapitation Fund is budgeting, staging,

the company's company, and the responsibility of the capitation funds received

by the FKTP of BPJS Healthcare.

4. Non-Kapitation rates are the magnitude of payment of claims by BPJS

Health to FKTP based on type and number of services

health provided.

5. The payment pattern Case Based Groups is one of the payment patterns

a prospective grouping of diagnoses and procedures that

has a clinical feature and the use of similar or similar resources.

6. Management and utilization of funds in FKTP and the government-owned FKRTL

the rules follow the rules of the invitational regulations, whereas

the management and utilization of funds in FKTP and the Private FKRTL

the arrangement is appropriate to the provisions applicable to such private faskes.

7. Health facilities are not allowed to request an iur of fee to

participants during the benefit of the health care service appropriate

in her right.

8. The Health Facility proposes a claim each month regularly the most

slow the next 10 months, unless the capitation, not necessary

is filed claim by the Health Facility.

9. The claim submitted by the health facility was first performed

verification by the BPJS Health verificator whose purpose is to

test the correctness of the service accountability administration that

has been implemented. by a health facility. Provisions regarding

verification of FKTP and FKRTL claims are further set up in the Directive

Technical Verification Claims issued by BPJS Healthcare.

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2014, No. 874 30

10. BPJS Health is required to pay the Health Facility for services

which is given to the slowest 15 (fifteen) working days

since the claim document is received complete at Branch Office/Office

Operational Services County/City of BPJS Health.

11. BPJS Health is required to provide feedback at the verification results

against the difference in fees submitted with the approved.

12. FKRTL is required to send softcopy individual claim already paid

by BPJS Healthcare to the Ministry of Health cq Center Financing

and Health Guarantee.

13. FKTP and FKRTL that do not cooperate with BPJS Healthcare

billed directly emergency services costs to

BPJS Healthcare.

14. BPJS Health pays emergency services costs using

tariffs in INA CBGs in accordance with hospital class designation by the Minister

Health and regionalisation of the tariffs in effect in the region.

15. The FKRTL which has yet to have a class designation, using the INA-

CBGs Class D Hospital rate

16. Claim expiry

a. Collective Claim

Maximum deadline submission for Health Facility

owned by the Government and Private, both First and

Advanced is 2 (two) years after the service given.

b. Individual Claim

The maximum time limit of individual claim submission is 2 (two)

years after the service is given, unless set specifically.

B. Funding Source

The funding source in the hosting of JKN comes from the iuran

PBI participants and not PBI.

1. The PBI Participant is paid for by the Government.

2. Iuran Participant is Not PBI:

a. The Up-Receiver worker is paid by the Worker and Workforce.

b. Workers Are Not Upah Recipients and Not Workers Are Paid by the participants

are concerned.

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874, No. 201431

C. Payment mechanism

1. Iuran Payment Mechanism

The participant's dues-payment mechanism to BPJS Health

is adjusted to the membership registered at BPJS Health.

a. Iuran for the PBI participants paid by the Central Government through

Ministry of Health to BPJS Health.

b. Iuran for participants registered by the Local Government

paid by the Local Government with minimum dues

equals large iuran for the PBI participants.

c. Health Guarantee for Upah Recipient Workers is paid

by the employers and workers with the following conditions:

1) The job of collecting dues from workers and paying dues

that is responsible Workable then iuran

saved to BPJS Healthcare.

2) The Central Government and Local Government as employers

lease the dues to BPJS Health through cash accounts

the country with the setting up of the settings repayment of state coffers

to BPJS Health as regulated by the Ministry

Finance.

d. Iuran for the Workers Participant Not Upah and Attendees Not

The worker was paid by the participants themselves to BPJS Healthcare

in accordance with the class of his treatment.

e. Iuran for retired recipients, veterans, and pioneers of independence

paid for by the government to BPJS Health.

2. Payment mechanism to the Health Facility

BPJS Health will pay to FKTP with Kapitation and Non

Kapitation. For FKRTL, BPJS Health will pay with the system

packet INA CBG's and outside the INA CBGs package.

3. Capitation Payment mechanism

The Kapitation Payment by BPJS Health is based on the amount

participants registered in FKTP in accordance with BPJS Health data.

The capitation payment to FKTP is performed by BPJS Healthcare each

The slowest month of 15 months is running. Prior to the invitation

Presidential Regulation (PERPRES) Number 32 of 2014 on

Management and maintenance of the JKN Kapitation Fund at the Facility

First-Level Health Property of Local Government and Regulation

Minister Health (PERMENKES) Number 19 Year 2014 about

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2014, No. 874 32

Use of JKN Kapitation Fund for Health Service Services and

Operational Cost Support at First-Level Health Facility

Property of Local Government, Payment Fund Capitation by BPJS to FKTP

The Local Government directly to the Kab/City Health Service that

next is tuned to the Regional Kas (KASDA) or directly from BPJS

Health to the Regional Kas as an area receipt.

Since the release of the 32/2014 Perpres and Permenkes 19/2014 fund

Kapitation directly paid by BPJS Health to FKTP belongs to

Local Government.

. The technical provisions are further set in the BPJS regulations

Health.

3. The provisions of the manner of the coordination of benefits are set in

a cooperation agreement between BPJS Health and program organizers

social security in the field of work accidents and traffic accidents or

program organizers Additional health insurance or body

Another guarantor.

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874, No. 201437

3) Private Hospital/Main Clinic

Dana proceeds payment claim, for Private Hospital/Clinic

Main of the settings are submitted to the health facility

that is.

b. The magnitude of the health care services in the Government's FKRTL

in the range of 30-50% (thirty to fifty

percent) of the total revenue of the health facility.

Whereas for referral health facilities Advanced level

Private property the rules are submitted to the facility

the health.

According to Law No. 1 of the Year 2004 of the Treasury Article 25 paragraph (1) that the bank interest and/or giro services were obtained Government is State/Regional Revenue

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2014, No. 874 38

BAB VI

GOVERNING BODY

A. General provisions

1. National Health Guarantee Organiser is BPJS Health

2. BPJS Health is a non-profit public legal entity and

is responsible to the President.

3. BPJS Health is based and is headquartered in the State capital

Republic of Indonesia, and has a representative office in the province and

branch offices in the district/city.

B. The BPJS organ

The BPJS Health organ is comprised of the Board of Trusts and Directors.

The Board of Trusts consists of 7 (seven) members of 2 (two)

Government elements, 2 (two) worker elements, 2 (two) persons of the element

Working Guide, 1 (one) of the People ' s Element of Community. The board consists of

at least 5 (five) member people who are from the professional element.

C. FUNCTIONS, DUTIES, AUTHORITY, RIGHTS, AND OBLIGATIONS

1. FUNCTIONALITY

BPJS Health serves to host a warranty program

health. In performing the function the BPJS is responsible for:

2. TUGAS

In implementing its function BPJS Health is responsible for:

a. perform and/or receive Participant registration;

b. collect and collect Iuran from Participant and Workforce;

c. receive Iuran Help from the Government;

d. manage the Social Security Fund for the benefit of the Participant;

e. Collect and manage the Social Security Program Participant's data;

f. pay the benefits and/or finance health services

in accordance with the provisions of the Social Security program; and

g. provide information about the hosting of the Warranty

Social Program to the Participants and the public.

3. AUTHORITY

In carrying out its duties, BPJS Health is authorized to:

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874, No. 201439

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2014, No. 874 40

a. invoice Iuran payment;

b. put the Social Security Fund for short-term investments and

long term by considering the liquidity aspects,

solvency, prucency, funding security, and adequate results;

c. conduct surveillance and Examination of the participant's compliance and

The Work Guide in meeting its obligations in accordance with the provisions

the national social security laws;

d. make a deal with a health facility regarding the large

payment of a health facility that refers to the standard rate that

is set by the Government;

e. create or stop working contracts with healthcare facilities;

f. wearing administrative sanction to Participant or Workforce

that does not meet its obligations;

g. report the Workout to the authorized instance of

its disobedience in paying Iuran or in meeting

other obligations in accordance with the provisions of the perinvite regulations-

invitation; and

h. doing cooperation with other parties in order

hosting the Social Security program.

4. Right

In carrying out its authority, BPJS Health reserves the right to:

a. obtain an operational fund for hosting programs that

sourced from the Social Security Fund and/or other sources appropriate

with the rules of the legislation; and

b. obtaining the monitoring and evaluation results of the program

Social Security of DJSN every 6 (six) months.

5. LIABILITY

In carrying out its duties, BPJS Health is obligated to:

a. provide a single identity number to the Participant;.

b. develop the assets of the Social Security Fund and the BPJS assets for

bulk interest in Participant;

c. providing information via print and electronic media

regarding performance, financial conditions, as well as wealth and results

its development;

d. provide benefits to all Participants in accordance with the Invite-

Invite about the National Social Security System;

e. provide information to participants regarding the rights and obligations

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874, No. 201441

to follow the applicable provisions;

f. provide information to participants regarding procedures for

obtain the rights and fulfill its obligations;

g. forming technical backups in accordance with the standard of actuarial practice

a common and common applicable;

h. doing bookkeeping in accordance with applicable accounting standards

in the implementation of Social Security; and

i. report on the execution of each program, including financial conditions,

periodically 6 (six) months to the President with

a gust to DJSN.

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2014, No. 874 42

BAB VII

MONITORING, EVALUATION AND HANDLING COMPLAINTS

A. General provisions

1. In the National Health Guarantee the various parties

carry out monitoring and evaluation according to the authorityovisions

laws Applicable.

d. Pratama Clinic and Doctor/Dentistry Practice

The refinancing and accountability of JKN funds both capitation and

non capitation at the Pratama Clinic and Doctor/Dentistry Practice

is fully done over provision at the Clinic

Pratama/Doctor/Dentistry Practice.

e. Bidan Jenets from FKTP

In the implementation of JKN Bidan as a service provider

the obstetrics and neonatal are a network of FKTP that has been

in cooperation with BPJS Health. In the coaching framewith

BPJS Health, Health Facility with BPJS Health, BPJS

Health with The Health Facility's association after mediation

by the Minister of Health can then be forwarded through

the court in accordance with the rules of the invite-invite rule.

3. The Complaint Handling Mechanism

The handling of the complaint is one of the instruments for

resolving the health care problem, both of which is

administrative and medical. Problems can occur between

Participants with a Health Facility; between Participants with BPJS

Health; between BPJS Health with Health Facility; or

between BPJS Health with the Health Facilities Association.

The mechanism that can be taken to complete the complaint, consisting

over:

a. If the participant has a complaint against the service that

is provided by a health facility in cooperation with BPJS

Health, Participants can submit a complaint to the Facility

Health in cooperation with BPJS Health. If

the complaint handling cannot be completed, then it can

be passed on to the next level (via Tim Monev

District/City, Team Monev Province, Central Monev Team, and

Health Minister).

b. If the participant has a complaint against the service

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2014, No. 874 46

granted BPJS Health, then it can convey a complaint

to the local BPJS Health. If the complaint handling is not

can be completed, it can be passed on to the next level

(via the District/city Monev Team, the Provincial Monev Team, Team

Monev Central, and the Health Minister).

c. In the event of a problem between the BPJS Health with

Health Facility or the BPJS Health with the Association

Health Facility then it should be resolved

the deliberations by the parties. If the complaint handling is not

can be completed, it can be passed on to the next level

(via the District/city Monev Team, the Provincial Monev Team, Team

Monev Central, and the Health Minister).

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874, No. 201447

BAB VIII

P E N U T U P

Health is a basic human necessity for a viable

and productive life, for which it is necessary for the hosting of health care

controlled costs and its students, through the National Health Guarantee program

(JKN) hosted by the Social Security Organizing Board

Health.

Health care fund management for JKN program participants

amanah that must have to be managed effectively and efficiently and implemented

coordinated and integrated from various parties regarding both the center and

area.

Expected health care for residents through this JKN program

can be executed as best as to realize an increase

degree of public health in full. May what is hopeful

we are all health guarantees for all/Universal Health Coverage at

2019 can be well realized and to all parties who have

provide his sumbanger, both ideas thoughts, power and contributions

others get a deserved reward from God Almighty Esa.

HEALTH MINISTER

REPUBLIC OF INDONESIA,

NAFSIAH MBOI

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