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Regulations Governing Body Health Social Security Number 1 2014

Original Language Title: Peraturan Badan Penyelenggara Jaminan Sosial Kesehatan Nomor 1 Tahun 2014

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STATE NEWS
REPUBLIC OF INDONESIA

No. 1, 2014 BPJS. Health insurance. The Guide of the Guidelines.


HEALTH SOCIAL SECURITY GUARANTEE ORGANIZER ' S RULES
No. 1 YEAR 2014
ABOUT
HOSTING THE HEALTH GUARANTEE

WITH THE GRACE OF THE ALMIGHTY GOD

PRINCIPAL DIRECTOR
THE GOVERNING BODY OF SOCIAL SECURITY GUARANTEES,

Weighing: that to implement the provisions of the Article, Section 15, Section 17 of the paragraph (7), Article 17 A paragraph (6), Section 26 of the paragraph (3), Section 31, Section 40 of the paragraph (5), and Article 42 of the paragraph (3) of the Presidential Regulation Number 12 Year 2013 on Health Guarantee as amended by the Presidential Regulation No. 111 of 2013 on the Changes to the Presidential Regulation No. 12 of 2013 on Health Guarantee, need to set the Health Social Security Governing Body ' s Regulation on Hosting Warranty Health;
Remembering: 1.   Law No. 40 of the Year 2004 on National Social Security System (Indonesian Republic of Indonesia Year 2004 Number 150, Additional Gazette of the Republic of Indonesia No. 4456);
2. Law No. 36 Year 2009 on Health (State Sheet of the Republic of Indonesia Year 2009 Number 144, Additional Sheet of State of Indonesia Republic No. 5063);
Three. Law No. 44 Year 2009 on Hospital (Sheet State Republic Of Indonesia In 2009 Number 153, Additional Leaf Of State Republic Of Indonesia Number 5072);
4. Law No. 24 Year 2011 on Social Security Organizing Agency (Sheet Country Indonesia Year 2011 Number 116, Additional Sheet Republic Of Indonesia Number 5256);
5. Government Regulation Number 101 of 2012 on Recipient Of Health Guarantee Assistance (State Sheet Of The Republic Of Indonesia Year 2012 Number 264, Additional Gazette Of The Republic Of Indonesia Number 5372);
6. Presidential Regulation Number 12 Year 2013 on Health Guarantee (State Sheet of the Republic of Indonesia Year 2013 Number 29) as amended by Presidential Regulation No. 111 of 2013 on Change of Presidential Regulation Number 12 Years 2013 on Health Guarantee (State Sheet of the Republic of Indonesia Year 2013 Number 255);

DECIDED:

Establish: "GOVERNING BODY 'S GOVERNING BODY' S GOVERNING BODY ' S HEALTH INSURANCE POLICY".

BAB I
UMUM CONDITIONS
Section 1
In this Health Social Security Organizing Agency Regulation, it is referred to:
1. Health Guarantee is a guarantee of health protection so that participants benefit health care benefits and protection in meeting the basic health needs given to each person who has paid dues or It's paid for by the government.
2. The next Health Social Security Organizing Board called BPJS Health is a legal entity that is set up to host the Health Guarantee program.
3. Participants are each person, including a foreigner who works the most short 6 (six) months in Indonesia, who has paid dues.
4. The Health Guarantee is a number of money paid regularly by Participants, employers, and/or Government for the Health Guarantee program.
5. The following Health Guarantee Assistance Recipients abbreviated PBI Warranty Health are poor facir and people cannot afford to be a participant of the Health Guarantee program.
6. Benefits are a social security faedah which is the rights of the Participants and/or members of his family.
7. Health facilities are health care facilities used to host individual health care efforts, either the promotion, preventive, curative or rehabilitative performed by the Government, the Local Government, and/or Society.
8. First-level health care is a non-specialistic (primary) individual health care service including outpatient and outpatient services.
9. The first level of street Rawat is a non-specialistic individual health service that is exercised in the first-degree health care provider for the purposes of observation, diagnosis, treatment, and/or health care. Otherwise.
10.Rawat is a non-specialistic individual health care service and is executed on first-degree health facilities, for the purposes of observation, treatment, diagnosis, treatment, and/or other medical services, where the participant and/or his family members are hospitalized at least 1 (one) days.
A further degree of secondary referral health is an attempt by a specific or sub-specialistic individual health service that includes advanced outpatient, advanced hospitalization and hospitalization of specialized care.
Another 12.Service health service is another health service set by the Minister.
13.A health tool is an instrument, apparatus, machine, and/or implant that does not contain the medication used to prevent, diagnose, cure and relieve disease, care for the sick and restore health in humans and/or forming structure and repairing body functions.
14.Tarif Indonesian-Case Based Groups which are subsequently called Tarif INA-CBG's is the magnitude of the payment of claims by BPJS Health to the Advanced Health Facility over a service package based on the classification of disease diagnoses.
15.2 The health care referral system is the hosting of healthcare that governs the abundance of duties and responsibilities of reciprocally health services, both vertical and horizontal.
16.Pegawai Government Non Civil Servants are Non-permanent Employees, Honorary Employees, Special Staff, and other employees paid by the State Shopping Revenue Budget or the Regional Shopping Revenue Budget.
The next 17.7 Indonesian National Armed Forces (Indonesian: Indonesian National Armed Forces) are personnel/soldiers of the state equipment in the field of defense that perform their duties under the leadership of the Chief of Staff of the Armed Forces or a joint under the Chief of the Armed Forces.
The next 18 Indonesian National Police (Indonesian National Police) is a civil servant in the Indonesian National Police who carries out the police function.
19.Virtual Account is a virtual account number provided by BPJS Health for entities and individuals as a destination account in the Health Guarantee payments.
20.Minister is the minister who organizes government affairs in the field of health.

Section 2
Hosting of Health Guarantee includes:
a.   Participation;
B.   The event of the event.
c. health care organizers;
D.   Quality control and cost control; and
e.   reporting and utilization of review.

BAB II
SACRILEENESS
The Kesatu section
General
Section 3
Health insurance coverage includes:
a.   Attendees;
B.   Participant's registration
c. verification and identification of the participants;
D.   rights and obligations of the participants;
e.   data changes and the status of the participant;

The Second Part
Participant
Paragraph 1
General
Section 4
Participants as referred to in Section 3 of the letter a consist of:
a.   Health Guarantee PBI participant
B.   Participants are not Health Insurance PBI.

Paragraph 2
Health Guarantee PBI participant
Section 5
Health Guarantee PBI participants as referred to in Section 4 of the letter a consist of:
a.   A man of the poor, and of the poor.
B.   People can't afford it.

Paragraph 3
Participants Are Not Health Guarantee PBI
Section 6
Participants are not a Health Guarantee PBI as referred to in Section 4 of the letter b consists of:
a.   Workers of the Retainer and family members include foreign nationals working in Indonesia at least 6 (six) months and members of his family;
B.   Workers are not the beneficiaries and members of his family including foreign nationals working in Indonesia the shortest 6 (six) months and members of his family;
C.   Not the worker and the family members.

Section 7
Participants of the Wage Recipient and family members included foreign nationals working in Indonesia at least 6 (six) months and members of his family as referred to in Article 6 of the letter a consist of:
a.   Civil servants;
B.   Members of the TNI;
C.   Members of the Polri;
D.   State Officials;
e.   Non-civil servants of the government;
f.   Private employees; and
G.   Workers who do not include a letter a up to the letter f receiving Upah.

Section 8
Workers are not the beneficiaries and members of their family including foreign nationals working in Indonesia at least 6 (six) months and members of his family as referred to in Article 6 of the letter b consist of:
a.   Workers outside of a working relationship or self-worker; and
B.   Workers who do not include a letter that is not an Upah recipient.

Section 9
(1) Not the Worker and his family members as referred to in Article 6 of the letter c consists of:
a.   Investors;
B.   Employers;
C.   Retirement Recipients;
D.   Veteran;
e.   Independence Pioneers;
f.   Widowed, widowed, or orphaned child of Veterans or Independence Pioneers; and
G.   It's not a worker that doesn't include a letter until it's an e capable of paying the dues.
(2) The retirement recipient as referred to in paragraph (1) the letter c consists of:
a.   Civil servants who cease with pension rights;
B.   Members of the TNI and Polri members who cease with pension rights;
C.   State officials who cease with pension rights;
D.   Widowed, widowed, or orphaned child of the retired recipient as referred to in letters a, letter b, and the letter c that gets the right of retirement;
e.   retirement recipients in addition to letters a, letter b, and letter c;
f.   Widowed, widowed, or orphaned child of a retired recipient as referred to in the letter e that got the right of retirement.

Section 10
(1) The family members as referred to in Section 6 include the lawful wife/husband, child, step-child of the lawful marriage, and the lawful adopted son, as many as 5 (five) persons.
(2) The biological child, step-child of a valid marriage, and a valid adopted child as referred to in paragraph (1), with the criterion:
a.   not or have never been married or have no income of its own; and
B.   not aged 21 (twenty-one) years or not aged 25 (twenty-five) years that still continue 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.

The Third Part
Participant Registration
Paragraph 1
General
Section 11
(1) The Health Guarantee Registration Act as referred to in Article 3 of the letter b is done, either alone or in the group.
(2) The Health Guarantee Registration Act as referred to in paragraph (1) may be done:
a.   data migration; or
B.   manual.

Section 12
The Health Guarantee Registration as referred to in Article 11 is done for:
a.   Health Care PBI; and
B.   It's not a medical guarantee.


Paragraph 2
Health Guarantee PBI Participant Registration
Section 13
(1) The Health Guarantee PBI participant registration as referred to in Article 12 of the letter a is performed by the Minister.
(2) The Minister in registering a Health Guarantee PBI participant as referred to in paragraph (1) is performed migrating data as referred to in Section 11 of the paragraph (2) letter a in accordance with the format specified by BPJS Health.

Paragraph 3
Registration Of Participants Is Not A Health Guarantee PBI
Section 14
The registration of the participant is not a Health Guarantee PBI as referred to in Article 12 of the letter b done to:
a.   Workers of the Retainer and family members include foreign nationals working in Indonesia at least 6 (six) months and members of his family;
B.   Workers are not the beneficiaries and members of his family including foreign nationals working in Indonesia the shortest 6 (six) months and members of his family;
C.   Not the worker and the family members.

Section 15
(1) The Registry of Health Guarantee participants for the Workers of the Upah as referred to in Article 14 of the letter a is performed by the Workforce.
(2) The registration of participants for Upah Recipient Workers is performed in a group through its identity to BPJS Health.
(3) The registration as referred to in paragraph (2) is performed on a migration of data in accordance with the format specified by BPJS Health or manually.
(4) The migration of data as referred to in paragraph (3) is performed at least for 1000 (thousand) participants.
(5) The registration manually as referred to in paragraph (3) is done in a way:
a.   coming directly to the BPJS Health office or through a third party designated by BPJS Health;
B.   fill out the form and submit the candidate data completeness.
(6) The third party as referred to in paragraph (5) the letter a includes:
a.   banking;
B.   other association of professions or associations;
C.   retail; and
D.   Other agencies.

Section 16
(1) In the event of a real Worklight does not register its Works to BPJS Health, the worker in question is entitled to register her as a Health Guarantee participant.
(2) The participant in which the Program is used as part of the Program is subject to the terms of the applicable Service.

Section 17
(1) The Job Guide in registering the job as referred to in Section 15 of the paragraph (1) must complete the candidate data that contains the least:
a.   character candidate name;
B.   population parent number;
c. date of birth; and
D.   the name of the first degree health facility that cooperate with BPJS Health and was chosen by prospective participants.
(2) The BPJS Health after receiving candidate data as referred to in paragraph (1) lists the participants to the first-level health facility chosen by the candidate.
(3) In terms of participants not choosing first-level facilities, BPJS Health sets the first-level health facility.

Section 18
(1) The Worker Registration Is Not A Recipient Of An Upah and Participant Is Not A Worker As It Is In Article 14 of the letter b and the letter c is performed alone by the person in question to BPJS Health.
(2) Workers Not Upah as referred to in verse (1) does not include Retired TNI, Retired Polri, Retired Civil Servant, Retired State Official, Veteran and Pioneer of Independence.

Section 19
(1) The Registration of the Workers Not of the Recipient and the participant is not a worker as referred to in Article 18 of the paragraph (1) is performed at the BPJS Health office whose work region includes the area where the candidate of the participant is domiciled or through a third party. appointed BPJS Healthcare.
(2) The registration as referred to in paragraph (1) can be performed:
a.   collective,:
1. manual by filling and submitting the participant fill list form as well as attaching a color photo fitting; or
2. The data migration delivered in the agreed format of the data format and submit a color photo fit.
B.   Alone by way of filling the Participants ' Isian List Form (FDIP), attach a photo image and show/show the document:
1. Original/photo copy of the Resident Card or Family Card.
2. For the WNA show the Ijin Card Stay While/Stay (KITAS/KITAP)

Section 20
Residents who do not yet have a Guarantee Keevision in an area can be registered by the Regional Government where the resident population is domicile.

The Fourth Part
Verify and Identity Participants
Section 21
(1) The verification and identity of the participants as referred to in Article 3 of the letter c is performed by BPJS Health after receiving data submitted by the candidate candidate.
(2) In terms of data as referred to in paragraph (1) are not complete and/or not correct, the BPJS Health in the most current time of 10 (ten) business days must notify the candidate for the complete and complete data to deliver the data in the correct and correct way.

Section 22
Candidates for most of the five (ten) days of work since the receipt of the notice as referred to in Section 21 of the paragraph (2) must resubmit the data completely and properly to BPJS Health.

Section 23
(1) If based on the results of the results of the candidate data verification is already declared complete and correct, BPJS Health publishes the Health Warranty Participant ID Card.
(2) The Health Warranty Participant ID card as referred to in paragraph (1) at least contains:
a.   Message number:
B.   Participant's name;
c. Date of birth
D.   population parent number;
e.   the name of the first degree health facility that cooperate with BPJS Health and was selected by the candidate candidate.
f.   Card issuer date.
(3) BPJS Health conducts recording and maintaining Health Guarantee Participants data in BPJS Health ' s database system (master file) system.

The Fifth Part
Participant's rights and Liability
Section 24
The rights and obligations of each participant as referred to in Article 3 of the letter d ensure the hosting of Health Security by BPJS Health to the participants.

Section 25
(1) Each participant has a right to:
a.   getting a participant's identity;
B.   get the Virtual Account Number;
c. select first-level health facility in cooperation with BPJS Health;
D.   obtaining Health Warranty benefits;
e.   delivering a complaint to a working-working Health and/or BPJS Health Facility;
f.   getting health care information; and
G.   following an additional health insurance program.
(2) The Health Guarantee Benefits as referred to in paragraph (1) of the letter d include promotional, preventive, curative, and rehabilitative services including drug services, health care and medical materials used in accordance with the medical needs of which the Client is entitled to use the Cloud Service. required and is carried out by the health care organizers who are working with BPJS Health.


Section 26
Each participant is mandatory:
a.   pay dues;
B.   Report on the following list:
c. report changes to the status of the membership; and
D.   reported damage and/or missing a Health Guarantee ID card.

The Sixth Part
Data changes and Status of Status
Section 27
(1) The change of data and status of the membership as referred to in Article 3 of the letter e that occurs in each participant is reported to the BPJS Health.
(2) The change of the error data as referred to in paragraph (1) may include:
a.   First-level health facilities;
B.   place of residence;
c. Workspace and/or New Workspace identity;
D.   Employee group;
e.   type of membership;
f.   family arrangement and/or number of attendees; and
G.   Additional family members.

Section 28
Any loss and/or costs caused by the delay and/or negligence of the reporting of the Health Guarantee data change into the Participant's load.

Section 29
The change in status of the membership status of the Health Guarantee PBI Participant is not a Health Guarantee PBI participant is performed at the time the Participant pays the dues for the first time.

Section 30
(1) The change in status of the membership of the Participant Not PBI of Health Warranty becomes a Health Guarantee PBI Participant can be performed for:
a.   Participant is not a Health Security PBI who has a total disability fixed and cannot afford;
B.   Participants are Not Health Guarantee PBI who are layoffs and do not get a job back within 6 (six) months and are declared unable to be a participant instead of the Health Guarantee PBI.
(2) The change in status of the membership of the Participant is not a Health Guarantee Participant as a Health Guarantee PBI Participant as referred to in the paragraph (1) performed in a way:
a.   The participant is not a Health Insurance PBI who has a total disability reporting on the condition of its wormness to the local Local Government by including the degree and the type of difficulty from the authorized physician;
B.   Participant is not a Health Security PBI who undergoes the termination of the Relationship Relationship and does not get a job back within 6 (six) months reporting to the local Local Government by including an uncapable letter from the official Authorized.

Section 31
(1) The Local Government is performing on the report of a change in the status of the membership status of the Participant's Warranted Health (PBI) to the Health Guarantee PBI Participant.
(2) The Local Government proposes a change in the status of a membership of the Participant's Bail Party to be a Health Guarantee PBI Participant to the Minister who is saving the government's affairs in the social field.

Section 32
(1) The Minister of Governing Government Affairs in the social sphere of conduct verification of the change in status of the membership of the Participant is not the Health Guarantee PBI Participant proposed by the Local Government.
(2) The Minister of government affairs in the social field conducted the validation of the Health Guarantee PBI Participant after coordinating with the Minister of Finance.
(3) The change and validation of the data of the PBI participants of the Health Guarantee by the Minister of the Governing business in the social sphere is performed every 6 months in the year of the budget running and set by the Minister who is saving the affairs of the affairs of the government. Government in the social field.
(4) The change and validation of the PBI participant's data in the social field as referred to in paragraph (3) is further submitted to the Minister to be registered as a Warranty PBI Participant. Health to BPJS Health.

BAB III
HEALTH GUARANTEE ' S SEVERING OF HEALTH CARE
The Kesatu section
General
Section 33
(1) The warranty of the Health Guarantee as referred to in Article 2 of the letter b is required to be paid by any participant of the Health Guarantee program.
(2) The Iuran as referred to in paragraph (1) shall be paid the slowest of the date of 10 (ten) each month at the Bank that has cooperated with BPJS Health.
(3) Warranty of the Health Guarantee for Health Guarantee participants in accordance with the provisions of the Perundang-Invitation Regulation.

Section 34
(1) The BPJS of Health conducts collection and billing of dues to participants.
(2) The bill as referred to in paragraph (1) at least contains details:
a.   Participant's data; and
B.   Nominal bill.

Section 35
(1) The taxpayer is to collect dues from its workers, pay the dues that it is responsible for, and lease the dues to BPJS Healthcare the slowest date of 10 (ten) each month.
(2) For local government work, the payment of the dues to the BPJS Health as referred to in paragraph (1) is done through the slowest state treasury account of the date of 10 (ten) each month.
(3) If the 10 (10) Day (1) is referred to in verse (1) falls on the Day of the Day, then the dues are paid on the day of the next day.
(4) The slowness of the Health Guarantee payment as referred to in paragraph (1) by the employers other than the state organizer, is charged with an administrative fine of 2% (two percent) per month of the total arrefyled dues. At most three (three) months, which is paid in conjunction with the total number of dues that the Workperson has ever been able to provide.
(5) In the case of the delay in the payment of the Health Guarantee as referred to in paragraph (1) more than 3 (three) months, the settlement may be temporarily terminated.

Section 36
The participant's dues as referred to in Article 33 of the paragraph (1) are paid for:
a.   Health Care PBI participants;
B.   Employers;
C.   Workers Are Not Beneficiaries;
D.   Not a Worker;
e.   Another member of the family.

The Second Part
Health Guarantee PBI participant
Section 37
(1) The participants of the Health Guarantee PBI as referred to in Article 36 of the letter a paid by the Minister in accordance with the provisions of the provisions of the negotiations.
(2) The BPJS Health after receiving payment as referred to in paragraph (1) does a data reconciliation with the Minister.
(3) Conciliation as referred to in paragraph (2) is performed every 6 (6) months.
(4) If the results of the data reconciliation as referred to in paragraph (3) occur less or more payment, excess or lack of such payment will be taken into account at the next payment of dues.
(5) The provisions of the manner of the provision, the thawing and liability of the dues are referred to in paragraph (1) and paragraph (2) as set forth in the Regulation of the Minister of Finance.

The Third Part
Employers
Paragraph 1
General
Section 38
The workman consists of:
a.   Employers of the country's organizer; and
B.   Employers in addition to country organizers

Paragraph 2
Country Organizing Workspace Section 39
The country's organizer of the country's organizer as referred to in Article 38 of the letter a consists of:
a.   government; and
B.   Local government.

Section 40
(1) The government as referred to in Article 39 of the letter a shadowing the Health Assurance Participant for the Central Civil Service, Member of the Indonesian Armed Forces, Member of the Police, State Officials and Public Employees of the Central Public Service
(2) The participant in the event referred to in paragraph (1) is provided through the country's cash account to the BPJS Health every month.
(3) BPJS Health after receiving the deposit as referred to in paragraph (2) did a data reconciliation with the Minister of Finance.
(4) The Reciliation as referred to in paragraph (3) is exercised every 3 (3) months.
(5) If the results of the data reconciliation as referred to in paragraph (4) occur less or more payment, excess or lack of such payment will be taken into account at the next payment of dues.
(6) The order of the calculation, provisioning, thawing and liability of the dues, as referred to in the paragraph (2) and paragraph (3) is performed in accordance with the provisions of the Rules of the Invitation.

Section 41
(1) The Local Government as referred to in section 39 of the letter b paid the dues of the Warranty Participant for the Regional Civil Service and Employees Of The Non-civil Service State.
(2) The participant in the event referred to in paragraph (1) is provided through the country's cash account to the BPJS Health every month.
(3) BPJS Healthcare after receiving a deposit as referred to in paragraph (2) conducting a reconciliation of data with the Local Government.
(4) The Reciliation as referred to in paragraph (3) is exercised every 3 (3) months.
(5) If the results of the data reconciliation as referred to in paragraph (4) occur less or more payment, excess or lack of such payment will be taken into account at the next payment of dues.
(6) The order of the calculation, provisioning, thawing and liability of the dues, as referred to in the paragraph (2) and paragraph (3) is performed in accordance with the provisions of the Rules of the Invitation.

Paragraph 3
Employers In Addition To The Country Organizer
Section 42
(1) The worker in addition to the state organizer as referred to in section 38 of the letter b pays the Health Guarantee dues for the Worker and its person and provides it to BPJS Healthcare the slowest date of 10 (ten) each month.
(2) The worker as referred to in paragraph (1) consists of:
a.   Private employees; and
B.   Workers who receive wages other than workers whose dues are paid by the country's organizer of the country.
(3) The deposit as referred to in paragraph (1) is carried out through the Virtual Account account provided by BPJS Health at the time of registration.
(4) Further provisions concerning the procedure and the manner of payment of dues are set up with the BPJS Healthcare Board of Directors.

The Fourth Part
Workers Are Not The Beneficiaries Of
Section 43
(1) Workers of the Workers Not of Upah as referred to in Article 36 of the letter c pay the Health Guarantee dues for the Workers and of Himself and provide it to the slowest BPJS Health of 10 (ten) each month.
(2) The prepaid as specified in paragraph (1) to the Virtual Account account provided by BPJS Health at the time of registration.
(3) Iuran payments can be performed for a time of 1 (one) month, 3 (three) months, 6 (six) months and 1 (one) years.
(4) Further provisions on procedures and methods of payment of dues for the Workers are Non-Recipients and Not the Workers are governed by the BPJS Health Board of Directors.

The Fifth Part
Not Worker
Section 44
(1) Participant Not the Worker as referred to in Article 36 of the letter d pays the Health Guarantee for himself and provides it to BPJS Healthcare the slowest date of 10 (ten) each month.
(2) The Participant is not a worker as referred to in verse (1) which is Veterans, Independence, and Pension Recipient, and its membership is paid by the Government.
(3) The government is paying an additional dues to the Pension Holder as referred to in paragraph (2) which is the responsibility of the Government to the BPJS Health every month.
(4) The retirement recipient as referred to in paragraph (2) consists of:
a.   Civil servants who cease with pension rights;
B.   Members of the TNI and Polri members who cease with pension rights;
C.   State officials who cease with pension rights;
D.   Widowed, widowed, or orphaned child of the retired recipient as referred to in letters a, letter b, and the letter c that gets the right of retirement;
e.   retirement recipients in addition to letters a, letter b, and letter c; and
f.   Widowed, widowed, or orphaned child of a retired recipient as referred to in the letter e that got the right of retirement.
(5) The retirement recipient as referred to in paragraph (3) is paying the Health Guarantee dues that are its obligations through the pension of pensions by the third party of the Pension.
(6) The third party of the retired hire provides the Iuran cut as referred to in paragraph (5) to BPJS Healthcare the slowest date of 10 (ten) each month.
(7) The BPJS Health after receiving the deposit as referred to in paragraph (1), paragraph (2) and paragraph (3) does a reconciliation of data with the Finance Minister and the third party of the retired payer.
(8) The conciliation of the data as referred to in paragraph (7) is performed every 3 (3) months.
(9) If the results of the data reconciliation as referred to in paragraph (7) occur less or more payment, excess or lack of such payment will be taken into account at the next payment of dues.
(10) The order of provision, thawing and accountability of funds as referred to in paragraph (1) and paragraph (2) are executed in accordance with the provisions of the Promulction Ordinance.

Section 45
(1) Participant is not a worker other than the one referred to in Article 44 of the paragraph (2) and the paragraph (3), pay and lease the Health Guarantee for himself to the BPJS Healthcare the slowest date of 10 (ten) each month.
(2) The payment is as referred to in the paragraph (1) through the Virtual Account account provided by BPJS Health at the time of the participant registration.
(3) Iuran payments can be performed for a time of 1 (one) month, 3 (three) months, 6 (six) months and 1 (one) years.
(4) Further provisions on procedures and methods of payment of dues for the Workers are Non-Recipients and Not the Workers are governed by the BPJS Health Board of Directors.

The Sixth Part
Other family members
Section 46
(1) The use of the Program for any other member of the family as referred to in Section 36 of the letter e of the participant is not a Health Guarantee paid by the participant instead of the Health Guarantee's PBI as referred to in Section 4 and made available to the BPJS Health is the slowest of the dates of 10 (ten) each month.
(2) The deposit as referred to in paragraph (1) is carried out through the Virtual Account account provided by BPJS Health at the time of the participant registration.
(3) Iuran payments can be performed for a time of 1 (one) month, 3 (three) months, 6 (six) months and 1 (one) years.
(4) Further provisions concerning the procedure and order of payment of dues for other members of the family as referred to in paragraph (1) are governed by the BPJS Health Board of Directors.

BAB IV
HEALTH CARE ORGANIZER
The part of the piece
General
Section 47
(1) Each participant is entitled to a health service that includes promotional, preventive, curative, and rehabilitative services including drug services and consumable medical materials in accordance with the necessary medical needs.
(2) Health services as referred to in paragraph (1) include all first-degree health facilities and advanced level health facilities, other health facilities set by the Minister in cooperation with BPJS Healthcare including the top-support health facility, consisting of:
a.   laboratory;
B.   Hospital pharmacy installation;
C.   pharmacy;
D.   Indonesian Red Cross/Blood Transfusion unit;
e.   optical;
f.   Consumable Ambulatory Peritonial Dialysis Providers (CAPD); and
G.   practice Bidan/Nurse or equivalent.
(3) Health services guaranteed by BPJS Health consist of:
a.   health services at first-level health facilities;
B.   health services at advanced health facilities;
c. Emergency services;
D.   drug services, health tools, and consumable medik materials;
e.   ambulance service;
f.   health screening services; and
G.   other health services set by the Minister;

The Second Part
Health Care Service At First Level Health Facility
Paragraph 1
General
Section 48
(1) The health service of the first level health facility as referred to in Article 47 of the paragraph (3) of the letter to the Participant is performed by the first-level health facility where the participant is registered.
(2) Participants as referred to in paragraph (1) may choose another level of health facility in at least 3 (three) months.
(3) The first level health facility as dimksud in paragraph (1) consists of:
a.   Puskesmas or equivalent;
B.   doctor practice;
c. dentists practice;
D.   The Pratama clinic or equivalent including the first-level health facility belongs to TNI/POLRI; and
e.   The Class D Pratama hospital or the equivalent.

Section 49
Health care services at the first-level health facility consist of:
a.   First-level outpatient health care;
B.   First-degree inpatient health service:
C.   Dental health services; and
D.   Health care by midwife and nurse.

Paragraph 2
Health Care Care Service First Level
Section 50
(1) First-level outpatient health care must have a comprehensive health care function of promotional health care, preventive, curative, rehabilitative, obstetrics services and emergency health care services including Support services that include simple laboratory examination and pharmaceutical services.
(2) The first level health service as referred to in paragraph (1) for medical services includes:
a.   a medical case that can be completed completely in the first-degree Health service;
B.    medical cases requiring initial handling prior to referrals;
c. Medical case backheader;
D.   examination, treatment and first-degree dental health care measures;
e.   examination of pregnant mothers, nifas, breastfeeding mothers, babies and child toddlers by midwives or doctors; and
f.   Basic medik rehabilitation.
(3) First Level Street Rawat Health Service includes non-specialistic health services that include:
a.   services administration that includes the participant registration administration fees for the drug, provisioning and granting of referral mail to advanced health facilities for diseases that cannot be dealt with at the first-level health facility;
B.   a promotional and preventive service that includes individual health counseling activities, basic immunization, family planning, health screening;
C.   examination, treatment, and medical consultation;
D.   Maternity checks are pregnant, nifas, nursing mothers, and babies;
e.   treatment efforts against contraceptive side effects;
f.   non-specialistic medical actions, both operative and non operative;
G.   Drug and medical services are used to use;
h.   First-level laboratory diagnostic support is a simple blood check (Hemoglobin, edge blood apusan, thrombocyte, leukocyte, hematocrit, eosinophils, erythrocytes, blood type, blood-deposit rate, malaria), simple urine (color, Type weight, virility, pH, leukocytes, erythrocytes), simple feces (benzidin tests, microscopic worms), blood sugar during;
i.   other simple support checks that can be performed at first-level health facilities;
J.   services of advanced health care facilities;
No,   service of the return program;
I.   implementation of prolanis and home visit; and
M.   Basic medik rehabilitation.

Paragraph 3
First-Level Hospitable Health Service
Section 51
(1) First-level outpatient health care services include:
a.   Outpatient treatment/treatment cases that can be completed completely in the first-tier health service;
B.   help of pervagam childbirth is not a high risk;
c. Help with childbirth with complication and/or pervaginal purification for the Neonatal Emergencies Basic Obstetrics Service (PONED);
D.   neonatal help with complications; and
e.   Blood transfusion services according to the competency of health facilities and/or medical needs.
(2) The first-level outpatient health care services include non-specialistic health services that include:
a.   The service administration consists of the cost of patient registration and other administrative costs that occur during the patient ' s care or health care process
B.   examination, treatment, and medical consultation;
c. Care and accommodation in the care room;
D.   small/simple medical action by Doctor or paramedic;
e.   a percopy per vagina without purview or with a purview;
f.   diagnostic support check during treatment period;
G.   Drug and medical services are used during times of care; and
h.   Blood transfusion services according to medical indications.

Paragraph 4
The Dental Health Service at the First Level Health Facility
Section 52
(1) The dental health service includes:
a.   The service administration consists of the cost of patient registration and other administrative costs that occur during the patient ' s care or health care process;
B.   examination, treatment, and medical consultation;
C.   premedications;
D.   The urgency of the oro-clinal;
e.   revocation of the oldest tooth (topical, infiltration);
f.   permanent removal of a tooth without purlit;
G.   post-extraction drug;
h.   Composit/GIC; and
compression. i.   Teeth skeling.
(2) The dental health service as referred to in paragraph (1) is performed by the dentist.

Paragraph 5
Health Care Service by Bidan and Nurse
at the First Level Health Facility
Section 53
(1) In the event of a sub-district there is no doctor based on the designation of a local county/city health service chief, the Health Social Security Organizing Board may cooperate with the practice of midwife and/or nurses according to His authority.
(2) The granting of health care by Bidan and Nurse in the event of a subdistrict there is no doctor as it is referred to in verse (1) covering the ministry of midwife and nurses with the scope of the ministry of midwife and the nurse in accordance with the competence and His authority.
(3) Bidan and nurse as referred to in paragraph (1) may only refer to the physician and/or the dentist of the first degree health care provider except in the study of childbirth, the emergency condition or the patient with the condition special outside of the competence of the physician or dentistry of the first-degree Health facility.

The Third Part
Health Care Service At Advanced Health Facilities
Paragraph 1
General
Section 54
(1) Health services on advanced-level health facilities as referred to in section 47 of paragraph (3) letter b must be provided to participants based on referrals from first-degree health facilities on advanced health facilities.
(2) The advanced level health facility as referred to in paragraph (1) consists of:
a.   Primary or equivalent clinic;
B.   Public hospitals; and
C.   Special hospital.
(3) General Hospital and Special Hospital as referred to in paragraph (2) letter b and c may be Government Hospital, Local Government, TNI, Polri and Private Hospital in association with BPJS Health.

Section 55
(1) To obtain health services on advanced health facilities, the first level health facility as referred to in Article 48 of the paragraph (3) is required to perform a single-level referral system by reference to:
a.    Minister's rules;
B.    national referral system guidelines; and
c. BPJS Health service administration guidelines.
(2) In the run of advanced health services, the first-level health facilities and advanced levels are required to perform a single-level referral system.
(3) The health facility may perform horizontal and vertical referrals.
(4) The horizontal persuasion is performed between health care in one level if the referencing is unable to provide health care according to the needs of the patient due to the limitations of its properties, equipment and/or business. Temporary or settled.
(5) The vertical persuasion is conducted between different levels of health services, which can be performed from a lower level of service to a higher level of service or vice versa.

Section 56
(1) Participants can be excluded from the gender referral health service system at the first health facility if:
a.   Emergency emergency;
B.   disaster;
c. Specicency of patient health problems;
D.   geo considerations; and
e.   Facility availability.
(2) The specificity of a patient health problem as referred to in paragraph (1) letter c only for cases that are already enforced by their therapy plans and such therapies can only be performed in advanced health facilities.

Section 57
(1) The health facility is required to provide plenary services including the provision of medicine, consumable medical materials, health tools and required examination of support.
(2) In terms of service that is required of an outpatient service then such health care can be given in one place or through the cooperation of health facilities with its jenets.
(3) Service provided by the health facility as referred to in paragraph (1) and paragraph (2), already included in capitation or non-capitation payments for first-degree health facilities, and the INA CBG's for degree health facilities Advanced.
(4) Further provisions on health care procedures outside of the capitation and outside of the INA CBG's provided by the health facility are supported by the BPJS Healthcare Board of Directors.

Section 58.
Health care services at advanced level health facilities consist of:
a.   Advanced health care services
B.   Advanced hospitalization health services.

Paragraph 2
Advanced Street Health Care Service
Section 59
(1) Advanced outpatient health care as referred to in Article 58 of the letter a is a specialistic and subspecialistic service.
(2) Advanced outpatient health care as referred to in paragraph (1) includes:
a.   the service administration consists of the patient registration fee and other administrative costs that occur during the patient ' s care or health care process
B.   examination, treatment and specialistic consultations by specialist physicians and subspecialists;
c. Specialistic medical measures correspond to medical indications;
D.   Drug and medical services are used to use;
e.   health tool service;
f.   advanced diagnostic support services in accordance with medical indications;
G.   medical rehabilitation;
h.   blood service;
i.   Clinical forensic services clinics include the creation of a visum et repertum or a medical certificate based on the forensic examination of the living and forensic psychiatry; and
J.   The service of the body was granted limited to the death of the deceased person at the Health Facility in cooperation with the BPJS Health where the patient was treated as a hearse and did not include a coffin.
(3) Further provisions concerning advanced outpatient health care procedures are set up with BPJS Health ' s Board of Directors.

Paragraph 3
Advanced Outpatient Health Care services
Section 60
(1) Advanced outpatient health care as referred to in Article 58 of the letter b to the participant is required based on the medical indication as evidenced by an outpatient warrant of the physician.
(2) Advanced outpatient health care includes all health care provided on advanced outpatient plus accommodation that is:
a.   non intensive stay treatment; and
B.   Intensive care.
(3) Accommodation or treatment space as referred to in paragraph (2) is as follows:
a.   Class III maintenance room for:
1. Health Guarantee PBI Participants; and
2. Workers ' Participants Are Not Upset Recipients and Participants are not employees who pay dues for the benefit of service in the Class III care room.
B.   Class II care room for:
1. Civil Servants and the retired Civil Servlet of the space I and the chamber group II and his family members;
2. Member of the Indonesian Armed Forces and the retired Indonesian Civil Service member of the room I and room II and his family members;
3. Member of the Polri and retired recipients of Polri Members of the Civil Service of the room I and the chamber group II and his family members;
4. Upah and Non-State Government Employees with salaries or wages up to 1.5 (one in five) times the income is not taxable with the mating status of 1 (one) child, and its family members; and
5. Workers ' Participants Are Not Upset Recipients and Participants are not employees who pay dues for the benefit of service in the class II care room.
c. Class I care space for:
1. State officials and family members;
2. Civil civil servants and retired civil servants of the III room group and room IV and his family members;
3. Member of the Indonesian Armed Forces and the retired Indonesian Civil Service member of the room III and chamber of room IV and his family members;
4. Member of the Polri and the retired National Civil Service member of the Polri Civil Service and room IV along with his family members;
5. Veteran and Pioneer Independence and his family members;
6. widow, widower, or orphaned child of Veterans or Independence Pioneers;
7. Upah and Non-Employees of the Government of the Non-Civil Servants, and the wages of one (1) of the two (two), and two (two) of the income of the child, and the children of their family, and their members, and their families. and
8. Workers ' Participants Were Not Upset Recipients and Participants were not workers who paid dues for the benefit of service in the classroom care room I.

Section 61
(1) In terms of inhospitable space that becomes a full participant ' s right, participants can be treated in a one-tier nursing class.
(2) In the event of circumstances such as referred to in paragraph (1), BPJS Health pays a participant care class in its right.
(3) If the treatment class in accordance with the rights of the participants is available, the participant is placed in the care class who becomes her right.
(4) A higher level of treatment as referred to in paragraph (1) at most (3) days.
(5) In the event of treatment as referred to in paragraph (4) more than 3 (three) days, the difference of such charges becomes the responsibility of the health facility in question or based on the consent of the patient referred to the health facility which equivalent.
(6) In the event of a condition as referred to in verse (1) and verse (5), participants are not subject to a crowdfunding charge.

Section 62.
(1) Participants can increase the nursing room class higher than those that are entitled by following additional health insurance, or pay themselves the difference between the costs guaranteed by BPJS Health based on INA-CBG's rates with expenses payable as a result of improving treatment classes.
(2) The maintenance of the care space class as referred to in paragraph (1) does not apply to the Health Guarantee PBI Participant.

The Fourth Part
Emergency Emergency Service
Section 63
(1) The Emergency Service as referred to in Article 47 of paragraph (3) of the letter c may be made an emergency according to the medical indication of emergency services.
(2) The emergency services as referred to in paragraph (1) are health services that must be provided immediately to prevent the death, severity, and/or disability, in accordance with the health facility ' s ability with certain creteria in accordance with the laws.
(3) The emergency services may be provided by:
a.   First-Level Health Facility;
B.   Advanced Level Health Facilities;
either in partnership with BPJS Health and not working together.
(4) The health facility that does not cooperate with BPJS Health as referred to in paragraph (3) must immediately refer to the health facility in cooperation with BPJS Health after its emergency is resolved and the patient is in condition can be moved.

Section 64
(1) The payment of emergency services carried out by the first level health facility in cooperation with BPJS Health is already included in the capitation component.
(2) Emergency services conducted by first-degree health facilities that do not cooperate with BPJS Health are charged directly by healthcare facilities to BPJS Health.
(3) Further provisions concerning emergency services payments as referred to in paragraph (2) are governed with the BPJS Healthcare Board of Directors.

Section 65
(1) The emergency services charge conducted by advanced referral health facilities in cooperation with BPJS Health is paid according to the INA-CBG ' s degan.
(2) Emergency services charges conducted by advanced-level health facilities that do not cooperate with BPJS Health are charged directly by healthcare facilities to BPJS Healthcare.
(3) The payment of emergency services as referred to in paragraph (2) uses the INA-CBG's tariff that applies in the region.
(4) Tarif INA-CBG's as referred to in verse (3) in accordance with the Hospital class set by the Minister.
(5) The hospital has yet to have a class designation, using the INA-CBG's Hospital Class D fare.

Section 66
Health facilities that provide emergency services both in cooperation or who are not cooperating with BPJS Health, are not allowed to withdraw fees to participants.

The Fifth Part
Drug Services, Health Tools, and
Use Medical Materials
Section 67
(1) Drug service, health care, and used medik materials required as referred to in Article 47 of the paragraph (3) of the d in accordance with medical indications are the rights of the health guarantee participants.
(2) Drug services, medical materials consumes, health tools as referred to in paragraph (1) may be provided on outpatient health care and/or hospitable health facilities at first-level health facilities and referral health facilities Advanced level.
(3) Drug services, health tools, and consumable medical materials provided to the Participants guideline on the list of drugs, and medical materials are used, and the health tools specified in accordance with the provisions of the laws.
(4) His health care facilities and jenets are required to provide drug services, health tools, and disposable medical materials required by Participant in accordance with medical indications.

Section 68
(1) The health tool service at first-level health facilities is already included in the capitation component paid by BPJS Health.
(2) The health care tools at advanced referral health facilities are already included in the INA-CBG ' s package.
(3) The health care facility and its jenets are required to provide the health tools required by Participants according to medical indications.
(4) The health tools that are not included in the INA-CBG's package are paid for by their own claims by BPJS Health.
(5) The type of health tool as referred to in paragraph (3) is set by the Minister.
(6) In special conditions for patient safety, health tools that are not included in the INA-CBG's package as referred to in paragraph (4) can be set by the Clinical Advisory Council with BPJS Health.
(7) The health tools already included in the INA-CBGs package cannot be billed on its own to BPJS Health and cannot be charged to the Participants.
(8) Further provisions on the manner and procedures of healthcare tools that are not included in the INA-CBG's package as referred to in paragraph (6) are governed by the BPJS Healthcare Board of Directors.

Section 69
(1) Drug service and medical materials discharged in first-level health facilities are already included in the capitation component paid by BPJS Health.
(2) Drug services, health tools, and the use of advanced medical materials on advanced referral health facilities are among the components paid in the INA-CBG ' s package.
(3) In terms of the medication required according to medical indications on advanced referral health facilities are not listed in the National Formularium, it can be used other drugs based on the approval of the Medic Committee and the Chief/Director of the Hospital.
(4) Drug services already included in the INA-CBGs package, either in reference to the National Formularium, cannot be charged on its own to BPJS Health as well as not being charged to the Participants.

Section 70
(1) The BPJS Health guarantees the needs of the drug and the examination of the reciprocity of the counter program.
(2) The return program is a health care service given to people with a chronic disease with stable conditions and still require long-term treatment or care to be carried out in the first-degree Health facility. On a recommendation/referral from a specialist/sub specialist who is caring for.
(3) The type of chronic disease as referred to in verse (2), hypertension and diabetes mellitus type 2 and can be adapted to the applicable policy.

Section 71
(1) The remedy program is obtained through the first-degree pharmacist or pharmacy depo of the first-degree health facility in cooperation with BPJS Health.
(2) Examination of feedback programs is provided by a laboratory in cooperation with BPJS Health or as a network of first-level health facilities.
(3) The drug as referred to in paragraph (1) and the allowance check as referred to in paragraph (2) are paid by the BPJS Health outside the capitation fee.
(4) The remedy of the Program is subject to the terms of the paragraph (1) and the examination of the support as referred to in the paragraph (2) are charged collectively through its own claim to the BPJS Health.
(5) The cost of the drug program consists of the price of a drug referring to the National Formularium established by the Minister and coupled with service factors and embalages.
(6) The financing of the drug and the examination of the visitor as referred to in paragraph (4), is exercised in accordance with the provisions of the laws.
(7) Further provisions of service procedures, restrictive terms, and maximal reagents as well as the allowance of reciprocity programs are set up with the BPJS Healthcare Board of Directors.

The Sixth Part
Ambulance Service
Section 72
(1) The ambulance service as referred to in Section 47 of the paragraph (3) of the letter e is the transport service of the referral patient with certain conditions between the health facilities accompanied by an effort or activities maintaining the stability of the patient's condition for Patient safety interests.
(2) Certain conditions as referred to in paragraph (1) must meet the provisions:
a.   patient conditions under medical indication based on the medical recommendation of the caring physician;
B.   The condition of the care class is appropriate for the full participant and the patient has been treated for at least 3 (three) days in one level above her right; or
c. The outpatient return patient who still requires an outpatient service at the destination Health facility.
(3) The ambulance service is only guaranteed when a referral is performed on a health facility that is in cooperation with BPJS or on the emergency case of a health facility that does not cooperate with BPJS Health with life-saving purposes Patient.
(4) The ambulance service is not guaranteed for service as follows:
a.   pick up patients other than from health facilities (home, road, other locations);
B.   delivering patients to other than health facilities;
c. partial referral (shuttle of patients or specimens in order to obtain a support check or action, which is a suite of patient care in one of the health facilities);
D.   ambulance/body car; and
e.   The patient is taking care of the road.
(5) The financing for the ambulance service is not included in the capitation and INA-CBG ' s.
(6) In terms of emergency emergencies, ambulance service of non-cooperative health facilities with BPJS Health can be billing to BPJS Health.
(7) Further provisions on the financing of ambulance services are executed in accordance with the provisions of the laws.

The Seventh Part
Health Skrining Service
Section 73
(1) Health screening services as referred to in Article 47 paragraph (3) of the letter f are given in person and selectively.
(2) Health screening services as referred to in paragraph (1) are intended to detect the risk of disease and prevent further impacts from the risk of certain diseases include:
a.   diabetes mellitus type 2;
B.   hypertension;
c. cervical cancer;
D.   breast cancer; and
e.   Another disease prescribed by the Minister.
(3) Health screening services as referred to in paragraph (2) letters a and letter b begin with the analysis of the health history, which is performed at least 1 (one) years.
(4) In the event that participants are identified as having a risk based on the health history as referred to in verse (3), enforcement is conducted via a specific diagnostic support check.

(5) Participants who have been diagnosed with a particular disease based on diagnostic enforcement as referred to in verse (4) are given treatment according to medical indications.
(6) The health screening service as referred to in paragraph (2) the letter c up to the letter e is performed according to medical indications.
(7) The financing of health screening is not included in the tariff of capitation and the INA-CBGs.
(8) Further provisions on the financing of health screening are carried out in accordance with the provisions of the laws.

BAB V
QUALITY IMPROVEMENT AND THE ADDITION OF HEALTH GUARANTEE BENEFITS
Section 74
(1) Improvement of quality and the addition of Health Guarantee benefits in the hosting of Health Guarantee can be carried out using the health technology assessment assessment results of health technology assessment).
(2) The development of the use of technology as referred to in paragraph (1) after the health technology assessment (2).
(3) The health technology assessment as referred to in verse (2) is conducted under the proposal of the Association of Health Facilities, Health Professates, and BPJS Healthcare.
(4) The health technology assessment as referred to in verse (3) is conducted by the Team Health Technology Assessment (HTA) set up by the Minister.
(5) Team Health Technology Assessment (HTA) as referred to in paragraph (4) in charge of performing assessments of health care categorized in new technologies, new methods, new drugs, special expertise, and other health services At a high cost.
(6) The Health Technology Assessment (HTA) team provides a recommendation to the Minister regarding the viability of health care as referred to in paragraph (5) to be included as a guaranteed health service.

(7) The BPJS Health conducts financial impact analysis and risks to the implementation of the Health Technology Assessment results.
(8) The analysis of the financial and risk impact as referred to in paragraph (7) is submitted to the Minister as consideration of the application of the results of Health Technology Assessment (HTA).

BAB VI
COMPENSATION
Section 75
(1) Required Compensation is granted by BPJS Health to participants if in an unavailable area of the Health Facility which is eligible to meet its medical needs.
(2) The determination of the area is not yet available a Health Facility which is eligible to meet the medical needs of a number of Participants is set forth by the local Health Service at the consideration of the BPJS Health and the Health Facilities Association.
(3) The Branch Office performs coordination with the District Health/City Health Service for the designation of the area as not available health facilities as referred to in paragraph (2).
(4) Compensation as referred to in paragraph (1) is given in form:
a.   cash replacement;
B.   health care delivery; or
c. provision of certain health facilities.

Section 76
(1) Compensation in the form of cash reimbursing as referred to in section 75 paragraph (4) of the letter a replacement of the health care costs provided by the health facility that does not cooperate with BPJS Health.
(2) The compensation reimbursed as referred to in Article paragraph 75 of the paragraph (4) in accordance with the provisions of the laws.

Section 77
(1) To be able to obtain cash compensation, participants residing in the region there are no eligible Health facilities must follow the procedure of a single-level referral service in accordance with applicable terms.
(2) To obtain health care, participants came to a nearby first-level health facility.
(3) If the nearest first-level health facility is referred to in paragraph (2) it is a Health facility in cooperation with BPJS Health, then the payment of the health care is already included in the capitation component It wasn't charged with its own.
(4) The Health Facility as referred to in paragraph (3) is not allowed to charge an additional charge to the Participant.
(5) If the nearest first-level health facility is referred to in verse (2) is a Health facility which is not in cooperation with BPJS Healthcare, then participants pay their health care fees first, then participants Billing for the BPJS Health through the individual claim.
(6) The individual claim as referred to in paragraph (5) is only applied to participants who are eligible for a first-degree health facility to not cooperate with BPJS Healthcare.
(7) In the emergency conditions, participants can directly head to the Hospital without following the applicable level of referral referral system.
(8) The expenses incurred as a result of the Hospital service as referred to in paragraph (7) were charged by the Hospital to BPJS Health, and participants were not charged with crowdfunding.
(9) Further provisions concerning the procedure and the administrative requirements of the cash compensation claim as referred to in paragraph (5) are governed by the BPJS Healthcare Board of Directors.

Section 78
Compensation in the form of health care delivery and the provision of a specific Health Facility as referred to in Article 75 paragraph (4) letter b and c may cooperate with the health service, the health profession organization, and/or association health facilities.

Section 79
(1) If an area is designated as an unavailable area of the Health facility is eligible, then the Branch Office conducts analysis of certain health care needs.
(2) The provision of certain health care facilities as referred to in Verse (1) is the provision of a health care team equipped with medical equipment to provide certain medical services according to the need in the region of the Visited.
(3) The BPJS Health Branch Office next is coordinating with the health service, the health profession organization, and/or the health facilities association to determine the health power delivery mechanism that among others includes:
a.   schedule;
B.   type of health care; and
c. amount of health power.
(4) The delivery of health care guaranteed BPJS health can be done through cooperation with local service, other government agencies, and private.
(5) Further provisions concerning the regulatory procedure of the delivery of healthcare are set up with the BPJS Health ' s Board of Directors.

BAB VII
QUALITY CONTROL AND COST CONTROL
The Kesatu section
General
Section 80
(1) The control of the quality and control of the health care charge is made to ensure that the health care of the Participant is appropriate and is hosted efficiently.
(2) Quality control and cost control as referred to in paragraph (1) includes:
a.   assessment of health technology assessment (Health Technology Assessment) against the development of health care use with technology;
B.   clinical assessment (Clinical Advisory) of the health care provided to the Participant;
c. The study and evaluation of the Health Guarantee Benefits for Participant; and
D.   monitoring and evaluation of the hosting of the Health Guarantee Service by healthcare facilities.
(3) The control of quality and control of the cost of health services to the Participants, as referred to in paragraph (1) and (2) is set by the Minister.
(4) To guarantee quality control and control of health care costs to participants, healthcare facilities in delivering services:
a.   drugs should refer to the National Formularium; and
B.   The Health Tool should refer to the Kompedium of the Health Tool.


Section 81
(1) Health services to health care participants must pay attention to the quality of the service, oriented toward the security aspects of the patient, the effectiveness of action, fitness with the patient ' s needs, as well as cost efficiency.
(2) The application of the healthcare quality control system is conducted thoroughly covering the fulfilment of the quality of the healthcare facility, ensuring the health care process is running by set standards, as well as monitoring the The health of the participants.

Section 82
Hosting quality control and cost by healthcare facilities is done through:
a.   health care settings in running the practice of the profession in accordance with competency;
B.   the utilization of medical reviews and audits;
c. ethics coaching and the discipline of the profession to the health workforce; and/or
D.   Monitoring and evaluation of drug use, health tools, and medical materials are used in regular health care which is implemented through the utilization of the health information system.

Section 83
Implementation of quality control and cost control by BPJS Healthcare is done through:
a.   Quality of the Health Facility's standards.
B.   the standard fulfilment of the health care process;
c. monitoring of the Attendees ' health care.

The Second Part
Quality Control and Cost Control Team
Section 84
In order to host quality control and cost control, BPJS Health forms a quality control and cost control team consisting of elements of the profession organization, academia, and clinical experts divided in the Coordination Team and Technical Team.

Section 85
(1) The Coordinating Team as referred to in Section 84 is at the level:
a.   Center;
B.   Regional Division; and
C.   Branch
(2) The coordination team as referred to in paragraph (1) has the function and authority to do:
a.   the socialization of the health care authority in running the practice of the profession by competence;
B.   list of medical reviews and audits;
c. ethics coaching and the discipline of the profession to the health workforce; and
D.   coordinate with health facilities that work closely with BPJS Health in terms of:
1. The health care settings in the running of the profession practice according to competency;
2. utilization of reviews and medical audits; and
3. ethics coaching and the discipline of the profession to the health workforce.

Section 86
(1) The technical team as referred to in Article 84 is in every health facility in partnership with BPJS Health.
(2) The technical team as referred to in paragraph (1) has the following functions and authority:
a.   request and obtain information for certain cases of identity, diagnosis, history of illness, examination history, and the history of the participant's treatment in the form of a copy/photocopy of the medical records to the Health Facility as needed; and
B.   conducting the monitoring and evaluation of drug use, health tools, and medical materials discharged in regular health care through the utilization of the health information system.

Section 87
In order to ensure quality control and control of the health care costs to BPJS Healthcare Participants, the Minister sets the standard health care tariff which is a reference for the hosting of Health Security.

Section 88
(1) BPJS Health makes payments to health facilities that have provided services to Participants.
(2) The payment of the BPJS Healthcare to health facilities as referred to in paragraph (1) is determined by agreement between the BPJS Health with the health facilities association in each province as well as referring to The standard rate specified by the Minister.
(3) The association of healthcare facilities as referred to in paragraph (2) for first-degree health facilities and advanced level health facilities refers to the Minister ' s Decision.
(4) In terms of payment magnate as referred to in paragraph (2) is not agreed upon by the association of health facilities and BPJS Healthcare, the magnitude of the payment on the Health Guarantee program as it is decided by the Minister.

BAB VIII
REPORTING AND UTILIZATION REVIEW
Section 89
(1) The health facility is required to make a regularly-provided health care report every month to the BPJS Health.
(2) Health facilities are required to implement the Utilization Review periodically and continuously.
(3) BPJS Health performs the implementation of the review utilization by measuring the utilization of services based on rate indicator, ratio as well as cost units.
(4) The BPJS Health based on rate indicator, ratio as well as cost units as referred to in paragraph (3) conduct evaluations and feedback.
(5) The BPJS Health commits a follow-up to the evaluation and feedback results as referred to in paragraph (4) in order control of the health care costs.
(6) Further provisions on the reporting mechanism, Utilization Review is set with the BPJS Health ' s Board of Directors.

BAB IX
CLOSING PROVISIONS
Section 90
The Health Social Security Organizing Board ' s regulations came into force on January 1, 2014.
In order for everyone to know, order the Governing Body Ordinance of the Social Security Act Regulation with its placement in the Republic of Indonesia News.

Set in Jakarta
on January 1, 2014
THE MAIN DIRECTOR OF THE HEALTH SOCIAL SECURITY ORGANIZER BOARD,

THE FACHMI IDRIS

Promulgated in Jakarta
On January 1, 2014.
MINISTER OF LAW AND HUMAN RIGHTS
REPUBLIC OF INDONESIA,

AMIR SYAMSUDIN