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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Back NEWS of the REPUBLIC of INDONESIA No. 1, 2014 BPJS. Health Coverage. The Organization Of The Guidelines.

REGULATIONS GOVERNING BODY HEALTH SOCIAL SECURITY number 1 2014 ABOUT PROVIDENCE HEALTH COVERAGE with the GRACE of GOD ALMIGHTY to the MAIN GOVERNING BODY DIRECTOR SOCIAL SECURITY health, Considering: that in order to implement the provisions of article, article 15, article 17 paragraph (7) of article 17 A, paragraph (6), article 26 paragraph (3), article 31, article 40 paragraph (5), and article 42 paragraph (3) Presidential Regulation No. 12 2013 of health coverage, as amended by regulation of the President Number 111 2013 about changes to the Presidential Regulation No. 12 2013 of health coverage, the need to set Rules governing body social security Health of the Organization of the health coverage;
Remember: 1. Act No. 40 of 2004 on National Social Security Systems (State Gazette of the Republic of Indonesia Number 150 in 2004, an additional Sheet of the Republic of Indonesia Number 4456);
2. Act No. 36 of 2009 about health (State Gazette of the Republic of Indonesia Number 144 in 2009, an additional Sheet of the Republic of Indonesia Number 5063);
3. Act No. 44 of 2009 about hospitals (State Gazette of the Republic of Indonesia Number 153 in 2009, an additional Sheet of the Republic of Indonesia Number 5072);
4. Law Number 24 year 2011 about social security governing body (State Gazette of the Republic of Indonesia Number 116 in 2011, an additional Sheet of the Republic of Indonesia Number 5256);
5. Government Regulation Number 101 in 2012 about Recipient defined contribution health coverage (Gazette of the Republic of Indonesia Number 264 by 2012, an additional Sheet of the Republic of Indonesia Number 5372);
6. Presidential Regulation No. 12 2013 of health coverage (State Gazette of the Republic of Indonesia by 2013 the number 29) as amended by regulation of the President Number 111 2013 regarding changes to the presidential Regulation No. 12 2013 of health coverage (State Gazette of the Republic of Indonesia by 2013 the number 255);
Decide: define: REGULATIONS GOVERNING BODY SOCIAL SECURITY HEALTH of the ORGANIZATION of the health coverage.
CHAPTER I GENERAL PROVISIONS article 1 in regulation governing body Health social security, that is: 1. Health coverage is a guarantee in the form of health protection in order for participants to benefit health care and protection in the meet the needs of basic health care that is given to any person who has paid dues or contributions paid by the Government.
2. the governing body's next Health social security called BPJS health is a legal entity formed to organise Health assurance program.
3. the participant is any person, including aliens who worked the shortest 6 (six) months in Indonesia, which has paid your dues.
4. Dues health coverage is a sum of money paid regularly by participants, employers, and/or Government programs for health coverage.
5. Recipient Dues health coverage hereinafter abbreviated PBI health coverage is poor and people cannot afford health coverage program as participants.
6. Benefits are avail social security rights of participants and/or members of his family.
7. Health facilities health care facilities are used to organize the efforts of individual health service, good promotif, preventive, curative as well as rehabilitative programmes undertaken by the Government, local governments, and/or the community.
8. the first level health care services is a non individual health, including specialised (primary) includes outpatient services and hospitalization.
9. first-level outpatient individual Health Ministry is non administered, including specialised on the first level health care giver for the purposes of observation, diagnosis, treatment, and/or other health services.
10. the first level of inpatient care is the health care of individuals, including specialised and a non implemented on first-level health facility, for the purpose of observation, care, diagnosis, treatment, and/or other medical services, where the participants and/or their family members admitted the shortest one (1) day.
11. Health Service reference advanced level individual health care services is an effort that is, including specialised or sub, including specialised outpatient covering advanced level, advanced level and inpatient hospitalization in the room special care.
12. other health services and other health services are established by the Minister.
13. Health Tools are instruments, apparatus, machines, and/or implants that do not contain the drugs used to prevent, diagnose, alleviate and cure diseases, care for the sick as well as restore health in humans and/or form structure and improve body function.
14. the price of the Indonesian-Based Case Groups are hereinafter referred to as Tariff INA-CBG ’ s is the magnitude of the payment of the claim by the BPJS Health Facilities Health advanced level over a package of services that is based on the classification of the diagnosis of the disease.
15. the Ministry of health is the reference system of organizing health services set up pelimpahan duties and responsibilities of the Ministry of health in reciprocity, either vertically or horizontally.
16. Government employees Non public servants are Employees not fixed, Honorary Officers, a special Staff, and other employees who are paid by the budget of the State Expenditures or budget Revenues Income Shopping area.
17. Indonesia national army which is hereinafter referred to as the TNI personnel/Warrior is a tool of the State in the field of defence are doing their job in matra under the command of the Chief of staff of the combined forces, or under the direction of the Commander of the TNI.
18. the State police of the Republic of Indonesia which is hereinafter referred to as members of the national police is a civil servant in the State police of the Republic of Indonesia that carries out the functions of the police.
19. Virtual Account is a virtual account number provided by the BPJS health to entities and individuals as the destination account in payment of the dues health coverage.
20. The Minister is the Minister who organized a Government Affairs in the field of health.
Article 2 the Organization of health coverage include: a. membership;
b. membership dues;
c. health care providers;
d. quality control and cost control; and e.  reporting and utilization review.
CHAPTER II MEMBERSHIP is considered part of the Common article 3 Membership health coverage include: a. participants;
b. registration of participants;
c. verification and identification of the participants;
d. rights and obligations of the participants;

e. changes to the data and status of the participants;
The second part of Paragraph 1 Participants General article 4 Participants referred to in article 3 letter a consists of: a. participants PBI health coverage; and b.  participants not PBI health coverage.
Paragraph 2 Pax PBI health coverage article 5 Participants PBI health coverage as mentioned in article 4 letter a consists of: a. a person who belongs to the poor; and b.  People are not able to.
Paragraph 3 of the participants rather than article 6 Healthcare PBI Participants not PBI health coverage as mentioned in article 4 subparagraph b consists of: a. Wage Workers and their family members including foreign nationals who work in Indonesia the shortest 6 (six) months and their family members;
b. Workers rather than Wage and their family members including foreign nationals who work in Indonesia the shortest 6 (six) months and their family members;
c. Not Workers and their family members.
Article 7 participants of Wage Workers and their family members including foreign nationals who work in Indonesia the shortest 6 (six) months and members of his family referred to in article 6 letter a consists of: a. the civil servant;
b. TNI members;
c. members of the national police;
d. State officials;
e. Government employees Non public servants;
f. private sector Employees; and g.  Workers who do not include the letter a to letter f who receive wages.
Article 8 instead of Wage Workers and their family members including foreign nationals who work in Indonesia the shortest 6 (six) months and members of his family referred to in article 6 letter b consists of: a. a worker outside the working relationship or self-employed; and b.  Workers who do not include the letter a that is not a wage.
Article 9 (1) is not a worker and members of his family referred to in article 6 letter c consists of: a. Investors;
b. the Employer;
c. the Recipients;
d. a Veteran;
e. pioneer of Independence;
f. widow, widower, or orphans of Veterans or the pioneer Independence; and g.  not the workers who did not include the letter with the letter a to e are able to pay dues.
(2) the recipient of a pension referred to in subsection (1) the letter c consists of: a. the civil servant who quit with pension rights;
b. members of the Indonesian armed forces and members of the national police who stopped the pension rights;
c. State officials who quit with pension rights;
d. the widow, widower, or children orphaned from the recipient of a pension referred to in letter a, letter b, letter c, and who got the rights to a pension;
e. pension recipients in addition to the letter a, letter b, and the letter c;
f. widow, widower, or children orphaned from the pension recipient as stated on the letter e that got the right of retirement.
Article 10 (1) the members of the family referred to in article 6 include the wife/husband, children, stepchildren of a legitimate marriage, and adopted children, as many 5 (five) persons.
(2) children, stepchildren of a legitimate marriage, and adopted children are legitimate as referred to in paragraph (1), the criteria: a. do not or have never been married or had no income of her own; and b.  yet age 21 (twenty one) years old or have not been aged 25 (twenty-five) years who still continue their formal education.
(3) a participant instead of PBI health coverage can include other family members.
(4) other family members referred to in subsection (3) includes a child to four (4) and so on, fathers, mothers, and in-laws.
The third part Registration Participants General 1 article 11 Paragraph (1) the registration of the participants of the health coverage as stipulated in article 3 letter b done, either singly or groups.
(2) registration of participants health coverage referred to in subsection (1) may be exercised: a. data migration; or b.  Manual.
Article 12 registration of participants health coverage as mentioned in article 11 is carried out for: a. PBI health coverage; and b.  Not The PBI Health Coverage.

Paragraph 2 registration of participants of the PBI health coverage Article 13 (1) the registration of the participants of the PBI health coverage as stipulated in article 12 letter a is done by the Minister.
(2) the Minister of Health Assurance PBI participants register referred to in subsection (1) done on data migration as referred to in article 11 paragraph (2) letter a in accordance with the format specified by the BPJS health.
Paragraph 3 the registration of Participants is not a PBI health coverage clause 14 the registration of participants is not a PBI health coverage as stipulated in article 12 letter b made against: a. Wage Workers and their family members including foreign nationals who work in Indonesia the shortest 6 (six) months and their family members;
b. Workers rather than Wage and their family members including foreign nationals who work in Indonesia the shortest 6 (six) months and their family members;
c. Not Workers and their family members.
Article 15 (1) registration of participants health coverage for workers Wage as stipulated in article 2 letter a is done by the Employer.
(2) registration of participants for the workers Wage is done in groups through the entity to the BPJS health.
(3) registration as referred to in paragraph (2) made in data migration in accordance with the format specified by the BPJS health or manually.
(4) the registration data migration as referred to in paragraph (3) was done at least to 1000 (one thousand) prospective participants.
(5) registration manually as mentioned in subsection (3) is carried out by means of: a. come directly to the Office of the BPJS health or through a third party appointed by the BPJS Health;
b. fill out the form and submit the data completeness of potential attendees.
(6) the third party referred to in subsection (5) the letter a include: a. banking;
b. the association profession or other associations;
c. retail; and d.  other institutions.
Article 16 (1) in the event the Employer significantly real-not Health Workers to register the BPJS, workers concerned shall have the right to register himself as a participant in health coverage.
(2) Contribution the participant for the workers who registered himself as a participant in health coverage referred to in subsection (1) remains payable in accordance with the provisions of the legislation regarding health coverage.
Article 17 (1) an employer in the register the workers referred to in Article 15 paragraph (1) should complement the data of potential attendees that include at least: a. the names of potential participants;
b. parent population numbers;
c. date of birth; and d.  the name of the first level health facilities in cooperation with the BPJS health and selected by potential participants.

(2) Health data after receiving the BPJS potential participants as referred to in paragraph (1) the register of participants to the first-level health facilities selected by potential participants.
(3) in the event that participants did not choose the first level facilities, BPJS Health health facilities first level setting.
Article 18 (1) the registration of Workers is not a recipient of the wages and the participants rather than the workers referred to in Article 2 letter b and c letters performed by corresponding to the BPJS health.
(2) the worker is not the recipient of the Wages as referred to in subsection (1) does not include a Retired INDONESIAN ARMY, retired police, Retired civil servants, Retired Officials, veterans and Independence Pioneers.
Article 19 (1) the registration of Workers is not a recipient of the wages and the participants rather than the workers referred to in Article 18 paragraph (1) will be conducted in the offices of a Health region BPJS works include the area where potential participants domiciled or through a third party designated Health BPJS.
(2) the registration referred to in subsection (1) may be made: a. the collective, are: 1. manual by filling out and submitting the form list of participants as well as field attach fitting color photos; or 2.  the migration of the data presented in the form of an agreed data format and submit the fitting color photos.
b. individually by way of filling out the form Fields List of participants (FDIP), attach the photo and shows/shows the document: 1. Original/copy Card Sign residents or family card.
2. For FOREIGN NATIONAL temporary residence permit card shows/fixed (KITAS/KITAP) article 20 residents who do not have a guarantee of Keehatan in an area can be registered by the Government of the region where the population concerned domicile.

The fourth part of the participant's identity verification and Article 21 (1) identity verification and participants referred to in article 3 of the letter c is done by the BPJS Health after receiving data submitted by potential participants.
(2) in the case of the data referred to in subsection (1) is incomplete and/or incorrect, BPJS Health within 10 (ten) working days must inform the prospective participants to deliver the data are complete and correct.
Section 22 Would-be participants in the longest period of 10 (ten) working days since the receipt of the notification referred to in Article 9 paragraph (2) should deliver back data are complete and true to the BPJS health.

Article 23 (1) if based on the results of the verification data of prospective participants complete and correct already stated, BPJS Health published the identity cards of the participants health coverage.
(2) an identity card Participants Health Guarantees as referred to in paragraph (1) contains at least: a. membership number;
b. the name of the participant;
c. date of birth d.  the number of the parent population;
e. name of first-level health facilities in cooperation with the BPJS health and selected by potential participants.
f. the date of issuance of the card.
(3) recording and doing the BPJS Health data keeping Healthcare Participants in the system database (master file) BPJS health.
The fifth part of the rights and obligations of Participants Article 24 the rights and obligations of each of the participants referred to in article 3 letter d this guarantee health coverage by the BPJS Health to participants.

Article 25 (1) each participant has the right to: a. obtain the identity of the participants;
b. get Virtual Account Number;
c. choose the first level health facilities in cooperation with the BPJS Health;
d. benefit health coverage;
e. delivered a complaint to the Health Facilities and/or BPJS health working together;
f. information health services; and g.  additional health insurance program.
(2) the guarantee of Health Benefits as referred to in paragraph (1) letter d include the Ministry of promotif, preventive, curative, and rehabilitative medicine services, including health and medical consumables in accordance with medical needs who required and performed by healthcare providers that cooperated with the BPJS health.

Article 26 each participant is obliged to: a. pay dues;
b. data retention changes report;
c. report on membership status changes; and d.  reported damage and/or loss of identity card Participants health coverage.
The sixth change of Membership Status Data and article 27 (1) change the data and status of membership referred to in article 3 of the letter e that occurs at each participant mandatory BPJS reported to health.
(2) change the data retention referred to in subsection (1) may include: a. first-level health facilities;
b. the place of residence;
c. the place of work and/or the identity of the new Employer;
d. the employment;
e. type of membership;
f. arrangement of family and/or number of participants; and g.  additional family members.
Article 28 any losses and/or costs incurred as a result of delay and/or neglect reporting Participants data changes health coverage becomes a load of participants.

Article 29 membership status changes of the participants of the PBI health coverage be not participants PBI health coverage was done at a time when Participants pay dues for the first time.

Article 30 (1) a change of the status of membership of Participants instead of PBI health coverage be Participants PBI health coverage can be made for: a. Participants Not PBI health coverage disabilities total remained and unable to;
b. Participants Not PBI health coverage that is experiencing LAYOFFS and did not get the job back within 6 (six) months and found not capable to be participants instead of PBI health coverage.
(2) change the status of membership of Participants instead of PBI health coverage be Participants PBI health coverage referred to in subsection (1) is carried out by means of: a. the participant not PBI health coverage disabilities total reported the condition of the defect to local Governments by including a description of the level and type of defect of the authorized physician;
b. Participants not PBI health coverage who experienced termination of the working relationship and not get the job back within 6 (six) months to report to local Government to include affidavits are not capable of an authorized officer.
Article 31 (1) local governments do logging statements changes the status of membership of Participants Not PBI health coverage be Participants PBI health coverage.
(2) the local Government proposes changes to the status of membership of Participants Not PBI health coverage be Participants PBI health coverage to a Minister of Government Affairs menyelengarakan in social field.
Article 32

(1) the Minister of menyelengarakan Affairs of Government in the social field over verify membership status changes of Participants instead of PBI health coverage be Participants PBI health coverage proposed by local governments.
(2) the Minister of menyelengarakan Affairs of Government in the social field do data validation PBI Participants health coverage after coordinating with the Minister of finance.
(3) data validation and Change participant PBI health coverage by the Minister of menyelengarakan Affairs of Government in the social field is performed every 6 (six) months of the budget year is running and is set by the Minister of menyelengarakan Affairs of Government in the social field.
(4) data validation and Change participant PBI health coverage by the Minister of menyelengarakan Affairs of Government in the social field referred to in paragraph (3) submitted to the Minister to be registered as a participant of PBI health coverage to the BPJS health.
CHAPTER III MEMBERSHIP DUES HEALTH COVERAGE Part One General Article 33 (1) Health Guarantee Membership Dues referred to in article 2 letter b mandatory paid by each participant Health assurance program.
(2) the Contribution referred to in subsection (1) must be paid no later than 10 (ten) of each month at the Bank has been cooperating with the BPJS health.
(3) the magnitude of dues health coverage for participants health coverage in accordance with the provisions of the legislation.
Article 34 (1) the BPJS Health do the collection and payment of dues billing to participants.
(2) Bill referred to in subsection (1) at least contains the details of: a. the participant data; and b.  nominal Bill.
Article 35 (1) the Employer is obligated to charge dues of workers, pay dues which becomes his responsibility, and deposit the dues to the BPJS Health no later than 10 (ten) each month.
(2) for the local government Employer, the remittance of dues to the BPJS Health referred to in subsection (1) is done through the account of the State Treasury at least 10 (ten) each month.
(3) when the date is 10 (ten) as referred to in paragraph (1) falls on a holiday, then the dues payable on the next working day.
(4) late payment Dues health coverage referred to in subsection (1) by an employer other than the employer organizer of State, an administrative penalty of 2% (two percent) per month of the total dues are delinquent for at most three (3) months, paid concurrently with the total dues are delinquent by the Employer.
(5) in case of delay in payment of the Dues health coverage referred to in subsection (1) more than three (3) months, the guarantee can be laid off temporarily.
Article 36 Dues participants as stipulated in article 33 paragraph (1) is payable for: a. Participants PBI health coverage;
b. the Employer;
c. Not Wage Workers;
d. Not Workers; and e.  Other family members.
The second part Participants PBI health coverage of article 37 (1) Contribution the participant PBI health coverage as stipulated in article 36 the letter a is payable by the Minister in accordance with the provisions of regulation perundangundangan.
(2) the BPJS Health after receiving the payment referred to in subsection (1) do the reconciliation of data with the Minister.
(3) the Reconciliation referred to in subsection (2) is conducted every 6 (six) months.
(4) if the results of the reconciliation of the data referred to in paragraph (3) occurs less or more payments, excess or lack of such payment will be taken into account in the payment of dues.
(5) the provisions concerning the procedures for the provision of, funds disbursement and accountability contribution referred to in subsection (1) and paragraph (2) as set forth in the regulation of the Minister of finance.
The third part of the Employer's General Article 1 Paragraph 38 employer consists of: a. employer organizer of the State; and b.  Employer in addition to the organizers of the country Paragraph 2 Employer organizer of State Article 39 Employer organizer of State as stipulated in article 38 the letter a consists of: a. the Government; and b.  the local government.
Article 40 (1) the Government as stipulated in article 39 a pay dues participants health coverage for civil servants, members of a Club. TNI, Polri, Member State officials and Government employees Non public servants (2) Contribution the participant referred to in subsection (1) is deposited through the accounts of the State Treasury to the BPJS Health each month.
(3) the BPJS Health after receiving the deposit referred to in subsection (2) to perform data reconciliation with the Finance Minister.
(4) Reconciliation referred to in paragraph (3) was carried out every 3 (three) months.
(5) if the results of the reconciliation of the data referred to in paragraph (4) occurs less or more payments, excess or lack of such payment will be taken into account in the payment of dues.
(6) of the Ordinance the calculation, provision, disbursement and accountability of the Fund levy referred to in subsection (2) and paragraph (3) was carried out in accordance with the provisions of the legislation.

Article 41 (1) of the local government as stipulated in article 39 letter b pay dues participants health coverage for civil servants and Government employees Non public servants area.
(2) Contribution the participant referred to in subsection (1) is deposited through the accounts of the State Treasury to the BPJS Health each month.
(3) the BPJS Health after receiving the deposit referred to in subsection (2) do the reconciliation of data with local governments.
(4) Reconciliation referred to in paragraph (3) was carried out every 3 (three) months.
(5) if the results of the reconciliation of the data referred to in paragraph (4) occurs less or more payments, excess or lack of such payment will be taken into account in the payment of dues.
(6) of the Ordinance the calculation, provision, disbursement and accountability of the Fund levy referred to in subsection (2) and paragraph (3) was carried out in accordance with the provisions of the legislation.
Paragraph 3 an employer other than the Organizer Country Article 42 (1) an employer other than the Organizer country as stipulated in article 38 the letter b pay dues health coverage for workers and himself and menyetorkannya to the BPJS Health at least 10 (ten) each month.
(2) the worker referred to in subsection (1) consists of: a. Private Employees; and b.  Workers who receive wages in addition to the contributions paid by the worker's employer organizer of the State.

(3) the deposit referred to in subsection (1) is done through the Virtual account an Account given by the BPJS Health at the time of registration.
(4) the provisions on procedures and the procedures for payment of dues is governed by rules of the Board of Directors Health BPJS.
The fourth part is not Wage Workers of article 43 (1) participants are Not Wage Workers referred to in Article 36 of the letter c pay dues health coverage for workers and himself and menyetorkannya to the BPJS Health at least 10 (ten) each month.
(2) the deposit referred to in subsection (1) to Virtual accounts given by the BPJS Health at the time of registration.
(3) the payment of Dues may be made for a period of time of one (1) month, three (3) months, 6 (six) months and one (1) year.
(4) the provisions on procedures and the procedures for payment of dues for the workers is not a Wage Worker and not governed by regulations of the Board of Directors Health BPJS.
The fifth section instead of Workers Article 44 (1) Participants are not the Workers referred to in Article 36 d pay dues health coverage for herself and menyetorkannya to the BPJS Health at least 10 (ten) each month.
(2) the participant is not a Worker referred to in subsection (1) who is a Veteran, pioneer of independence, and the recipients of pensions, tuition paid by the Government of kepesertaannya.
(3) the Government paid an additional contribution to Pension Recipients as referred to in paragraph (2) are the responsibility of the Government to the BPJS Health each month.
(4) the recipient of a pension referred to in subsection (2) consists of: a. the civil servant who quit with pension rights;
b. members of the Indonesian armed forces and members of the national police who stopped the pension rights;
c. State officials who quit with pension rights;
d. the widow, widower, or children orphaned from the recipient of a pension referred to in letter a, letter b, letter c, and who got the rights to a pension;
e. pension recipients in addition to the letter a, letter b, and the letter c; and f.  widow, widower, or children orphaned from the pension recipient as stated on the letter e that got the right of retirement.
(5) the recipient of a pension referred to in subsection (3) to pay dues health coverage that become obligations through pension cuts by third-party payers of pensions.
(6) the third-party payer retirement deposit pieces of Dues as mentioned in subsection (5) to the BPJS Health at least 10 (ten) each month.
(7) the BPJS Health after receiving the deposit referred to in subsection (1), subsection (2) and subsection (3) do the reconciliation of data with Financial Menterian and third-party payers of pensions.
(8) a reconciliation of the data referred to in paragraph (7) be carried out every 3 (three) months.
(9) if the results of the reconciliation of the data referred to in paragraph (7) occurs less or more payments, excess or lack of such payment will be taken into account in the payment of dues.
(10) an Ordinance provision, disbursement and accountability of the Fund levy referred to in subsection (1) and paragraph (2) was carried out in accordance with the provisions of the legislation.
Article 45 (1) participants are Not Workers other than those referred to in article 44 paragraph (2) and paragraph (3), pay tuition deposit and Guarantee health for himself to the BPJS Health at least 10 (ten) each month.
(2) the deposit referred to in subsection (1) of the Virtual account via the Account given by the BPJS Health at the time of registration of the participants.
(3) the payment of Dues may be made for a period of time of one (1) month, three (3) months, 6 (six) months and one (1) year.
(4) the provisions on procedures and the procedures for payment of dues for the workers is not a Wage Worker and not governed by regulations of the Board of Directors Health BPJS.
The sixth member of the family of the other Article 46 (1) Contribution the participant for the rest of the family as referred to in article 36 of the letter e participants not PBI health coverage is paid by participants instead of PBI health coverage as stipulated in article 4 and deposited to the BPJS Health no later than 10 (ten) each month.
(2) the deposit referred to in subsection (1) is done through the Virtual account an Account given by the BPJS Health at the time of registration of the participants.
(3) the payment of Dues may be made for a period of time of one (1) month, three (3) months, 6 (six) months and one (1) year.
(4) the provisions on procedures and the procedures for payment of dues for the rest of the family as referred to in paragraph (1) are governed by regulations of the Board of Directors Health BPJS.
CHAPTER IV ORGANIZERS considered part of Public HEALTH SERVICES of article 47 (1) each participant has the right to obtain health services include services promotif, preventive, curative, and rehabilitative medicine services including medical materials and consumables in accordance with the needs of the medically necessary.
(2) health service referred to in subsection (1) includes all first-level health facilities and health facilities, advanced level of other health facilities that are set by the Ministry of Health in collaboration with the BPJS including ancillary health facilities consisting of: a. laboratories;
b. installation of Hospital Pharmacy;
c. pharmacy;
d. blood transfusion unit/Red Cross Indonesia;
e. optical;
f. Consumable service giver Peritonial Ambulatory Dialysis (CAPD); and g.  the practice of Midwives/Nurses or equivalent.
(3) health services guaranteed by the BPJS Health consists of: a. health services at the first level health facilities;
b. health services at the health facility level follow-up;
c. emergency service;
d. the Ministry of health, medicine, medical materials and consumables;
e. service ambulance;
f. health screening services; and g.  other health services established by the Minister;
The second part of health services At the first Level health facilities Paragraph 1 General Article 48 (1) health services at the first level health facilities as stipulated in article 47 paragraph (2) letter a for participants is done by first-level health facilities place registered participants.
(2) a participant referred to in subsection (1) may choose the first level health facilities to another for a period of at least three (3) months.
(3) the first level health facilities as dimksud in subsection (1) consists of: a. public health or equivalent;
b. the practice of doctors;
c. the practice of dentists;
d. Pratama clinic or equivalent including first-level health facilities belonging to the TNI/POLRI; and e.  Hospital Grade D Pratama or equivalent.

Article 49 health services at the first level health facilities consist of: a. the outpatient medical services first rate;
b. health services hospitalization rate first: c. Dental Health Services; and d.  Health care by midwives and nurses.
Paragraph 2 Outpatient medical services first rate article 50 (1) outpatient medical services first rate must have comprehensive health services function in the form of promotif health services, preventive, curative, rehabilitative, and midwifery services emergency medical services including support services which include simple laboratory inspection and service of pharmacy.
(2) the first level health services referred to in subsection (1) for medical services include the following: a. medical cases that can be resolved completely in first-level health services;
b. medical cases that require initial prior to handling the reference;
c. medical cases refer back;
d. the examination, treatment and dental health services act of first degree;
e. the examination expectant mothers, childbirth, nursing mothers, infants and toddlers by a midwife or doctor; and f.  medical rehabilitation basis.
(3) health service Outpatient first level include health services including specialised non which includes: a. administrative services which include administration costs of registration of participants for medical treatment, provision and the granting of letters of referral to secondary health facilities for diseases that cannot be treated at the first level health facilities;
b. promotif and preventive service covering the activities of individual health counselling, basic immunization, family planning, health screening;
c. examination, treatment, and medical consultation;
d. the examination expectant mothers, childbirth, breastfeeding mothers, and infants;
e. efforts of healing of the side effects of contraceptives;
f. actions including specialised medical, both operative and non operative;
g. Ministry of drugs and medical consumables materials;
h. examination of first-level laboratory diagnostic support in the form of a simple examination of blood (Haemoglobin, blood banks, apusan, leukocytes, platelets hematokrit, eosinophils, erythrocytes, blood type, blood creep rate, malaria), urine (color, specific gravity, pH, clarity, leukocyte, erythrocytes), a simple stool (benzidin tests, microscopic worms), when blood sugar;
i. examination of another simple support can be done in first level health facilities;
j. the Ministry referred back from advanced health facilities;
k. programme service refer back;
b.  the implementation of prolanis and home visit; and m.  medical rehabilitation basis.
Paragraph 3 Inpatient health services first rate Article 51 (1) inpatient healthcare first level includes: a. inpatient treatment/care cases that can be resolved completely in first-level health services;
b. aid delivery pervaginam not a high risk;
c. aid delivery with complications and/or penyulit pervaginam for the Health Ministry civil defence Emergency Obstetric Neonatal Basic (PONED);
d. neonatal aid with complications; and e.  blood transfusion service according the competence of health facilities and/or medical needs.
(2) health services hospitalization rate first covering health services including specialised non which includes: a. Administrative services consisting of the registration fee and the administrative fee of other patients that occurred during the process of patient care or health services b.  examination, treatment, and medical consultation;
c. the care and accommodation at the treatment rooms;
d. medical small/simple action by doctors or paramedics;
e. labor per vaginam without penyulit or penyulit;
f. ancillary diagnostic examinations during treatment;
g. Ministry of drugs and medical consumables materials during treatment; and h.  blood transfusion service according to medical indication.
Paragraph 4 Dental Health services at the first level health facilities of article 52 (1) dental health services include the following: a. Administrative services consisting of the registration fee and the administrative fee of other patients that occurred during the process of patient care or health services;
b. examination, treatment, and medical consultation;
c. premedikasi;
d. kegawatdaruratan oro-dental;
e. revocation teeth firstborn (topical, infiltration);
f. repeal of permanent teeth without penyulit;
g. remedies post extraction;
h. tumpatan composite/GIC; and i.  skeling teeth.
(2) dental health services referred to in subsection (1) done by a dentist.
Paragraph 5 health care by midwives and nurses in the first Level health facilities of article 53 (1) in the case of a sub there are no physicians based on the determination of the head of Department health kabupaten/kota, the governing body of a health social security can work together with the practice of midwives and/or nurses in accordance with those powers.
(2) the granting of health care by midwives and Nurses in terms of a sub there are no doctors referred to in subsection (1) includes the service of midwives and nurses with midwife and nurse service coverage in accordance with the competence and those powers.
(4) midwives and nurses referred to in subsection (1) may only do a referral to the physician and/or dentist first level health care giver except in Aid delivery, emergency conditions or patients with special conditions outside the competence of the doctor or dentist first-level health facilities.
The third section of health service at the health facility Level Paragraph 1 General Article 54 (1) the Ministry of health at the health facility level as stipulated in article 47 paragraph (3) the letter b must be awarded to participants upon referral from the first level health facilities at advanced level health facilities.
(2) advanced level health facilities as referred to in subsection (1) consists of: a. primary Clinics or equivalent;
b. General Hospital; and c.  Specialty hospital.
(3) public hospitals and specialized Hospitals as referred to in paragraph (2) letter b and c can be any Government-owned Hospitals, local governments, the TNI, Polri nor private hospital in cooperation with the BPJS health.
Article 55 (1) to get health service at the health facility level, first-level health facilities as stipulated in article 48 paragraph (3) the debtor to do referral system is hierarchical with refers to: a. the regulation of the Minister;
b. the national reference system guidelines; and c.   guidelines for Administration of the Ministry of health of the BPJS.

(2) in carrying out its health services advanced level, first-level health facilities and advanced level tiered referral system is obligatory.
(3) health facilities can do horizontal and vertical reference.
(4) the reference horizontal was done between health services in one level if the referrer is not able to provide health services in accordance with the needs of the patient because of limited facilities, equipment and/or workforce which is temporarily or settled.
(5) vertical Reference is done between the different health service levels, service levels can be done from a lower to a higher level of service or otherwise.
Article 56 (1) a participant may be excluded from the system of health services referral health facilities first on tiered if: a. emergency circumstances occurring;
b. disaster;
c. particulars of patient's health problems;
d. geographical considerations; and e.  consideration of the availability of the facilities (2) particulars of the patient's health problems as referred to in paragraph (2) Letter c is only for cases which had already upheld the plan of terapinya and therapy can only be done in advanced health facilities.
Article 57 (1) compulsory health Facilities providing services in the provision of drugs, including plenary material for medical consumables, health equipment and examination support is needed.
(2) in the event that the required service in the form of outpatient services so that health services can be provided in one place or health facility through collaboration with jejaringnya.
(3) the services provided by health facilities as referred to in paragraph (1) and paragraph (2), is included in the payment kapitasi or non kapitasi for first-level health facilities, and INA CBG ’ s for advanced level health facilities.
(4) further Provisions regarding the procedures of healthcare outside of kapitasi and outside the INA CBG ’ s health facilities provided by the regulations of the Board of Directors with the BPJS ditur health.
Article 58 medical services at the health facility level consists of: a. outpatient health services advanced level; and b.  inpatient health services advanced level.
Paragraph 2 Outpatient health services advanced level Article 59 (1) outpatient health services advanced level referred to in Article 58 the letter a is the nature of the service, including specialised and subspesialistik.
(2) health service outpatient advanced level referred to in subsection (1) includes the following: a. administrative services consisting of the registration fee and the administrative fee of other patients that occurred during the process of patient care or health services b.  examination, treatment and consultation by a specialist, including specialised and subspecialty;
c. medical actions, including specialised in accordance with medical indications;
d. Ministry of drugs and medical consumables materials;
e. the Ministry of health;
f. supporting services for Advanced Diagnostics in accordance with medical indications;
g. medical rehabilitation;
h. service of blood;
i. the service of forensic medicine clinic includes the manufacture of visum et repertum or medical certificate based on forensic examination of living persons and forensic psychiatry examination; and j.  Service bodies was given limited only for participants died post hospitalization in health facilities who work with patients place Health BPJS treated form of pemulasaran bodies and does not include the coffin.
(3) further Provisions regarding the procedure for outpatient health services advanced level is controlled by a Board of Directors ' Regulations BPJS health.
Paragraph 3 Inpatient health services advanced level Article 60 (1) inpatient healthcare advanced level referred to in Article 58 the letter b to the attendees do if needed based on medical indications as evidenced by warrant inpatient care from a doctor.
(2) the form of inpatient health services advanced levels covering all medical services provided in outpatient advanced coupled with accommodation in the form of: a. when the non-intensive care; and b.  When intensive care.
(3) accommodation spaces of treatment referred to in subsection (2) is as follows: a. class III treatment rooms for: 1. the participants of the PBI health coverage; and 2.  Participants Workers rather than Wage and participants not workers who pay dues to the benefits of the services in class III treatment rooms.
b. class II treatment rooms for: 1. Civil servants and retired civil servant the spaces I and the II room with members of his family;
2. the members of the Indonesian armed forces and the recipient of the retiring Members of the INDONESIAN civil servants equivalent to the space I and the II room with members of his family;
3. Members of the national police and the national police Members recipients of equal civil servant of Group I and group spaces spaces II along with members of his family;
4. Participants of the Wage Workers and Government employees Non public servants with salary or wages up to 1.5 (one coma five) times income taxable status to mate with one (1) child, along with members of his family; and 5.  Participants Workers rather than Wage and participants not workers who pay dues to the benefits service at class II treatment rooms.
c. maintenance room class I for: 1. State officials and their family members;
2. Civil servants and retired civil servant of Group III and the room space IV along with members of his family;
3. the members of the Indonesian armed forces and the recipient of the retiring Members of the INDONESIAN civil servants are equivalent classes of spaces III and IV space along with the members of his family;
4. The members of the national police and the national police Members recipients of equal civil servant of Group III and the room space IV along with members of his family;
5. Veterans and Independence Pioneers along with their family members;
6. a widow, widower, or orphans of Veterans or the pioneer Independence;
7. Participants of the Wage Workers and Government employees Non public servants with a salary or wage start 1.5 (one coma five) up to 2 (two) times income taxable status to mate with one (1) child, along with members of his family; and 8.  Participants Workers rather than Wage and participants not workers who pay dues to the benefit of service in a maintenance room class I.
Article 61 (1) in the case of room hospitalization full participant rights, participants can be treated in the treatment of class one level higher.
(2) in case of a State referred to in paragraph (1), pay Health care class BPJS participants fit right.

(3) In accordance with the right care class participants have available, participants are placed in the class of treatments that become his right.
(4) treatment of one level higher as referred to in paragraph (1) the longest of three (3) days.
(5) in the event of treatment referred to in subsection (4) more than 3 (three) days, the difference in the cost is the responsibility of the relevant health facilities or with the approval of the patient was referred to the health facilities that equivalents.
(6) in case the condition referred to in subsection (1) and paragraph (5), participants do not incur fees. urun
Article 62 (1) a participant may increase classroom space treatment is higher than that being right by following the additional health insurance, or pay the difference between the cost of its own that is guaranteed by the BPJS Health based on the price of the INA-CBG ’ s and costs to be paid due to an increase in class treatment.
(2) Increased classroom space treatment referred to in subsection (1) does not apply to participants of the PBI health coverage.
Part four emergency Service Article 63 (1) critical Services as stipulated in article 47 paragraph (3) the letter c can be carried out in accordance with the emergency medical service emergency indication.
(2) Emergency Services as referred to in subsection (1) is the health services should be given as soon as possible to prevent death, severity, and/or disability, in accordance with the capabilities of health facilities with a particular kreteria in accordance with the legislation.
(3) Emergency Services may be provided by: a. first-level health facilities;
b. advanced level health facilities;

either that or Health in collaboration with the BPJS leaving.
(4) health facilities which do not co-operate with the BPJS Health referred to in paragraph (3) should be referred to a health facility in cooperation with the State of health after BPJS daruratnya is resolved and the patient can be moved in condition.
Article 64 (1) the payment of the emergency services conducted by first-level health facilities in cooperation with the BPJS Health is included in the component kapitasi.
(2) Emergency Services are performed by the first-level health facilities were not cooperating with Health BPJS invoiced directly by health facilities to the BPJS health.
(3) the provisions on payment of emergency services as referred to in paragraph (2) is set by the Board of Directors Regulations BPJS health.
Article 65 (1) emergency services Billing done by advanced level referral health facilities in cooperation with the BPJS Health are paid in accordance with INA-CBG ’ s.
(2) emergency services Billing done by advanced level health facilities which do not co-operate with the BPJS Health be billed directly by the health facility to the BPJS health.
(3) the payment of emergency services as referred to in paragraph (2) to use the price of the INA-CBG ’ s prevailing in the region.
(4) price of INA-CBG ’ s referred to in subsection (3) in accordance with the classes of the hospital established by the Minister.
(5) the Hospital does not yet have a class assignment, use the price of the INA-CBG ’ s Hospital grade D.
Article 66 health facilities that provide emergency services both cooperate or not cooperate with BPJS health, may not attract cost to participants.

The fifth section of the Ministry of Health, Medicine, Medical Materials and Consumables Section 67 (1) of the Ministry of health, medicine, medical materials and consumables required as referred to in article 47 paragraph (3) the letter d in accordance with medical indications constitutes rights of the participants of the health coverage.
(2) the service of medicine, medical consumables, health equipment referred to in subsection (1) may be given on an outpatient health care and/or hospitalization in both the first-level health facilities as well as advanced level referral health facilities.
(3) the Ministry of health, drugs, medical consumables and materials given to Participants based on a list of drugs, medical materials and consumables, and health equipment defined in accordance with the provisions of the legislation.
(4) the mandatory jejaringnya and health facilities provide services tool, health medicine, medical materials and consumables required by medical indications of appropriate Participants.
Article 68 (1) the Ministry of health in the first level health facilities is included in the component kapitasi paid BPJS health.
(2) the Ministry of health in advanced level referral health facilities is included in the package of the INA-CBG ’ s.
(3) health facilities and providing mandatory health jejaringnya required by medical indications of appropriate Participants.
(4) Health Tools that are not included in the package INT-CBG ’ s paid with a separate claim by the BPJS health.
(5) the types of health equipment as referred to in paragraph (3) is specified by the Minister.
(6) special conditions for patient safety, health tools that are not included in the package INT-CBG ’ s referred to subsection (4) may be assigned by the Board of Clinical Considerations together BPJS health.
(7) Health Tools already included in package INA CBGs-cannot be charged individually to the BPJS health and cannot be charged to participants.
(8) further Provisions regarding the procedures for and the procedure of the Ministry of health tools that are not included in the package INT-CBG ’ s referred to in subsection (6) is set by the Board of Directors Regulations BPJS health.
Article 69 (1) service of drugs and medical materials consumables in the first level health facilities is included in the component kapitasi paid BPJS health.
(2) the Ministry of health, drugs, medical consumables and materials on advanced level referral health facilities is one of the components of the package paid out in INA-CBG ’ s.
(3) in respect of the drug is needed according to medical indication at advanced level referral health facilities not listed in National Formularium, other drugs may be used with the approval of the Committee and head of the Medical/Hospital Director.
(4) the service of a drug that is included in the package of the INA-CBGs, either referring to Formularium national, cannot be charged individually to the BPJS Health and cannot be charged to participants.
Article 70 (1) of the health guarantees the BPJS needs medication and examination of supporting programs refer back.

(2) the programme referred back is health care that is given to sufferers of chronic diseases with stable condition and still require treatment or long-term nursing care at the first level health facilities on the recommendation/referral of specialists/sub specialists who take care of.
(3) types of chronic diseases as referred to in paragraph (2), hypertension and diabetes mellitus type 2 and can be adjusted with the applicable policy.
Article 71 (1) drug programs refer back obtained through pharmacy or pharmaceutical Depot first-level health facilities who work with Health BPJS.
(2) an examination of the supporting program refer back given by the laboratory that works with health or BPJS as first-level health facilities networks.
(3) the drug referred to in subsection (1) and the supporting examination referred to in subsection (2) is paid by the BPJS Health beyond the cost of kapitasi.
(4) drug programs refer back as mentioned on paragraph (1) and the supporting examination as referred to in paragraph (2) be charged collectively through its own claim to the BPJS health.
(5) the cost of the drug program refer back consists of drug prices that refers to National Formularium set by Ministers and coupled with the factor of service and embalage.
(8) Financing medicine and complementary examination referred to in subsection (4), implemented in accordance with the provisions of the legislation.
(7) further Provisions regarding the procedures of service restriction, these terms, and prescribing the maximum as well as the examination of supporting programs refer back set with Regulation Board of Directors Health BPJS.
The ambulance service of the Sixth part of article 72 (1) of the Ambulance Service as stipulated in article 47 paragraph (3) the letter e is the Ministry of transport of patients with certain conditions between referral health facilities accompanied by efforts or activities to maintain the stability of patient's condition in the interest of patient safety.
(2) the conditions referred to in subsection (1) must satisfy the conditions: a. patient's condition according to medical recommendations based on medical indication from the treating physician;
b. conditions of care appropriate class right full participants and patients already hospitalized at least 3 (three) days processed one level above its due; or c.  the patient referred back hospitalization still need inpatient services in health facilities purpose.
(3) the Ambulance Service is only guaranteed when the reference is done at health facilities in cooperation with the BPJS or in case of emergency health facilities that do not cooperate with the BPJS Health with the aim of rescue the lives of patients.
(4) the Ambulance Service is not guaranteed for the following services: a. patient transfers apart from health facilities (home, road, other locations);
b. take the patient to a health facility;
c. partial reference (shuttle patient or specimen in order to get support or act examination, which is a series of patient care at one of the health facilities);
d. ambulance/hearse; and e.  patients are referred to outpatient back.
(8) financing for the ambulance service is not included in the rate kapitasi and INA-CBG ’ s.
(6) in the event of a State of emergency, the ambulance service of the health facilities that do not co-operate with the BPJS Health billing can be done to the BPJS health.
(7) the provisions on the financing of the ambulance service is carried out in accordance with the provisions of the legislation.
The seventh section of the Ministry of Health Screening Article 73 (1) of the health screening Services as stipulated in article 47 paragraph (3) the letter f is given individually and selective.
(2) the health screening Services as referred to in subsection (1) is intended to detect the risk of illness and prevent the impact of certain disease risk include: a. type 2 diabetes mellitus;
b. hypertension;
c. cervical cancer;
d. breast cancer; and e.  other diseases specified by the Minister.
(3) the health screening Services as referred to in paragraph (2) letter a and letter b begins with a medical history analysis, conducted at least 1 (one) year.
(4) in the case of participants identified risk based on medical history as referred to in paragraph (3), was conducted Diagnostics through enforcement examination of particular diagnostic support.
(5) Participants who have a certain disease based on enforcement of terdiagnosa diagnosis referred to in subsection (4) is given the treatment in accordance with medical indications.
(6) health screening Services as referred to in paragraph (2) Letter c up to letter e done according to medical indication.
(8) Financing healthcare screening is not included in the rate kapitasi and INA-CBGs.
(8) the provisions on the financing of health screening carried out in accordance with the provisions of the legislation.
CHAPTER V, IMPROVED QUALITY and INCREASED HEALTH COVERAGE BENEFITS of article 74 (1) improved quality and increased Healthcare benefits in implementing health coverage can be done using the results of the technology development of health technology assessment).
(2) the development of the use of technology as referred to in paragraph (1) after an assessment of health technologies (health technology assessment).
(3) Health Technology Assessment (health technology assessment) as referred to in paragraph (2) was performed on the basis of a proposal from the Association of health facilities, health professional organizations, and Health BPJS.
(4) Health Technology Assessment (health technology assessment) as referred to in paragraph (3) was conducted by a team of Health Technology Assessment (HTA) formed by the Minister.
(5) the team of Health Technology Assessment (HTA) referred to in subsection (4) is in charge of doing the assessment of health services categorized in new technologies, new methods, new medicine, specialty, and other health services with high costs.
(6) the team of Health Technology Assessment (HTA) provide recommendations to the Minister regarding the appropriateness of health services as referred to in paragraph (5) to be included as a health service that is guaranteed.
(7) Health BPJS do financial impact analysis and Risk Assessment results against implementations of health technology (Health Technology Assessment).
(8) the financial impact and risk Analysis as referred to in paragraph (7) submitted to the Minister as a result of the application of the consideration of Health Technology Assessment (HTA).
CHAPTER VI COMPENSATION Article 75

(1) a mandatory Compensation given by the BPJS Health to participants when in an area not yet available health facilities that qualify to meet his medical needs.
(2) the determination of areas not yet available health facilities that qualify to meet the medical needs of a number of Participants are set by local Health Agency discretion BPJS health and Health Facilities Association.
(3) regional offices conduct coordination with health service district/city for regional assignment not available health facilities as referred to in paragraph (2).
(4) the compensation referred to in subsection (1) is given in the form of: a. replacement of cash;
b. delivery of health workers; or c.  the provision of certain healthcare facilities.
Article 76 (1) Compensation in the form of reimbursement of cash as referred to in section 75 subsection (4) the letter a in the form of reimbursement for the costs of health services provided by health facilities that do not cooperate with the BPJS health.
(2) the replacement of the compensation referred to in Section 75 subsection subsection (4) in accordance with the provisions of the legislation.
Article 77 (1) to be able to obtain cash compensation, participants living in the territory there are no health facilities must follow the procedure appropriate tiered referral service conditions.
(2) to obtain health services, participants came to the first level health facilities nearby.
(3) when the nearest first-level health facilities as referred to in paragraph (2) is collaborating with the health facilities Health BPJS, then payment for health services is included in the component kapitasi cannot be charged.
(4) health facilities as referred to in paragraph (3) may not charge additional fees to participants.
(5) when the nearest first-level health facilities as referred to in paragraph (2) is not a health facility in collaboration with the Health, then BPJS participants pay a health service fee in advance, and then participants invoice BPJS Health through individual claims.
(6) individual Claims as referred to in subsection (5) is only imposed on participants who obtain services at the first level health facilities were not cooperating with Health BPJS.
(7) In emergency conditions, participants can go directly to the hospital without following applicable tiered referral system.
(8) the costs incurred due to Hospital services as referred to in paragraph (7) may be billed by the hospital to the BPJS health, and participants do not incur fees. urun
(9) further Provisions regarding the procedures and requirements of its administrative HR cash compensation claims as referred to in subsection (5) is set by the Board of Directors Regulations BPJS health.
Article 78 the compensation in the form of delivery of health care personnel and the provision of certain healthcare facilities as referred to in article 75 (4) paragraph letter b and c can work together with the health service, the health profession organizations, and/or the Association of healthcare facilities.

Article 79 (1) In an area designated as a regional Health facilities are not eligible, then the Branch Office perform specific health workforce needs analysis.
(2) the provision of a particular health facility referred to in subsection (1) in the form of the provision of a team of health workers equipped with medical equipment to provide certain medical services according to the needs in the region that will be visited.
(3) regional offices Health BPJS next coordinate with health services, the health profession organizations, and/or the Association of healthcare facilities to determine the mechanism of delivery of health workers which include: a. a schedule;
b. types of health workers; and c.  the number of health workers.
(4) delivery of health workers who can first health BPJS guaranteed through cooperation with local service, other government agencies, and private.
(5) further Provisions regarding shipping procedures health workers is set by regulation of Board of Directors Health BPJS.
CHAPTER VII QUALITY CONTROL and COST CONTROL Part One General Article 80 (1) quality control and control the cost of health care is done to ensure health services to participants in accordance with the specified quality and organized efficiently.
(2) quality control and cost control as referred to in subsection (1) include the following: a. assessing health technologies (Health Technology Assessment) towards the development of the use of health services by technology;
b. consideration of clinical (Clinical Advisory) for health services provided to Participants;
c. review and evaluation over health coverage Benefits for participants; and d.  monitoring and evaluation in the Organization of Healthcare services by healthcare facilities.
(3) quality control and cost control of medical services to participants, as referred to in paragraph (1) and (2) specified by the Minister.
(4) to ensure quality control and cost control of medical services to participants, providing services in health facilities: a. drug should refer to National Formularium; and b.  Health equipment must refer to the compendium of health equipment.

Article 81 (1) medical services to participants of health coverage should pay attention to the quality of service, patient safety aspect-oriented, the effectiveness of the Act, compliance with the needs of the patient, as well as cost efficiency.
(2) the application of quality control system of the Ministry of health coverage is done thoroughly covers the fulfillment of standard quality health facilities, ensuring health services process goes according to standards set forth, as well as external monitoring the health of the participants.
Article 82 the Organization of quality control and costs by health facilities is done through: a. setting authority health workers in carrying out the practice of the profession of appropriate competencies;
b. utilization review and medical audit;
c. coaching ethics and discipline of the profession to health workers; and/or d.  monitoring and evaluation of the use of the drug, health equipment, medical materials and consumables in the Ministry of health periodically executed through utilization of health information systems.
Article 83 the Organization of quality control and cost control by the BPJS Health done through: a. the fulfilment of quality standards of Health Facilities;
b. fulfillment of standard process of health services; and c.  external monitoring of the health of the participants.
The second part of a team of quality control and Cost Control


Article 84 in the framework of the Organization of quality control and cost control, BPJS Health formed a team of quality control and cost control which consists of professional organizations, academia, and clinical experts in Coordination Team and the technical team.

Article 85 (1) Team Coordination as referred to in Article 84 are at the level of: a. the Centre;
b. Regional Divisions; and c.  Branch (2) Team coordination as referred to in paragraph (1) has the functions and authorities of committing: a. socializing health care personnel authority in the running of the practice of the profession of appropriate competencies;
b. utilization review and medical audit;
c. coaching ethics and discipline of the profession to health workers; and d.  coordinate with health facilities who work with Health BPJS in terms of: 1. the settings of the authorities of the health workforce in the running of the practice of the profession of appropriate competencies;
2. utilization review and medical audit; and 3.  Coaching ethics and discipline of the profession to health workers.
Article 86 (1) technical team as stipulated in article 84 be at every health facility in cooperation with the BPJS health.
(2) technical team referred to in subsection (1) has the functions and authority of the following: a. ask and get information for the particular case regarding the identity, diagnosis, disease history, examination history, and a history of the treatment of participants in the form of a copy of a medical record/copy to health facilities as needed; and b.  monitoring and evaluation of the use of the drug, health equipment, medical materials and consumables in the Ministry of health on a regular basis through the utilization of health information systems.
Article 87 to ensure quality control and cost control of medical services to participants of the BPJS health, the Minister set the standard price of health services became the reference for the Organization of the health coverage.

Article 88 (1) to make a payment to the health of the BPJS health facility that has been providing services to the participants.
(2) the magnitude of payments made to health care facilities Health BPJS referred to in subsection (1) is determined on the basis of agreement between the BPJS Health with health facilities Association in each province as well as the standard reference to the rates fixed by the Minister.
(3) health facilities Association referred to in subsection (2) for the first level health facilities and health facilities are advanced level refers to the decision of the Minister.
(4) in terms of the magnitude of the payments referred to in subsection (2) is not agreed upon by the Association of health facilities and Health BPJS, quantity payment for Healthcare programs as decided by the Minister.
CHAPTER VIII REPORTING and UTILIZATION REVIEW article 89 (1) mandatory reporting for health facilities health care activities are given regularly every month to the BPJS health.
(2) compulsory health Facilities apply a Utilization Review regularly and continuously.
(3) implementation of utilization do Health BPJS review by measuring the utilization of service based on the indicator rate, ratio and unit cost.
(4) based on Health indicators BPJS rate, ratio and unit cost as referred to in paragraph (3) did the evaluation and feedback.
(5) the BPJS Health did a follow-up top evaluation results and feedback as referred to in paragraph (4) in order to control healthcare costs.
(6) further Provisions regarding the reporting, Utilization Review mechanisms established by regulation of the Board of Directors Health BPJS.
CHAPTER IX PROVISIONS COVER Article 90 of regulation governing body this health social security came into force on January 1, 2014.

In order to make everyone aware of it, ordered the enactment of regulations governing body this health social security with its placement in the news of the Republic of Indonesia.

Established in Jakarta on January 1, 2014, the MAIN GOVERNING BODY DIRECTOR SOCIAL SECURITY health, FACHMI IDRIS Enacted in Jakarta on January 1, 2014.

MINISTER of LAW and HUMAN RIGHTS REPUBLIC of INDONESIA, AMIR SYAMSUDDIN FNFOOTER ();

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