Indonesia launched its universal health insurance system in 2014. Commonly referred to as “BPJS,” this system requires even foreign nationals working in Indonesia for six months or longer to enroll. Accordingly, companies entering the Indonesian market are obligated to register their employees under BPJS and cover a portion of the insurance premiums.

This article provides an overview of the BPJS system, including the types of coverage, the procedures for enrolling employees, the cost-sharing responsibilities of employers, and the steps and precautions for utilizing the insurance.

What is BPJS?

Indonesia’s national social security system is known as SJSN (Sistem Jaminan Sosial Nasional). It is divided into two components: health insurance and workers’ social security. These are managed by:

• BPJS Kesehatan (Health Insurance)
• BPJS Ketenagakerjaan (Workers’ Social Security)

These are collectively referred to as “BPJS.” This article focuses primarily on BPJS Kesehatan, with a summary of BPJS Ketenagakerjaan provided at the end.

Overview of Indonesia’s Health Insurance Program: BPJS Kesehatan

Launched in 2014, BPJS Kesehatan has achieved an enrollment rate of about 86% as of 2022.

Eligibility for BPJS Kesehatan

All Indonesian citizens are required to enroll. Foreign nationals working in Indonesia for six months or more are also required to participate. Coverage includes the insured, a spouse, and up to three children (under 21 or under 25 if in education). Additional family members require 1% extra premium. Dual-income households must enroll separately.

Source: Ministry of Health, Japan – 2019 Overseas Labor Policy Report

Scope of Coverage under BPJS Kesehatan

Services Covered

BPJS covers outpatient and inpatient care, maternity, and medications—only within affiliated hospitals and within regulated service categories.

Services Not Covered

• Overseas medical care
• Addiction treatment
• Self-inflicted injury
• Alternative/experimental therapies
• Contraceptives
• Cosmetic procedures
• Home health devices
• Occupational injury treatments
• Infertility treatment
• Orthodontics

Source: KOMPAS.com

Coordination of Benefits (COB) Program

COB allows additional private insurance to cover services not included in BPJS. It may cover room upgrades and non-affiliated hospital care within limits. As of 2018, COB was adopted by only 757 companies (approx. 1.8% of employees).

Source: Kontan.co.id

Premiums and Employer Contributions for BPJS Kesehatan

BPJS Kesehatan Premiums and Employer Contribution Rates

1. Wage-based Workers

• Premium: 5% of monthly salary (base + fixed allowances)
• Employer pays 4%, employee 1%
• Premium cap: IDR 12 million (~USD 770); floor: regional minimum wage

Note: Revised in August 2022 from 3%/2% to 4%/1% split.

2. Non-Wage and Non-Working Participants

Fixed premium by hospital room class:

• Class III: IDR 42,000 (IDR 35,000 by individual + IDR 7,000 subsidy)
• Class II: IDR 100,000
• Class I: IDR 150,000

Source: BPJS Kesehatan

Medical Insurance “BPJS Kesehatan” Classifications

BPJS classifications refer to the “inpatient room class.” Room classes are determined by factors such as the number of beds per room and whether the room is equipped with air conditioning or a fan. Although the types of medical treatments, services, and medications available to insured individuals are supposed to be the same across all classes, differences may exist depending on the hospital.

There are five room classes: VVIP, VIP, Class 1, Class 2, and Class 3. Among these, Class 1, Class 2, and Class 3 are covered under BPJS depending on the premium amount paid. By paying the difference at the time of admission, it is also possible to choose a higher-grade room, including VVIP or VIP.

Classification by Salary

As mentioned above, for non-wage workers and non-working individuals, the insurance premium varies depending on the desired inpatient room class. On the other hand, for wage-based workers, including employees of Japanese companies, the room class is determined based on monthly salary as follows:

• Employees with a monthly salary over IDR 4,000,000: Class 1
• Employees with a monthly salary up to IDR 4,000,000: Class 2
• Dismissed employees: Class 3
  Note: Dismissed employees can continue to receive benefits for up to six months without paying premiums after termination.

Source: Gadjian.com

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Company Formation in Indonesia

Procedures for Japanese Companies to Register Employees for BPJS Kesehatan

Company Registration

1. Register company via BPJS website or eDabu
2. Activate eDabu account via email link

Employee Registration

1. Input employee data (name, salary, ID, family clinic, dependents)
2. Pay premiums via designated banks (Mandiri, BRI, BNI) or digital channels
3. Print insurance card via Mobile JKN app or local BPJS office

Source: Gadjian.com

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How to Use BPJS Kesehatan Services

1. Visit registered primary care provider
2. Obtain referral to BPJS-affiliated hospital
3. Get treatment and apply coverage at BPJS counter

Direct hospital visits without referral are not covered (except emergencies).

Considerations for Japanese Companies When Implementing BPJS Kesehatan

BPJS is effectively “free” healthcare—but only within defined hospitals and services. The process is complex and foreign nationals may find the system difficult. Many companies provide supplementary private insurance.

It is important to educate employees on how to use BPJS and any additional plans.

Potential Changes to the BPJS Kesehatan System

As of September 2022, BPJS is considering replacing the room class system with KRIS (Kelas Rawat Inap Standar). Pilot testing is ongoing. Implementation timeline and criteria are yet to be determined.

Sources:

1. Detiksumut
2. Kanal Berita PEMKAB BATANG

Overview of BPJS Ketenagakerjaan (Workers’ Social Security Program)

Coverage and Premiums of the Workers’ Social Security Program “BPJS Ketenagakerjaan”

Launched July 2015, it consists of:

Program	Description	Contribution
JKK (Work Accident)	Medical & compensation for work-related incidents	0.24–1.74% by employer
JKM (Death Benefit)	Non-work-related death benefit	0.3% by employer
JHT (Old Age Security)	Lump-sum payout at retirement	3.7% by employer, 2% by employee
JP (Pension)	Monthly pension (various types)	2% by employer, 1% by employee

JHT can be withdrawn upon resignation (e.g., expatriates returning home).

Eligibility

• All employees under non-government employers
• Non-wage workers (self-employed)
• Foreign nationals working ≥6 months
  Note: Foreigners are exempt from JP (pension) participation.

Sources:

1. Ministry of Health, Japan
2. KOMPAS.com

Understand BPJS Thoroughly for a Smooth Business Expansion into Indonesia

BPJS differs greatly from Japan’s system. BPJS Kesehatan still faces challenges in coverage and usability. Many private hospitals are not affiliated, and benefits are limited.

Nevertheless, it is a vital safety net. Companies should consider combining BPJS with private insurance and ensure that employees understand how to use the available systems.