Does BPJS Include Insurance? The difference with Private Insurance

Hello friends! This time I want to discuss BPJS and private insurance. Do you already know what BPJS and private insurance are? What are the differences and advantages of each? Come on, see my review below!


BPJS is the abbreviation of the Social Security Administrative Body. BPJS Health is health insurance organized by the government to provide health protection for all Indonesian people. BPJS Health is a change from PT Askes (Persero) which previously managed health insurance for civil servants and the TNI/Polri.

Private insurance

Private insurance is health insurance organized by private companies that have business licenses from the Financial Services Authority (OJK). Private insurance offers a wide range of health insurance products with varying benefits and premiums. Private insurance is usually aimed at the upper middle class who want better and faster health services.

Does BPJS include insurance?

In a way, BPJS Health is included as insurance. The difference is, insurance from BPJS is provided by the government, not by private companies. This definition is also in line with the definition of insurance contained in Law No. 40 of 2014 which states that insurance is a form of agreement between the policyholder and the insurance provider. Then, what are the differences between BPJS Kesehatan and private insurance? Here I summarize some of the main differences between these two types of health insurance:
    1. premium . Premiums are fees that must be paid by insurance participants every month to get health protection. The BPJS Health premium is determined by the government based on Law No. 24 of 2011 and is divided into three classes, namely class I, II, and III. BPJS Kesehatan premiums range from IDR 42,000 to IDR 150,000 per month. Meanwhile, private insurance premiums are determined by each insurance company based on the type of product, benefits, age, gender, and other risk factors. Private insurance premiums are usually higher than BPJS Health premiums and can reach millions of rupiah per month.
    2. Benefits . Benefits are the rights that are obtained by insurance participants when experiencing health risks covered by the insurance policy. BPJS Health benefits include basic, advanced and inpatient health services at first-level health facilities (puskesmas or clinics), second-level (type C or D hospitals), or third-level (type A or B hospitals) according to the class of participant . BPJS Health benefits also include referral services to major or overseas hospitals if needed. Private insurance benefits vary depending on the product chosen by the participant. Some general benefits offered by private insurance include outpatient services, inpatient care, emergency care, surgery, childbirth, dental, eye, critical illness, daily compensation, death benefits, and others. Private insurance benefits are usually more extensive and flexible than BPJS Health benefits.
    3. Service . Service is the way insurance providers provide services to insurance participants in terms of claims, administration, information, and others. The BPJS Kesehatan service is famous for its tiered referral system which requires participants to come to the first level health facility before being referred to a higher level health facility. BPJS Kesehatan services also often experience long queues, limited facilities and medical personnel, and denial or restriction of services in several hospitals. Private insurance services are usually faster and easier because participants can come directly to a specialist doctor or hospital of choice without needing a referral. Private insurance services are also more friendly and professional because participants can contact customer service or insurance agents to get information or assistance.
    4. Membership . Membership is a person’s status as a member or not a member of an insurance program. BPJS Health membership is mandatory for all Indonesian citizens and must be registered by employers for formal workers. BPJS Kesehatan membership is also for life and cannot be canceled unless for certain reasons such as death or becoming a citizen of another country. Private insurance participation is voluntary for anyone who wants to have additional health protection apart from BPJS Kesehatan. Private insurance participation is also temporary and can be canceled at any time by the participant or insurance provider in accordance with the policy provisions.
    5. Limit . Limit is the maximum limit of coverage given by insurance providers to participants in one policy year. There is no or unlimited limit for BPJS Health as long as participants meet the administrative and medical requirements to get health services according to the provisions. However, BPJS Health limits can vary depending on financial conditions and government policies. Private insurance limits exist or are limited according to the amount of premium paid by the participant. Private insurance limits are usually higher than BPJS Health limits and can reach billions of rupiah per year.
Baca Juga  Apa itu Asuransi Perjalanan? Jenis Asuransi yang Jarang di Dengar
So, those are some of the differences between BPJS Health and private insurance that you need to know. Hopefully this article is useful for those of you who are looking for information about health protection in Indonesia. That’s all from me, see you in the next article!
Notify of
Inline Feedbacks
View all comments