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Update 2025! List of 140+ Diseases Not Covered by BPJS
A rather shocking news for the public appeared in the year 2025, namely the release of a list of diseases not covered by BPJS. Previously, the existing list was available, but not widely known to the Indonesian public.
As a program of public health insurance, the Social Security Agency (BPJS) Health continuously updates its services. This is not just related to membership classes and the amount of regular contribution payments, but also to the diseases that are covered and those that are not covered.
However, it was revealed in an article on social media, specifically in Tribun Medan, that this rule is actually an old regulation, which covers more than 140 diagnoses according to the competencies of Primary Health Care Facilities (FKTP) or can be resolved at that health facility. Referrals can be made if they are in accordance with the indications for specialist referrals referring to the Indonesian Doctor Competency Standards 2021.
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Why is this done?
The implementation of this rule, established by Presidential Regulation Number 82 of 2018 regarding Health Insurance, essentially specifies the types of health services that are not covered by BPJS benefits.
The regulations that serve as the basis also govern the procedures and other provisions related to the organization of health insurance nationwide.
So why is this regulation enforced?
The reason is to optimize treatment in FKTP so that access to health services for every citizen can become more equitable. On the other hand, this regulation is also enforced to avoid the accumulation of participants in a certain health facility, which could hinder the services that should be provided.
This means that the list of diseases not covered by BPJS does not refer to the cessation of health services, but rather to optimize services in FKTP so that complaints can be resolved without the need for referrals to advanced health facilities.
List of 140+ Diseases Not Covered by BPJS Complete with Services Included as Exceptions
1. 140+ Diseases Not Covered by BPJS.
Completely, here is a list of 144 diseases not covered by BPJS based on the latest applicable regulations.
- Fever seizures
- Tetanus
- HIV/AIDS without complications
- Tension headache
- Migraine
- Bell’s Palsy
- Vertigo
- Somatoform disorder-Insomnia
- Foreign body in the conjunctiva
- Conjunctivitis
- Subconjunctival hemorrhage
- Dry eye
- Blepharitis
- Hordeolum
- Trichiasis
- Episcleritis
- Mild hyperopia
- Mild myopia
- Mild astigmatism
- Presbyopia
- Night blindness
- Otitis externa
- Otitis media acute
- Cerumen prop
- Motion sickness
- Furuncle on the nose
- Acute rhinitis
- Vasomotor rhinitis
- Foreign body
- Epistaxis
- Influenza
- Whooping cough
- Pharyngitis
- Tonsillitis
- Laryngitis
- Bronchial asthma
- Acute bronchitis
- Pneumonia, bronchopneumonia
- Pulmonary tuberculosis without complications
- Essential hypertension
- Oral candidiasis
- Oral ulcer
- Parotitis
- Infection in the umbilicus
- Gastritis
- Gastroenteritis
- Gastroesophageal reflux
- Typhoid fever
- Food intolerance
- Food allergy
- Food poisoning
- Hookworm disease
- Strongyloidiasis
- Ascaris infection
- Schistosomiasis
- Taeniasis
- Hepatitis A
- Bacillary dysentery
- Grade 1/2 hemorrhoids
- Urinary tract infection
- Gonorrhea
- Uncomplicated pyelonephritis
- Phimosis
- Paraphimosis
- Duh syndrome
- Lower urinary tract infection
- Vulvitis
- Vaginitis
- Bacterial vaginosis
- Salpingitis
- Normal pregnancy
- Complete spontaneous abortion
- Iron deficiency anemia in pregnancy
- 1st/2nd degree perineal rupture
- Hair follicle abscess
- Mastitis
- Cracked nipple
- Inverted nipple
- Type 1 diabetes
- Type 2 diabetes
- Mild hypoglycemia
- Protein
- energy malnutrition
- Vitamin deficiency
- Mineral deficiency, dyslipidemia
- Hyperuricemia
- Obesity
- Iron deficiency anemia
- Lymphadenitis
- Dengue fever
- Malaria
- Uncomplicated leptospirosis
- Anaphylactic reaction
- Ulcer on the leg
- Lipoma
- Vulgaris wart
- Molluscum contagiosum
- Uncomplicated herpes zoster
- Uncomplicated measles
- Uncomplicated chickenpox
- Uncomplicated herpes simplex
- Impetigo
- Ulcerative impetigo
- Superficial folliculitis
- Furuncle, carbuncle
- Erythrasma
- Erysipelas
- Scrofuloderma
- Leprosy
- Syphilis stage 1 and 2
- Tinea capitis
- Tinea barbae
- Tinea facialis
- Tinea corporis
- Tinea manus
- Tinea unguium
- Tinea cruris
- Tinea pedis
- Pityriasis versicolor
- Mild mucocutaneous candidiasis
- Cutaneous larva migrans
- Filariasis
- Head lice
- Pubic lice
- Scabies
- Insect bite reaction
- Irritant contact dermatitis
- Atopic dermatitis
- Nummular dermatitis
- Napkin eczema
- Seborrheic dermatitis
- Pityriasis rosea
- Mild acne vulgaris
- Suppurative hidradenitis
- Perioral dermatitis
- Miliaria
- Acute urticaria
- Exanthematous drug eruption,
- fixed drug eruption
- Laceration wound, puncture
- First and second-degree burn
- Blunt force trauma
- Sharp object trauma
If referring to the explanations provided, the series of diseases that are not covered by BPJS ideally can be cured or addressed at the FKTP which is the nearest health facility for the community. If further symptoms are then found, referrals can still be given as long as the predetermined criteria are met.
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21 Health Services Not Covered by BPJS.
In addition to the 140+ diseases mentioned above, there are also several health services that are not practically covered by BPJS. The services or actions referred to are as follows.
- Diseases in the form of epidemics or extraordinary events
- Beauty and aesthetic related treatments
- Tooth alignment such as braces
- Diseases resulting from criminal acts, such as abuse or sexual violence
- Diseases or injuries resulting from self
- harm or suicide attempts
- Diseases due to alcohol consumption or drug dependence
- Treatment for infertility or sterility
- Diseases or injuries resulting from events such as riots
- Healthcare services provided abroad
- Medical treatments and procedures categorized as experimental or trial
- Complementary, alternative, and traditional treatments not established as effective based on health technology assessments
- Contraceptive devices
- Household health supplies
- Health services that do not comply with the provisions of laws and regulations, consisting of self-requested referrals and other health services that do not comply with laws and regulations
- Health services in health facilities that do not cooperate with BPJS Health, except in emergencies
- Health services for diseases or injuries due to work accidents or employment relations covered by work accident insurance programs or are the responsibility of the employer
- Health services covered by mandatory traffic accident insurance programs up to the amount covered by the traffic accident insurance program according to the rights and class of care of the participants
- Certain health services related to the Ministry of Defense, the Indonesian National Army, and the National Police
- Health services organized for social service purposes
- Services already covered by other programs
- Other services that are not related to the benefits of the health insurance provided.
So what does it mean that all medical costs must be borne by oneself?
In primary health care facilities, treatment will be provided according to the applicable procedures. However, if health complaints do not improve, you will receive a referral to seek treatment at the recommended advanced health care facility.
On the other hand, concerns arise when coverage is not provided for various diseases that are not on this list. As many people know, medical costs are not cheap, and often require follow-up care that is also quite expensive.
So what is the solution to the need for medical expenses and the treatment of various diseases that are not covered by BPJS?
Supplementary Health Insurance becomes the answer to these concerns.
Health Insurance from PT AXA Insurance Indonesia.
PT AXA Insurance Indonesia truly understands the needs of the Indonesian people to receive the best healthcare services in every situation. This is why the SmartMedicare Domestic Insurance product is the right choice to address your concerns.
This health insurance is truly reliable and trustworthy, as it can provide benefits in various undesired situations due to illness or other health conditions. This insurance is a health insurance product specifically designed to meet your needs for health protection against medical treatment costs due to illness or accidents. With this insurance, you will receive easy healthcare services with a cashless system at hospitals or clinics affiliated with PT AXA Insurance Indonesia, which has a very extensive network.
Also read: Leptospirosis, One of the Diseases of the Rainy Season
PT AXA Insurance Indonesia always provides solutions for various protection needs you have. In response to the list of diseases not covered by BPJS as mentioned above, SmartMedicare Domestic Insurance can be the solution. Contact us immediately, and get complete information regarding this insurance right now!
Referensi:
- https://www.cnbcindonesia.com/lifestyle/20250413141303-33-625575/daftar-terkini-21-penyakit-tak-ditanggung-bpjs-kesehatan
- https://fahum.umsu.ac.id/info/cek-21-penyakit-tidak-ditanggung-bpjs-kesehatan-di-2025
- https://medan.tribunnews.com/2025/01/15/daftar-144-penyakit-yang-tidak-ditanggung-bpjs-kesehatan-2025-ada-apa-saja?page=all#goog_rewarded
- https://www.antaranews.com/berita/4877133/21-penyakit-dan-layanan-yang-tidak-ditanggung-bpjs-kesehatan-2025
- https://rri.co.id/nasional/1261727/bpjs-kesehatan-beberkan-alasan-tidak-menanggung-semua-pengobatan
- https://www.liputan6.com/hot/read/5904541/bpjs-kesehatan-tidak-mengcover-144-penyakit-ternyata-begini-faktanya
- https://bumame.com/news/daftar-penyakit-yang-ditanggung-bpjs
