Hospitalization: Procedures and Rules You Need to Know from PT AXA Insurance

When your health is compromised, visiting a healthcare facility is highly recommended. The examination will determine whether you require inpatient or outpatient care, depending on your condition as determined by the doctor and medical staff.

In Indonesia, the issue of inpatient care is nothing new. This facility is provided by the public health insurance program, BPJS Kesehatan, to ensure that every Indonesian citizen receives adequate care at a hospital or clinic.

Of course, there are clear regulations governing conditions that require inpatient care, are merely recommendations or suggestions, or can be treated with outpatient care. So, let's delve into this topic and learn about the importance of proper health insurance to ensure the quality of care you receive when needed.

Also read: Differences between Individual Health Insurance and Employee Health Insurance

What is Inpatient Care?

According to the definition provided on the official website of Meuraxa Regional Hospital, Banda Aceh, inpatient care can be understood as individual healthcare services that include observation, diagnosis, treatment, nursing care, and medical rehabilitation, requiring an overnight stay in a hospital ward where the patient is required for medical reasons.

Patients will be placed in an inpatient ward with the necessary facilities to maintain their health condition until they recover and improve. Of course, not all patients require hospitalization, but they are clearly categorized because available healthcare facilities have a clearly defined priority scale.

There are at least five factors to consider when deciding whether a patient should be hospitalized.

• First, they have severe symptoms that negatively and significantly impact their ability to perform activities.
• Second, they need to be physically stabilized.
• Third, the patient's safety would be at risk if they did not come to the hospital and were treated.
• Fourth, they have an unstable health condition and require close observation by healthcare professionals.
• Fifth, they require intensive recovery after surgery or other procedures.

Procedures for Obtaining Inpatient Care with Facilities from BPJS Health

In Indonesia, inpatient care is also included in the benefits provided by BPJS Kesehatan (Indonesian Health Insurance). However, to receive this benefit, you or other BPJS Kesehatan participants must follow established procedures.

Similar procedures may also apply to other health insurance plans, such as those provided by PT AXA Insurance Indonesia. However, more details regarding the insurance products and procedures for PT AXA Insurance Indonesia Health Insurance will be discussed in more depth in the next section.

To obtain inpatient services covered by BPJS Kesehatan (Indonesian Health Insurance), the procedure is as follows.

• Patients who are not in an emergency situation can receive this service, starting by visiting a First-Level Health Facility (FKTP) (community health center, or clinic that collaborates with BPJS Kesehatan).
• If the FKTP has inpatient facilities, the patient will be admitted there. If inpatient facilities are not available, the doctor will provide a referral to the next-level hospital or health facility.
• Prepare the necessary documents, including your BPJS Kesehatan card, ID card, family card, referral letter from the FKTP, and participant eligibility letter.
• After the referral, the doctor at the referring hospital will conduct further examinations to determine whether the patient requires hospitalization.
• If so, the patient will be treated according to their medical needs.

Each patient's hospitalization needs may vary depending on the examination performed by the doctor. This also depends on the length of hospitalization, which also depends on the test results.

Also read: Leptospirosis, a disease of the rainy season

Issues of Implemented Inpatient Time Limits

Following the enactment of the latest regulations regarding BPJS Kesehatan (Social Security Agency for Health), many people suspected that there was a specific time limit for inpatient stays.

This issue naturally raised public concern, as it was interpreted as meaning that once this limit was reached, a person would be discharged from the healthcare facility and no longer be able to use inpatient care at that hospital.

However, this issue was later denied by BPJS Kesehatan President Director Ali Ghufron Mukti at the 2024 Public Expose on BPJS Kesehatan Program and Financial Management. As quoted from an article on health.kompas.com, BPJS Kesehatan President Director Ali Ghufron Mukti stated: "So, there is no policy from BPJS that requires patients to go home after three days."

Therefore, with this statement, it is hoped that the public will no longer misunderstand that there is no limit to the length of hospitalization covered by BPJS Kesehatan as long as the applicable provisions stipulated in the contract between BPJS Kesehatan and the relevant healthcare facility are met.

To ensure equitable distribution of healthcare services in every region, BPJS Kesehatan and the government are taking necessary steps, which may cause inconvenience for some groups who require premium services to ensure their health.

This is why PT AXA Insurance Indonesia Health Insurance is needed as support to ensure you always receive the best services and facilities when facing inpatient conditions.

PT AXA Insurance Indonesia Health Insurance

PT AXA Insurance Indonesia's health insurance offers reliable, easy-to-understand products that provide optimal benefits for each type. For example, with SmartMedicare Executive Insurance, you can obtain a health insurance product specifically designed to meet your health protection needs for medical expenses resulting from illness or accident. With SmartCare Executive Insurance, you can access convenient, cashless healthcare services at partner hospitals or clinics at PT AXA Insurance Indonesia.

The advantages of PT AXA Insurance Indonesia's Health Insurance products lie in several points:

• Additional benefits in the form of cashless payments, a disability benefit limit that is not based on service, and additional benefits for ambulance costs, outpatient care, and accidental death benefits subject to certain limits.
• 24-hour healthcare services.
• Extensive network of partner hospitals and clinics.
• Second child and beyond receive a 50% premium discount.
• Easy benefit checking, status, and submission.
• Claims and searching for partner hospitals can be done online
• Easy claims processing with a claim form that can be downloaded directly from the SmartMedicare Claim Form Download link.

And many more.

Also read: Personal Accident Insurance: Protect Yourself, Enjoy Your Activities with Peace of Mind!

Understanding the concept of inpatient care, procedures, and applicable regulations is clearly important for you and everyone else today. Given the increasing awareness of information transparency, data like this should be readily available for everyone.

PT AXA Insurance Indonesia understands the importance of optimal inpatient care and services. With its SmartMedicare Executive insurance product, PT AXA Insurance Indonesia wants to ensure you receive the necessary facilities to recover quickly and return to your daily activities with your family and loved ones. So, get a reliable insurance product from PT AXA Insurance Indonesia today and maximize the protection that can protect you and your family members!

Referensi:

• https://www.gooddoctor.co.id/hidup-sehat/info-sehat/serba-serbi-rawat-inap-pengertian-jenis-jenis-dan-prosedurnya/#:~:text=Pasien%20dengan%20kondisi%20seperti%20apa,observasi%20ketat%20dan%20mengancam%20keselamatan.
• https://health.kompas.com/read/25G15150000968/bpjs-kesehatan-tegaskan-tak-ada-batas-waktu-rawat-inap-bagi-peserta-jkn
• https://rsudksa.depok.go.id/pemberitahuan/
• https://www.antaranews.com/berita/4811929/berapa-lama-pasien-bpjs-kesehatan-bisa-rawat-inap
• https://www.antaranews.com/berita/4600190/kebijakan-baru-bpjs-sistem-kelas-rawat-inap-kris-berlaku-2025
• https://www.hukumonline.com/klinik/a/apa-itu-kris-dalam-bpjs-kesehatan-dan-kapan-mulai-diberlakukan-lt664b89133fdee/
• https://www.cnbcindonesia.com/news/20250812062925-4-657121/daftar-iuran-bpjs-kesehatan-12-agustus-2025-kelas-1-2-bayar-segini
• https://www.bpjs-kesehatan.go.id/#/
• https://rsum.bandaacehkota.go.id/rawat-inap/#:~:text=Rawat%20inap%20adalah%20pelayanan%20kesehatan,alasan%20medik%20penderita%20harus%20menginap.