TEMPO.CO, Jakarta - The Health Care and Social Security Agency (BPJS Kesehatan) does not cover all types of accidents. According to Indonesiabaik.id, BPJS Kesehatan only provides claim services for certain types of accidents.

BPJS Kesehatan participants are eligible to file claims for health services related to certain accidents, such as single-vehicle traffic accidents that are not work-related, provided the victim is an active participant in the National Health Insurance –Indonesia Health Card (JKN-KIS) program.

However, there are cases that are not covered by BPJS Kesehatan. The following are four types of accidents that are not covered:

1. Workplace Accidents

The 2004 National Social Security System Law (Law No. 40/2004) defines workplace accidents as those occurring during work hours, including during travel to and from work, or while performing official duties. Workplace accidents involving traffic incidents are covered by different agencies: PT Asabri (Persero) covers military personnel (TNI) and police officers (Polri), PT Taspen (Persero) covers civil servants (ASN), and BPJS Ketenagakerjaan covers private-sector employees.

2. Single-Vehicle Traffic Accidents Due to Negligence

Single-vehicle traffic accidents occur when one vehicle is involved in an incident with another road user or driver, often caused by personal negligence, such as drowsy driving. Victims of such accidents in official transportation modes who have paid the required fees are covered by PT Jasa Raharja (Persero).

3. Multi-Vehicle Traffic Accidents

Multiple-vehicle traffic accidents involve two or more vehicles or a vehicle colliding with a pedestrian or other road user. PT Jasa Raharja (Persero) covers these incidents, providing insurance benefits up to a maximum of Rp 20 million.

4. Multi-Vehicle Traffic Accidents Involving Passengers of Public Transportation

Accidents involving passengers in public transportation are not covered by BPJS Kesehatan, as they fall under the responsibility of PT Jasa Raharja (Persero).

Andika Dwi dan Winda Oktavia contributed to the writing of this article.

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