BPJS Kesehatan Coverage Details for 2026

Understanding Covered and Non-Covered Services

BPJS Kesehatan has provided clarity on medical conditions and services that will be covered and those that won't be covered starting January 1, 2026. The national health insurance program continues to cover various chronic diseases, medical examinations, and certain medical devices based on medical indications and established referral procedures ¹

Services Not Covered by BPJS Kesehatan

The health insurance program explicitly excludes coverage for 21 specific medical conditions and services. These include:

• Cosmetic procedures and aesthetic treatments
• Infertility treatment and related services
• Self-inflicted injuries or attempted suicide
• Injuries resulting from criminal acts or violence
• Medical services received abroad
• Experimental or complementary medical treatments
• Contraception devices and household health supplies
• Services not compliant with healthcare regulations

Registration and Access to Services

Participants can conveniently register for JKN through the Mobile JKN application, ensuring easy access to healthcare services. To maintain coverage, participants must:

1. Keep their membership active
2. Pay premiums on time
3. Follow the established healthcare pathway from primary to advanced care facilities

Implications for Participants

Understanding the scope of coverage is crucial for participants to maximize their benefits. While certain conditions remain uncovered, the program continues to provide comprehensive coverage for essential medical needs. The clear guidelines help participants make informed decisions about their healthcare needs and additional insurance requirements.