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P REPI DEN
REPUBLIC OF INDONESIA

REGULATION OF THE PRESIDENT OF THE REPUBLIC OF INDONESIA

NUMBER 82 YEAR 20 18

ABOUT

HEALTH INSURANCE

BY THE GRACE OF GOD ALMIGHTY

PRESIDENT OF THE REPUBLIC OF INDONESIA,

Weigh a. that to implement the provisions of Article 13

paragraph (2), Article 2 1 paragraph (4), Article 22 paragraph (3), Article 23

paragraph (5), Article 26, Article 27 paragraph (5), and Article 28

paragraph (2) of Law Number 40 Year 200 4

about the National Social Security System and

provisions of Article 15 paragraph (3) and Article 19 paragraph (5)

letter a Law Number 24 Year 20 1 1

regarding the Social Security Organizing Agency, already

Presidential Regulation No. 12 Year is stipulated

20 13 regarding Health Insurance as already

several times amended, most recently by Regulation

President Number 28 Year 20 1 6 concerning Change

Third, Presidential Regulation Number 12 Year

20 13 regarding Health Insurance;

b. that Presidential Regulation Number 12 Year 20 13

about Health Insurance as already

several times amended, most recently by Regulation


President Number 28 of 201 6 concerning Change

Third, Presidential Regulation Number 12 Year

20 13 about Guarantee Health need

perfected to improve quality and

sustainability of the Health Insurance program;

c. that ...

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c. that based on consideration as


referred to in letters a and b, necessary
establish Presidential Regulations on Guarantees
Health;

Remembering 1. Article 4 paragraph (1) of the State Constitution


Republic of Indonesia of 1945;
2 Law Number 40 Year 2 004 concerning
National Social Security System (State Gazette
Republic of Indonesia Year 2 004 Number 150,
Additional State Gazette of the Republic of Indonesia
Number 4456);
3. Law Number 24 Year 2 011 concerning
Social Security Administration Agency (Gazette
Republic of Indonesia Year 2 011 Number 116,
Additional State Gazette of the Republic of Indonesia
Number 52 56);

DECIDING:
Set REGULATION PRESIDENT ABOUT GUARANTEE AN
HEALTH.

PIG
GENERAL REQUIREMENTS
article 1
In this Presidential Regulation what is meant by:
1. Health Insurance is Jamman
health protection so that participants get
health care and protection benefits
in meeting basic health needs that are
given to everyone who has paid
Health Insurance Fees or Health Insurance Fees
His health is paid for by the Central Government or
Regional government.
2 Participant ...

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2 Participants are everyone, including people asmg

who works for a minimum of 6 (six) months at


Indonesia, which has paid the Guaranteed Contribution

Health.

3. Health Insurance fee, hereinafter referred to

Contribution is the amount of money paid in a manner

regularly by Participants, Employers, and / or

Central Government or Local Government for


Health Insurance program.

4. Benefits are the benefits of social security

the rights of Participants and / or family members.


5 Recipients of Health Insurance contributions

hereinafter referred to as PSI Health Insurance is

poor and disadvantaged people as Participants

Health Insurance program.

6. Workers are everyone who works with


receive Salaries, Wages, or rewards in kind

other.
7. Wage Recipient Workers hereinafter abbreviated
PPU is everyone who works for the Giver

Work by receiving salary or wages.

8. Next Non-Wage Worker Workers

abbreviated as PBPU is every person who works

or try at your own risk.


9
Not Workers, hereinafter abbreviated as BP is

everyone who is not a PPU group,


PBPU, PSI Health Insurance, and residents who

registered by the Regional Government.

10. State Officials are members and members


state institutions as referred to in
The Constitution of the Republic of Indonesia

Year 1945 and other officials determined


by law.

11. Employee ...

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11. Civil Servants, hereinafter referred to as PNS


is a fulfilling Indonesian citizen

certain conditions, appointed as Apparatus Employees

State Civil permanently by the guiding officials


staffing for occupy position
government hold.

12. Soldier is a member of the Indonesian National Army.


13. Members of the Indonesian National Police who are
hereinafter referred to as Polri Members are Members

Polri as referred to in the Act


governing hit1 Police Country

Republic of Indonesia.
14. Veterans is a veteran Republic Indonesia
as referred to in the Act
regulates the Veterans of the Republic of Indonesia.
15. Pioneer of Independence is Pioneer of Independence

as referred to in the Act


governs the Pioneer of Independence or
awards / benefits to Pioneer

Movement to Nation / Independence.

16. Giver Work is person individual,

businessman, legal entity, or other legal entity

employ workers, or organizers


a country that employs Civil Servants
State by paying salaries, wages, or rewards

in other forms.

17. Salary or Wages are Workers' rights received


and stated in money as compensation
from the Provider to the appointed Worker
and paid according to a work agreement,
agreement, or statutory regulation,
including benefits for workers and their families
for a work and / or service that is known
will be done.

18. Termination ...

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18. Subsequent termination of employment

abbreviated as layoff is the termination of employment

because of a certain thing that resulted

the ending right and obligation Among

Workers / laborers and Employer Work based

laws and regulations.

19 Amenities Health ad al ah facility services

health used to administer


individual health care efforts, both
promotive, preventive, curative, and rehabilitative

conducted by the Central Government, the Government

Region and / or community.

20. Facilities Health Level First that

next abbreviated as FKTP is a facility

Health is doing health services

non-specific individuals for

the need for observation, promotion, prevention, diagnosis,

care, treatment, and / or service

other health.

21. Advanced Referral Health Facilities a

hereinafter abbreviated as FKRTL is Facility

Health is doing health services

individuals who are specialized or sub

specialties which include outpatient level

advanced, advanced level hospitalization, and care

stay in a special treatment room.

22. Total Permanent Disability is a defect that results

someone's inability to do

profession.

23. An accident ...

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23. Work Accidents are accidents that occur

in work relationships, including accidents that are

occurred on the way from home to place

work or vice versa, and diseases caused

by the work environment.


24. Fraud (fraud) is an action taken

on purpose, for profit

financial from the Health Insurance program in

National Social Security System through deeds

cheat that is not in accordance with the provisions

laws and regulations.

25. Sort Fee is the additional cost paid

Participants when receiving service benefits

health that could give rise to

abuse of service.

26. Government Center is President Republic

Indonesia holds government power

Republic of Indonesia which is assisted by Deputy

President and ministers as referred to in

The Constitution of the Republic of Indonesia

1945.

27. Minister is the governing minister

government affairs in the health sector.

28. Health Social Security Organizing Body

hereinafter referred to as BPJS Health is

bad an law that was formed for

organize a Health Insurance program.

29. Regional Government is the regional head as

element of regional government administrators who

lead the implementation of government affairs which

becomes the authority of the autonomous region.

30. Area ...

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30 Autonomous Regions, hereinafter referred to as Regions
is unity Public law that

has authorized territorial boundaries

regulate and take care of Government Affairs and

interests Public local according to

the initiative itself is based on community aspirations

in the system of the Unitary Republic of Indonesia.

CHAPTER II

PARTICIPANTS AND PARTICIPATION

Part One

Health Insurance Participants

Section 2

Participants in Health Insurance include:

a. PBI Health Insurance; and

b. Not PBI Health Insurance.

Article 3

PBI participants for Health Insurance as intended

in Article 2 letter a is determined by the minister who

holding government affairs in the social field.

Article 4

(1) Participants not PBI Health Insurance as

referred to in Article 2 letter b consists of:

a. PPU and its family members;

b. PBPU and family members; and


c.
BP and family members.

(2) PPU ...

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(2) PPU as referred to in paragraph (1) letter a

consists of:

a. State officials;

b. p1mpman and members of the House of Representatives

Regional People's;

c. Civil servants;

d. Soldier;

e. National Police Member;

f. village head and village apparatus;

g. private employees; and

h. Workers / employees not included in letter a

up to the letter g that receives a salary

or wages.

(3) PBPU as referred to in paragraph (1) letter b

consists of:

a. Workers outside the employment relationship or Workers

independent; and

b. Workers who do not include the letter a yang

not a salary or wage recipient.

(4) BP as referred to in paragraph (1) letter c

consists of:

a. investor;

b. Employer;

c. pension recipients;

d. Veteran;

e. Pioneer of Independence;

f. widow, widower, or children orphaned and / or strays

from Veterans or Pioneer of Independence; and

g. BP that does not include letters a through to

the letter f who is able to pay contributions.

(5) Recipients ...


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(5) Pension recipients as referred to in paragraph

(4) letter c consists of:

a. State officials who quit with rights

pens1un;

b. Civil servants who stop with pension rights;

c. Soldiers and Police Members who stop by

pension rights;

d. widows, widowers, or orphans and / or parents

from the pension recipient as intended

in letter a, letter b, and letter c that

get pension rights;

e. pension recipients other than letters a, b, and

letter c; and

f. widows, widowers, or orphans and / or orphans

from the pension recipient as intended

in the letter e that gets pension rights.

Article 5

(1) Family members of PPU participants include

legal wife / husband, biological children, stepchildren of

legal marriage, and legal adopted child,

at most 4 (four) people.

(2) Natural children, stepchildren of legal marriages,

and legal adopted child as intended

in paragraph (1), with the following criteria:

a. never or never been married or not

have own income; and

b. not yet 21 (twenty one) years or

not yet 2 5 (twenty five) years old

who are still in formal education.


(3) Besides ...

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(3) Other than the family members referred to

on paragraph
(1) for Participant PPU could

include other family members.

(4) Other family members as intended


in paragraph (3) includes the 4th child (four) and

so on, father, mother, and in-laws.

The second part


Membership Administration

Health insurance

Paragraph 1
Registration of participants

Article 6

(1) Every Indonesian citizen must participate in


the Health Insurance program.
(2) Participate in the Health Insurance program

as referred to in paragraph (1) is implemented

by registering or being registered at BPJS


Health.

(3) When registering or being registered with the BPJS

Health as referred to in paragraph (2),


Prospective Participants are entitled to determine the FKTP

wanted.

Article 7
(1) Participants can replace the FKTP in the Participant's place
registered after a period of 3 (three) months.
(2) FKTP Replacement by Participants as
referred to in paragraph (1) can be done in

period of less than 3 (three) months with

conditions as follows:

a. Participant ...

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a. Participants move to domicile within a period of time

less than 3 (three) months after being registered at


Initial FKTP, as evidenced by the letter
statement of domicile; or
b. Participants in official assignments or training

in a period of less than 3 (three) months,

as evidenced by a certificate
assignment or training.
(3) Replacement of FKTP as referred to in paragraph

(1) and paragraph (2) come into force as from the 1st of on

next month.
(4) In terms of the condition of Participants registered in FKTP

not evenly distributed, BPJS Health can do

transfer of Participants to another FKTP.


(5) Transferring Participants to another FKTP as is

referred to in paragraph (4) must consider


the number of registered Participants, the availability of doctors,

health workers other than doctors, and facilities


infrastructure at FKTP.

(6) In the case of Participants being transferred as

referred to in paragraph (4), the Participant's objection


can request to be transferred to the FKTP

is desirable.

(7) Transfer of Participants as referred to in


paragraph (4) is carried out after coordinating with:

a. service health district / city for

transfers between government FKTPs;

b. association of health facilities for transfer


FKTP does not belong to the government; or
c.
district / city health offices and associations
health facilities for transfer between
FKTP belongs to the government with FKTP not
government property.

(8) In ...

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(8) In the event of a transfer of Participants originating

from Warriors or Polri Members, BPJS Health

must coordinate with the National Army

Indonesia and the Indonesian National Police.

(9) Further provisions concerning removal

Participants are regulated by the Health BPJS Regulations

after coordinating with the Minister.

Article 8

(1) Every Participant who has registered with BPJS

Health has the right to obtain Participant's identity.

(2) Participant's identity as referred to in paragraph

(1) in the form of the fewest Indonesia Health Cards

contains the name and identification number of the Participant

integrated with the Population Identity Number,

except for newborns.


(3) Healthy Indonesia Card as referred to in

paragraph (2) is given to Participants in stages.

(4) Participant's identification number as intended

in paragraph (2) is a single identity number

which applies to all social security programs.

Article 9

PBI Health Insurance stipulated by the minister

which organizes government affairs in the field

socially as referred to in Article 3, is registered

by the Minister as a Participant to BPJS Health.

Article 10 ...

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Article 10

Babies born to registered birth mothers


as a PBI Participant in Health Insurance automatically

designated as a PBI Participant in Health Insurance


corresponding
with provisions the rules legislation
invitation.

Article 1 1

(1) Participants who are not PBI Health Insurance


experiencing total permanent disability and incapability,
entitled to become a PBI Participant in Health Insurance.

(2) Determination of Total Permanent Disability as referred to

in paragraph (1) is carried out by an authorized doctor.


(3) Determination of people with permanent and total disabilities

able as PSI Participants in Health Insurance


as referred to in paragraph (1) is carried out

in accordance with statutory provisions


invitation.

Article 12

Residents who have not been registered as Guarantee Participants


Health can be registered with the Health BPJS by
Provincial Regional Government or Regional Government

district / city.

Article 13

(1) The employer must register himself and

Workers as Health Insurance Participants


to BPJS Health by paying Juran.

(2) In the case that the Employer clearly does not


register workers with BPJS Health,

The worker concerned has the right to register


himself as a Health Insurance Participant.

(3) Registration. . .

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(3) Registration by the Workers as intended

in paragraph (2) is done by attaching

document that prove status

to his workforce.

(4) Workers who register themselves as Participants

Health Insurance as referred to in

paragraph (2), the fees are paid in accordance with the provisions

This Presidential Regulation.

(5) In the event that the Employer has not registered and

pay contributions for workers to BPJS


Health, the employer is responsible

when workers need services

health in accordance with the benefits provided

by BPJS Health.

(6) Employers other than state administrators who

violate the provisions referred to in

paragraph (1) will be subjected to administrative sanctions in the form of:

a. written warning;

b. fine; and / or

c. do not get certain public services.

(7) Tata way imposition penalty administrative

as referred to in paragraph (6) is implemented

in accordance with statutory provisions

invitation.

Article 14

(1) In the case of husband and wife respectively

is a The worker then both Required

registered as PPU Participants by each

Employer and pay contributions.

(2) Husband ...

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(2) Husband, wife and child of PPU Participants

as referred to in paragraph (1) has the right

choose the highest class of care.

Article 15

(1) Every PBPU and BP must register themselves and


family members individually or

collectively as a Health Insurance Participant in

Health BPJS by paying dues.

(2) BPJS Health must verify

registration as referred to in paragraph (1)

within 14 (fourteen) days from

registration.

(3) Registration for PBPU Participants or BP Participants who

done in a mannerindividually, payment

Contributions can be made after 14 (fourteen)

days from being declared eligible based on verification

registration.

Article 16

(1) Newborns from Health Insurance Participants

must be registered with the Health BPJS at most

28 (twenty eight) days from birth.

(2) Participants who do not register babies as such

referred to in paragraph (1) is subject to sanctions accordingly

with the provisions of the legislation.

(3) Further provisions regarding baby registration

newborn as referred to in paragraph (1)

regulated in the BPJS Health Regulations after

coordinate with relevant ministries / institutions.

Article 17 ...

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Article 17

(1) Kev.rajiban registers as a Participant


Health Insurance that has been determined sest.1ai

with a deadline but has not been done

then be subject to sanctions in accordance with the provisions

laws and regulations.

(2) Obligation to register as a Participant

Health insurance for PBPU and BP is implemented

no later than January 1, 2019.

Article 18

In the context of registering Participants, BPJS Health

must develop a system to make it easier

access registration.

Article 19

Further provisions regarding registration procedures

and membership administration is regulated by Regulation

BPJS Health after coordinate with

relevant ministries / institutions.

Paragraph 2

Change in Membership Status

Article 20

(1) Membership status can change to guarantee

sustainability of membership.

(2) Changes status membership how

referred to in paragraph (1) does not eliminate

obligations of Participants, Employers, or Government

Regions to pay off arrears of contributions.

(3) Obligations ...

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(3) Obligations of Participants, Employers, or the Government

Area for pay off arrears Tuition

as referred to in paragraph (2) is carried out

a maximum of 6 (six) months from the membership status

change.

(4) Change status membership as is

referred to in paragraph (1) still requires Participants

for register self and / or member

his family to a new type of membership.

(5) Obligations pay arrears as is

referred to in paragraph (2) does not result

Termination of Health Insurance Benefits.

Article 21

(1) Change in membership status of PBl Participants


Health Insurance is not a PBI Participant

Health insurance is done through registration

to BPJS Health by paying the contribution

first.

(2) Changes status membership how

referred to in paragraph (1) no result in

Termination of Health Insurance Benefits.

(3) Change of membership status of non-Participants

PBI Health Insurance becomes PBI Participant

Health insurance is carried out in accordance with

the provisions of the legislation.

Article 22

(1) PPU participants must submit data changes

membership to the giver Work included

change status membership and all over

arrears dues.

(2) Giver ...

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(2) The Employer is required to report changes in data

Membership as referred to in paragraph (1)

to BPJS Health no later than 7 (seven) days

since the change of data by the Worker.

(3) In the case that the Employer clearly does not

report changes in membership data to

BPJS Health, Workers concerned can be

report changes in membership data

directly to BPJS Health.

Article 23

PBPU participants and BP participants must submit

changes in membership data to the Health BPJS.

Article 24

Participants who move to work are required to report data

membership and identity of the new Employer

to BPJS Health by showing their identity

Participant.

Article 25

Registration and amendment of PPU membership data for

village heads and village officials are carried out collectively

through the Regency / City Regional Government.

Article 26

Further provisions regarding the procedure for changes

membership status is regulated by BPJS Regulations

Health after coordinate with

relevant ministries / institutions.

Section ...
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Third Part
Experienced Participants

Work termination

Article 27

(1) PPU participants who experience layoffs still obtain


Health Insurance Benefit rights no later than 6
(six) months since being laid off, without paying contributions.
(2) Layoffs as referred to in paragraph (1) must be

meet the criteria:


a. Existing layoffs sentence
relationship industrial, proven with
industrial relations court decision / deed;

b. Laid off because merging company,


evidenced by a notarial deed;
c.
Layoffs because the company went bankrupt or experienced
loss, proven with decision

bankruptcy from the court; or


d. Layoffs because workers experience a sickness

prolonged and unable to work,

evidenced by a doctor's letter.

(3) In the event of a dispute over the proposed dismissal

through the institution settlement dispute


industrial relations, both employers and
Workers must continue to carry out obligations

pay dues up to the verdict

with permanent legal force.


(4) Health Insurance Benefits as intended

in paragraph (1) is given in the form of service benefits at


Class III treatment room.

(5) Participants as referred to in paragraph (1) are


have worked again must extend the status
membership by paying dues.

(6) In ...

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(6) In the case of Participants as referred to in paragraph

(1) and paragraph (2) do not work again and no clan

able, registered as a PBI Guarantee Participant

Health.

CHAPTER III

URAN

Part One

Magnitude Juran

Article 28

(1) Contribution for PBI Health Insurance Participants is paid

by the Central Government.

(2) Contributions for residents registered by

Local Government is paid by the Regional Government.

(3) Dues for PPU Participants shall be paid by the Employer

and workers.

(4) Dues for PBPU Participants and BP Participants shall be paid by

Participants or other parties on behalf of Participants.

(5) Provisions as referred to in paragraph (3)

does not apply to:

a. pension recipients as intended

in Article 4 paragraph (5) letter a, letter b, letter c,


and letter d; and
b. Veterans and Pioneer of Independence.

(6) Contributions for newborns are paid by Participants

or other parties on behalf of Participants at the time

register no later than 28 (twenty eight) days

since birth.

Article 29 ...

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Article 29

Contribution for PBI Participants in Health Insurance and

residents registered by the Regional Government

in the amount of Rp.23,000.00 (twenty three thousand rupiah)

per person per month.

Article 30

(1) Contribution for PPU Participants consisting of Officials

State, leadership and members of the House of Representatives

Regional People, Civil Servants, Soldiers, Members of the National Police, chief
village and village apparatus, and workers / employees

as referred to in Article 4 paragraph (2) letter

h, namely 5% (five percent) of Salary or Wages

per month.

(2) Fees as referred to in paragraph (1) are paid

with the following conditions:

a. 3% (three percent) is paid by the employer;

and

b. 2% (two percent) is paid by Participants.

(3) Obligations of the Employer in paying Contribution

as referred to in paragraph (2) letter a,


implemented by:

a. Central Government for Contributions for Officials

State, central civil servants, Soldiers, Members of the National Police, and

Workers / employees as referred to in

Article 4 paragraph (2) letter h central agencies; and

b. Local Government for contributions to the head

regional and deputy regional heads, leaders and

member of the Regional People's Representative Council, PNS

regions, village heads and village officials, and

Workers / employees as referred to in

Article 4 paragraph (2) letter h of regional institutions.

(4) Fees ...

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(4) Fees as referred to in paragraph (3)


paid directly by the Employer

to BPJS Health through state treasury except

for village heads and village officials.

Article 31

(1) Contribution for PPU Participants other than Participants as

referred to in Article 30 paragraph (1) in the amount of 5%

(five percent) of Salary or Wages per month with

conditions:

a. 4% (four percent) is paid by the employer;


and

b. 1% (one percent) is paid by Participants.

(2) Fees as referred to in paragraph (1)

paid directly by the Employer

to BPJS Health.
Article 32

(1) The highest limit for salary or wages per month

used as a basis for calculating contribution rates

for PPU Participants as referred to in

Article 3 1 paragraph (1), village heads and village officials,

and Workers / employees as referred to in

Article 4 paragraph (2) letter h, namely equal to

Rp.8,000,000.00 (eight million rupiah).

(2) The lowest limit for Salary or Wages per month

used as a basis for calculating contribution rates

for PPU Participants other than the state organizer,

head village and device village, and


Workers / employees as referred to in

Article 4 paragraph (2) letter h, which is equal to wages

district / city minimum.

(3) In ...

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(3) In the case that the Regional Government does not stipulate

district / city minimum wages then become

basis for calculating contribution rates as is

referred to in paragraph (2) that is the amount of wages

provincial mm1mum.

(4) The lowest limit provisions as

referred to in paragraph (2) does not apply to Givers

Work that get a hold of

obligation to pay a minimum Salary or Wage

province / district / city determined by

Local government.
Article 33

(1) Salary or wages used as a basis

Contribution calculation for PPU participants for officials

State, leadership and members of the House of Representatives

Regional People, Civil Servants, Soldiers, or Members of the National Police

as referred to in Article 30 paragraph (1)

consists of basic salary or wages and benefits

family.

(2) Salary or wages used as a basis

Contribution calculation for PPU participants for the head

village and village apparatus and Workers / employees

as referred to in Article 4 paragraph (2) letter

h is calculated based on fixed income.

(3) Salary or wages used as a basis

Contribution calculation for PPU Participants other than Participants

as referred to in paragraph (1) and paragraph (2)

consists of basic salary or wages and benefits

permanent.

(4) Allowances ...

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(4) Permanent benefits as referred to in paragraph

(3) is an allowance paid to

Workers without taking into account the presence of workers.

Article34

Fees for PBPU Participants and BP Participants are as follows:

a. Rp.25,500.00 (twenty-five thousand five hundred rupiah)

per person per month with Benefits of service at


Class III treatment room;

b. Rp5,000,000 (fifty one thousand rupiah) per person

per month with the Benefits of service in space

Class II care; or

c. Rp. 80,000.00 (eighty thousand rupiah) per person

per month with the Benefits of service in space

Class I care.

Article35

(1) Contribution for pension recipients as intended

in Article 4 paragraph (5) letter a, letter b, letter c, and

letter d that is equal to 5% (five percent) of the amount

basic pensions and family benefits

received per month.

(2) Fees as referred to in paragraph (1) are paid

by the Central Government and pension recipients

with the following conditions:

a. 3% (three percent) is paid by the Central Government;

and

b. 2% (two percent) is paid by pension recipients.

(3) contributions for pension recipients as intended

in Article 4 paragraph (5) letter e and letter f follow

the provisions referred to in Article 34.

(4) Fees ...

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(4) Fees for Veterans, Pioneer of Independence, widows,

widower, know orphans and / or parents from Veterans

or Pioneer of Independence, which is 5% (five


percent) of 45% (forty-five percent) Salary
principal of civil servants class III / a with years of service

14 (fourteen) years per month, paid by

Central government.

Article 36

(1) Contribution to other family members of Participants

PPU is paid by Participants.

(2) Amount of contribution for other family members

as referred to in paragraph (1), that is

1% (one percent) of PPU Participant Salary or Wages

per person per month.

(3) Amount of contribution for other family members

as referred to in paragraph (1) for Participants

PBPU and BP Participants are determined according to Benefits

treatment room selected refers to

master's agreement as referred to in Article 34.

(4) Payment of fees for other family members

as referred to in paragraph (2) begins with

granting power of attorney from the Worker to the Giver

Work to make additional cuts

Contribution and pay to the Health BPJS.

Article 37

(1) Participants of Indonesian citizens who live outside

the country for 6 (six) consecutive months can be

stop the membership while the tare.

(2) In ...

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REPUBLIC OF INDONESIA
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(2) In the event that a Participant terminates his participation

as meant in paragraph (1),

The participant in question did not get it

The benefits.

(3) The provisions referred to in paragraph (1)

excluded for the PPU Participants who are still in love

get a salary or wage in Indonesia.

(4) Participants as referred to in paragraph (1) are

returning to Indonesia must report to BPJS

Health and the lowest payment possible 1

(one) month after returning and has the right to receive opinions

The benefits.

Article38

(1) Amount of contribution is reviewed no later than 2 (two) years

once.

(2) Provisions regarding the amount of exemption

referred to in paragraph (1) shall be regulated by Regulation

President.

The second part

Procedure for Payment of Contributions

Article39

(1) Giver Work must collect contributions from

Workers pay dues which are borne

he replied, and paid the contribution to BPJS

Health no later than the 10th of every month.

(2) If ...

Page 27
PRESIDENT
REPUBLIC OF INOONESIA

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(2) If the Employer is a Central Government

or Regional Government, depositing Juran to

Health BPJS as referred to in paragraph

(1) Done through most state treasury accounts

by the 10th of every month.

(3) Dues for PPU Participants to the village head and

village officials are collected and paid for by

Regency / city regional government as the giver

Work directly to most BPJS Health

by the 10th of every month.

(4) In the case of the 10th day referred to in


paragraph (1) falls on a holiday, then contributions are paid

the next working day.

(5) Provisions regarding the transmission of Employer Fees

Local Government from the state treasury account to

Health BPJS is regulated by Ministerial Regulation

which organizes government affairs in

financial sector.

(6) Further provisions regarding procedures

Juran payments for PPU Participants are regulated by

BPJS Health Regulations after coordinating

with relevant ministries / institutions.

Article 40

(1) PBPU Participants and BP Participants must pay the contribution

to BPJS Health no later than the date of 1 0

each month.

(2) Juran can be paid for more than 1 (one)

month done at the beginning.

(3) BPJS ...


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(3) BPJS Health must develop a mechanism

effective and efficient contribution of withdrawal for Participants

PBPU and BP Participants as referred to in

paragraph (1).

(4) Further provisions regarding procedures

Payment of Contribution for PBPU Participants and BP Participants

regulated by BPJS Health Regulations after

coordinate with relevant ministries / institutions.

Article 41

(1) Payment of Contributions for PBPU Participants and BP Participants

conducted collectively on the total bill for

all family members according to data

engraved tum in the family card.

(2) Further provisions regarding procedures

Payment of contributions made collectively

as referred to in paragraph (1) shall be regulated by

BPJS Health Regulations after coordinating

with relevant ministries / institutions.

Article 42

(1) In the case of Participants and / or Employers not

pay contributions until the end of the month

proceeding, the guarantee of the Participant is terminated

while from the 1st of the following month.

(2) In the event that the employer has not paid the arrears

Fees as referred to in paragraph (1) to

BPJS Health, Employers must be responsible

answer on when The workers need

health services in accordance with its Benefits

was given.
(3) Termination ...

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(3) Temporary termination of Participant Guarantee

as referred to in paragraph (1) ends and

re-active membership status, if Participant:

a. have paid in arrears for the month, the most

many for a period of 24 (twenty four)

month; and
b. pay contributions for the month the Participant wishes

end dismissal while

guarantee.
(4) Payment of arrears Contributions can be paid by

Participants or other parties on behalf of Participants.

(5) Within 45 (forty five) days from

re-active membership status as

referred to in paragraph (3), Participant as referred to

referred to in paragraph (1) must pay a fine

to BPJS Health for each service

advanced level care map

obtained.

(6) Fines as referred to in paragraph (5), i.e.

at 2.5% (two point five percent) of the estimate

Indonesian Case Based Groups package costs


based on preliminary diagnoses and procedures for

every month in arrears with the provisions:

a. the maximum number of months in arrears is 12 (two

twelve) months; and

b. the maximum fine is Rp. 30,000,000.00 (three


twenty thousand rupiah).
(7) For PPU Participants, payment of Contribution is as

referred to in paragraph (3) and penalties as stated

referred to in paragraph (6) shall be borne by the Giver

Work.

(8) Provisions. . .

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(8) Provisions payment Tuition as is

referred to in paragraph (3) and penalties as stated

referred to in paragraph (6) is excluded for Participants

PBI Health Insurance, Participants registered

by Local Governments, and Participants who do not

able as evidenced by a certificate

from the authorized agency.


(9) Further provisions regarding payment of contributions

as referred to in paragraph (3) and fines


as referred to in paragraph (6) is regulated by

BPJS Health Regulations after coordinating

with relevant ministries / institutions.

Article 43

BPJS Health must record and collect arrears

Contributions as BPJS Health receivables at most

for 24 (twenty four) months.

Article 44

(1) Regulation of the provision, disbursement, and

liability contributions originating from

The State Budget is regulated

by implementing Ministerial Regulation


government affairs in the financial sector.

(2) Provisions concerning the payment of contributions from civil servants,

Workers / employees as referred to in

Article 4 paragraph (2) letter h, and the Regional Government

regulated with Regulation Minister that

holding government affairs in the field

finance a tau Regulation Minister that

organize government affairs in

the country in accordance with its authority.

(3) Provisions ...

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REPUBLIC OF INDONESIA

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(3) Further provisions concerning cutting,

deposit, and payment of contributions to the village head

and village officials are regulated by Ministerial Regulation

which holds government affairs

domestic.

Third Part

Advantages and Weaknesses of Contributions

Article 45

(1) BPJS Health must calculate every excess

or lack of contribution in accordance with Salary or

Worker Wages.

(2) Calculation of any excess or lack of contributions

as referred to in paragraph (1) is based


on the Worker's Salary or Wage list and changes

membership status or membership data.

(3) In the event of excess or deficiency

Payment of Contributions caused by changes

membership data, the Health BPJS must

notify the Employer and / or

Participants no later than 14 (fourteen) working days

since receipt of contributions.

(4) Over or underpaid Juran payments

as referred to in paragraph (1) counts

with payment of contribution the following month.

CHAPTER IV ...

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REPUBLIC OF INDONESIA

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32 -

CHAPTER IV

BENEFITS OF HEALTH GUARANTEE

Part One

Guaranteed benefits

Article 46

(1) Every Participant is entitled to receive Guarantee Benefits

Health that is a health service

individual, covers service promotive,

preventive, curative, and rehabilitative, including


drug services, medical devices, and medical materials
consumables according to medical needs which are

is required.

(2) Health Insurance Benefits referred to

Paragraph (1) consists of medical benefits and benefits

non-medical.

(3) Medical benefits as referred to in paragraph (2)

administered according to medical indications and standards

services and are not differentiated based on

Participant Contribution amount.

(4) Non-medical benefits referred to in paragraph

(2) is given based on the size of Participant's selection.

(5) Health Insurance Benefits referred to

Paragraph (1) also applies to newborn babies

Participants must have a maximum of 28 (twenty eight) days

since birth.

Article 47 ...

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Article 47

(1) Guaranteed health services consist of:

a. first level health services, including

non-specialist health services

includes:

1. service administration;

2. promotive and preventive services;

3. examination, treatment, and consultation

medical;
4. non-specific medical measures, good

operative or nonoperative;

5. drug services, medical devices, and materials

medical consumables;

6 examination pen Un Jang diagnostic

Primary level laboratory; and

7. first-degree hospitalization according to

medical indication;

b. advanced referral health services,

includes health services which include:

1 service administration;

2. examination, treatment, and consultation

basic medical;

3. examination, treatment, and consultation

specialty;

4 specialist medical procedures, both surgical

or non-surgical as indicated

med is;

5. drug services, medical devices, and materials

medical consumables;

6. Advanced diagnostic support services

according to medical indications;

7. rehabilitation ...

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7. medical rehabilitation;

8. blood service;

9. screening corpse Participant that

died in a health facility;

10. family planning services;


1 1. nonintensive inpatient care; and

12. inpatient care in intensive care;

c. land or water ambulance services.

(2) Health services as referred to in

paragraph (1) letter b number 2 only applies to

health services in the emergency department.

(3) Medical devices as referred to in paragraph (1)

letter b number 5 is all medical devices

which is used in the framework of healing,

including health aids.

(4) Health services as referred to in

paragraph (1) letter b number 10, excluding services

family planning that has been funded by the Government

Pu sat.

(5) Land ambulance services or water as is

referred to in paragraph (1) letter c is

pas1en transportation services referral to

certain conditions between Health Facilities are accompanied

with efforts to maintain the stability of the patient's condition

for the sake of patient safety.

Article 48

(1) Benefits of promotive and preventive services include

service delivery:

a. individual health education;

b. routine immunization;

c. family ...

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REPUBLIC OF INDONESIA

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c. family planning;
d. health history screening and services

specific health screening or screening;


and

e. improving health for sufferers

chronic disease.

(2) Individual health education as is


referred to in paragraph (1) letter a includes at most

a little counseling about managing factors


risk of disease and clean and healthy life behavior.

(3) Routine immunization services as intended


pacla paragraph (1) letter b includes the giving of types

routine immunization in accordance with regulatory requirements

legislation.

(4) Service family planned as is


referred to in paragraph (1) letter c includes counseling

and contraceptive services, including vasectomy and

tubectomy work same with Body

National Population and Family Planning.

(5) Provisions regarding the fulfillment of equipment needs


and contraceptive drugs for Guarantee Participants

Health in a Health Facility is regulated by

Regulation of the Head of Population and Agency

National Family Planning.


(6) Vaccines for routine immunizations and drug clans

contraception as referred to in paragraph (3)

clan paragraph (4) is provided by the Central Government

and / or the Government Region according to


the provisions of the legislation.

(7) Medical history screening services as

referred to in paragraph (1) letter d is given in a manner

selective aimed at detecting risk


disease using certain methods.

(8) Service ...

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(8) Health screening or screening services

certain referred to in paragraph (1) letter

d is given selectively as intended

detect disease risks and prevent impacts

continued risk of certain diseases.

(9) Types of health screening or screening services

certain referred to in paragraph (8)

stipulated by the Minister.

(10) Health improvement for participants

chronic diseases as referred to in paragraph

(1) letter e is addressed to Participant sufferers

certain chronic diseases to reduce risk 1

due to complications of the disease he suffered.

(11) Further provisions regarding implementation

screening history health and service

specific health screening or screening as well

improving health for sufferers

chronic diseases as referred to in paragraph

(7), paragraph (8), and paragraph (10) are regulated by Regulation

BPJS Health after coordinating with

relevant ministries / institutions.

Article 49

The Minister can stipulate other health services

which is guaranteed based on the assessment of health technology

taking into account the adequacy of Juran after

coordinate with the organizing minister

government affairs in the financial sector.

Article 50 ...
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Article 50

Non-medical benefits as maximized in Article

46 paragraph (4) in the form of accommodation for inpatient services as

following:

a. Class III treatment room for:

1 PBI Participants in Health Insurance and residents

registered by the Regional Government;

2 PBPU participants and BP participants pay

Contributions for the benefits of services in the room

class III care; and

3. PPU participants who have been laid off along with

his family.

b. Class II treatment room for:

1. Civil servants and pension recipients of space group civil servants

and class II and their members

his family;

2. Soldiers and Penenun pens1un Warriors who

equivalent to class I civil servants and class

room I and his family members;

3. Members of the National Police and pension recipients Members

National Police equivalent to space group I and civil servants

space group II and their family members;

4. Participants of PPU other than numbers 1 through

number 3, village head and village official, clan

Workers / employees as referred to in

Article 4 paragraph (2) letter h, with Salary or Wages

up to Rp.4,000,000.00 (four million

rupiah); and

5. PBPU participants and BP participants pay

Contributions for the benefits of services in the room

class II care.

c. the room ...


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c. Class I treatment room for:


1 State officials and family members;

2. Leaders and members of the House of Representatives


Regional People and their family members;

3. Civil servants and pension recipients of PNS space groups


III and class IV and their members
his family;
4. Soldiers and Warrior retired recipients

equivalent to class III civil servants and class


room IV and its family members;
5. Members of the National Police and pension recipients Members

National Police equivalent to space III and civil servants

space group IV and their family members;


6. Veterans and Pioneer of Independence together

his family members;


7. widow, widower, or child who is worried and / or orphaned

from Veterans or Pioneer of Independence;

8. Participants of PPU other than numbers 1 through

number 5, village head and village official, and


Workers / employees as referred to in

Article 4 paragraph (2) letter h, with Salary or Wages


more than Rp4,000,000.00 (four million rupiah);

and
9. PBPU participants and BP participants pay

Contributions for the benefits of services in the room


class I care.

Article 5 1

(1) Participants can increase more care

height of his rights including outpatient executive


by taking additional health insurance

or pay the difference between the guaranteed costs


by BPJS Health at a cost that has to be

paid due to service improvement.

(2) Difference ...


'.

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REPUBLIC OF INDONESIA

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(2) Difference between fees guaranteed by BPJS

Health costs due to increase

services can be paid for by:

a. Participants concerned;

b. Employer; or

c. additional health insurance.

(3) Provisions as referred to in paragraph (1)

excluded for:

a. PBI Health Insurance;


b. Participants registered by the Government

Regions as referred to in Article 12;

clan

c. PPU participants who have experienced layoffs and members

his family.

The second part

Unsecured Benefits

Article 52

(1) Health services that are not guaranteed include:

a. health services that are not in accordance with

the provisions of the legislation;

b. health services carried out at


Health facilities that do not work together
with BPJS Health, except in

emergency state;

c. health services for diseases or

work accident or relationship injuries

work guaranteed by the guarantee program

Work accident or dependents

Employer;

d. service ...

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d. health services guaranteed by the program

collateral traffic collateral

mandatory up to the value borne by

a traffic accident insurance program accordingly

entitlement of Participant's nursing classes;

e. outside health services

country;

f. health services for aesthetic purposes;

g. services to deal with infertility;

h. May service: - dental or orthodontic service;


i.
disruption health / disease consequence

drug and / or alcohol dependence;

J health problems due to intentionally hurting

yourself or the result of doing that hobby

endanger yourself;

k. complementary, alternative medicine, and

traditional, which has not been declared effective


based on health technology assessment;
1 treatment and action medical that

categorized as as trial a tau

experiment;

m. contraceptive devices and drugs, cosmetics;

n. household health supplies;

o. health services due to disasters in

really responsive emergency, incident the outside

ordinary / outbreak;

p. health services in non-event

expected that can be prevented;

q. organized health services

in the framework of social service;

r. service ...

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REPUBLIC OF INDONESIA

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r. health services due to crime

molestation, sexual assault, victim

terrorism and trade crime

people in accordance with regulatory requirements

legislation;

s. certain health related services

with Ministry of Defense, Army

Indonesian National, and National Police

Republic of Indonesia;

t. other services that are not related

with the Health Insurance Benefits

given; or
u. services already covered in

another program.

(2) Health services which are not in accordance with

provisions the rules legislation

as referred to in paragraph (1) letter a

includes referrals at their own request and

other health services which are not in accordance with

the provisions of the legislation.

(3) Health problems caused by intentional self-harm

alone or consequence
To do a hobby

endanger yourself as intended

in paragraph (1) letter j, treatment and action

medical categorized as an experiment or

experiment as referred to in paragraph (1)

letter 1, and unexpected events that can

prevented as referred to in paragraph (1) letter

p stipulated by the Minister.

Section ...

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Third Part

Coordination Between Guarantee Organizers

Article 53

(1) BPJS Health can coordinate with

other guarantee providers that provide

Benefits of health services.

(2) Organizer guarantee the other how


referred to in paragraph (1) includes:
a. Body Organizer Guarantee Social

Employment, PT. Savings Funds and

Insurance for Civil Servants (Persero), and PT.

Republic of Armed Forces Social Insurance

Indonesia (Persero) for the Jamman program

Occupational accidents and occupational diseases;

b. PT. J asa Raharj a (Persero) for the program

traffic accident insurance; or

c. other guarantee providers that provide

Benefits of health services.

(3) In case BPJS Health pays first

first the cost of health services that should be

guaranteed by other guarantee providers

as referred to in paragraph (2) then

other guarantee providers must pay

cost of health services to BPJS Health.

Article 54

Further provisions concerning interagency coordination

guarantee organizers are regulated by Ministerial Regulation

which organizes government affairs in the field of defense

finance.

CHAPTER V ...

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CHAPTER V

ORGANIZATION

HEALTH SERVICES
Part One
Health Care Procedure

Article 55

(1) Health services for Participants are carried out

in stages according to medical needs and

Health Facilities competency starts from FKTP

Participant registered, except in the circumstances

medical emergency.

(2) First level health services for Participants

held at FKTP where Participants are registered,

except for Participants who:

a. is outside the FKTP area where the Participant is

registered; or

b. in a state of medical emergency.

(3) Participants outside the FKTP area where

Participants are registered as referred to in paragraph

(2) letter a can access outpatient services

first level at other FKTP for the most

3 (three) visits in a maximum period of 1

(one) month at the same FKTP.

(4) In the event that Participants need health services

advanced level, FKTP must refer to FKRTL

according to the case and competence of the Facility

Health and referral system.

(5) Services provided to Participants who

referred to FKRTL as referred to in paragraph

(4) it is conducted for a maximum of 3 (three) months.

(6) FKRTL ...

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(6) FKRTL who perform services as

referred to in paragraph (5) must make a back referral

to FKTP where Participants are registered.

(7) Provisions as referred to in paragraph (5)

excluded for certain cases.

(8) More provisions further regarding service

first level health care, health services

advanced level referral, and referral service

governed by Ministerial Regulation.

Article 56

(1) Facilities Health Required ensure Participant

get drugs, medical devices, and medical materials

consumables needed as indicated

med is.

(2) Health facilities which do not have facilities

supporters, must build JeJanng with

Supporting health facilities to guarantee

availability of drugs, consumable medical materials, and

supporting examination needed.

Article 57

(1) BPJS Health can develop the system

health services.

(2) Development sis tern service health

as referred to in paragraph (1) is submitted

to the Minister.

(3) The Minister establishes a health service system

as referred to in paragraph (2).

Section ...

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The second part


Drug Services, Medical Devices,

and Consumable Medical Materials

Article 58

(1) Central Government, Regional Government and Facilities

Health is responsible for availability

medicine, medical devices, and medical consumables


in organizing the Health Insurance program

in accordance with their authority.

(2) Drugs, medical devices, and consumable medical materials

which is used in government programs besides

the Health Insurance program is provided by

Central Government and / or Regional Government

in accordance with statutory provisions

invitation.

Article 59

(1) Drug services, medical devices, and medical materials

consumables for Health Insurance Participants at


Health facilities are guided by the list of drugs,

medical devices, and medical consumables which

stipulated by the Minister.

(2) The Minister in determining the list of drugs, tools

health, and ingredients medical disposable

as referred to in paragraph (1) form

national committee.

(3) The national committee as referred to in paragraph


(2) consists of elements of the Ministry of Health, Sadan

Watchdog Drug and Food, Sadan

National Population and Family Planning,

BPJS Health, professional organizations, universities

high, and expert.

(4) Register ...


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(4) The drug list, medical devices, and medical materials are used up

use as maximized in paragraph (1)

set forth in a national formulary or

compendium of medical devices.

(5) National committee in compiling the formulary

national and compendium of medical devices must

prioritizing drugs, medical devices, and ingredients

medical consumables in domestic production.

Article 60

(1) Procurement of drugs, medical devices and / or materials

medical consumables by owned Health Facilities

government or private to the Guarantee program

Health done through e-purchasing

based on an electronic catalog.

(2) In the case of procurement of drugs, medical devices,

and / or medical materials can not be used

done through e-purchasing how

referred to in paragraph (1), the procurement of clapat

can be done manually based on the catalog

electronic.

(3) In the case of drugs, medical devices, and / or materials

medical consumables required by the Facility

Health is not in the electronic catalog

then the Health Facility in conducting medicine,

medical devices, and / or consumable medical materials

still refer to the national formulary or

compendium of medical devices.


(4) In ...

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(4) In the case of drugs, medical devices, and / or materials

medical consumables needed are not available

in the national formulary and compendium of tools

health then Amenities Health could

procure drugs, medical devices, and / or materials

medical consumables with the approval of the head or

hospital director.

(5) In the case of drugs, medical devices, and / or materials

medical consumables claimed separately by the Facility

Health to BPJS Health then prices

based on electronic catalogs or prices

stipulated by the Minister.

(6) In the event of a drug procurement failure with

electronic catalogs resulting in a drug vacancy

then the Health Facility can hold medicine

with the same active substance in accordance with the provisions

laws and regulations.

(7) Payment of drugs as referred to in paragraph

(6) which can be claimed separately by the Facility

Health to BPJS Health, guided by

at electronic catalog prices or prices that are

stipulated by the Minister.

Article 61

In the case of problems with the procurement of drugs, tools

health, and / or medical materials can only be used


can potentially lead to a drug vacancy then

Central Government, Local Government, or Facilities

Health makes an effort to resolve it according to

problems and authority.

Article 62 ...

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Article 62

Health facilities in providing services

health for program Guarantee Health

prioritizing the use of production medical devices

domestic.

Third Part

Service in Situation

Emergency

Article 63

(1) Participants who require emergency services

can immediately get service in each

Health facilities both working together and

who are not cooperating with BPJS Health.

(2) Emergency criteria as referred to in

paragraph (1), namely:

a. life threatening, endangering yourself and

other people / environment;

b. there is interference with the airway, breathing,

and circulation;
c. a decrease in awareness;

d. presence of hemodynamic disorders; and / or

e. requires immediate action.

(3) The Minister can set emergency criteria

other than as referred to in paragraph (2).

(4) Doctor in charge of patient is authorized

establish compliance with emergency criteria

as referred to in paragraph (2).

(5) In ...

Page 49

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(5) In the event that a Participant receives an emergency service

emergency in a non-working Health Facility

the same as BPJS Health, the patient must

immediately referred to a working Health Facility

the same as BPJS Health after the situation

emergency department is resolved and the patient is in condition

can be moved.

Fourth part

Service in Situation

There are no health facilities

Eligible

Article 64

(1) In the case of an area where facilities are not yet available

Health that meets the requirements to fulfill


medical needs of a number of Participants, BPJS Health

must provide compensation.

(2) Compensation as referred to in paragraph (1)

can be cash replacements.

(3) In addition to compensation as referred to in

paragraph (2), BPJS Health can cooperate with

other parties to provide health facilities.

(4) More provisions continued about giving

compensation as referred to in paragraph (1)

up to paragraph (3) regulated by Regulation

Minister.

Article 65 ...

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Article 65

(1) In order giving compensation and

fulfillment of services in the Region is not yet available

Eligible Health Facilities, BPJS

Health can develop financing patterns

health services.

(2) Development po la financing service

health as referred to in paragraph (1)

covers pattern financing for service

mobile health, based health services

telemedicine, and / or service development


other health stipulated by the Minister.
CHAPTER VI
MEDICAL FACILITY

Part One

Health Service Provider

Article 66

(1) Government Center and Government Area

responsible for availability Amenities

Health as organizer service

health for the implementation of the program Guarantee

Health.

(2) The Central Government and Regional Governments must

provide an opportunity for the private sector to

participate in meeting the availability of facilities

Health and implementation service

health.

Article 67 ...

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Article 67

(1) Organizer service health for

the implementation of the Health Insurance program includes

all Health Facilities that work together

with BPJS Health.

(2) Health Facilities owned by the Central Government and

Local Government that meets the requirements

must cooperate with the Health BPJS.

(3) Compliant privately owned Health Facilities

requirements can cooperate with BPJS


Health.

(4) Cooperation as referred to in paragraph (2)

and paragraph (3) is implemented by making

written agreement.

(5) In the framework of implementing cooperation with

Health Facilities, BPJS Health coordinates

with the district / city health office.

(6) Provisions regarding the requirements as

referred to in paragraph (2) and paragraph (3) shall be regulated by

Ministerial regulation.

Article 68

(1) Health facilities in collaboration with BPJS

Health is prohibited from charging service fees

health to Participant During Participant

get appropriate health care benefits

with its rights.

(2) In the case of providing emergency services,

Health facilities both working together and

who are not cooperating with BPJS Health

it is prohibited to charge fees for health services to

Participant.

(3) Costs ...

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(3) Health service costs as intended

in paragraph (1) and paragraph (2) shall be borne by BPJS

Health is in accordance with regulatory requirements

legislation.
The second part
Standard Rates and Mechanisms
Payments to Health Facilities

Article 69

(1) Standard health service tariffs in FKTP and

FKRTL is determined by the Minister.

(2) The Minister establishes the tariff standards as stated

referred to in paragraph (1) after:

a. get input from BPJS Health

together with the association of health facilities;


clan

b. consider availability Amenities

Health, consumer price index, and index

Regional expensiveness.

Article 70

Tariff standards set by the Minister as set forth

referred to in Article 69 is used by BPJS

Health as the amount of payment to the facility


Health.

Article 71

(1) BPJS Health makes payments to:

a. FKTP in a mannereffort or capitation

based on the number of Participants registered at

FKTP; and

b. FKRTL in Indonesian Case Based Groups.

(2) In ...

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(2) Under certain conditions and / or in an area


FKTP does not allow payment by way of

pre-effort or capitation, BPJS Health can


develop other payment systems.

(3) BPJS Health can develop the system


more effective payment at FKRTL

while still referring to Indonesian Case Based

Groups
(4) Further provisions regarding development
payment system as referred to in

paragraph (2) and paragraph (3) regulated by BPJS Regulation


Health after getting approval from

Minister.
(5) Approval as referred to in paragraph (4)

given no later than 30 (thirty) days from

date of submission from the Health BPJS to

Minister.

(6) If within 30 (thirty) days


approval as referred to in paragraph (4)

not obtained then the Health BPJS Regulation

hit development system payment


as referred to in paragraph (2) and paragraph (3)

applicable.

Article 72

(1) Method of payment using Indonesian Case Based

Groups as referred to in Article 7 1 paragraph


(1) letter b for FKRTL is determined according to class
hospital.

(2) In the case of discrepancies found in the home class

sick based on statutory provisions


invitation at the time of credentials or re-credentials

then BPJS Health must report to

Minister for review.

(3) Review ...

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(3) Review of hospital class as intended

in paragraph (2) is carried out no later than 3 (three)

month by involving elements of the Ministry

Health, BPJS Health, and home associations

sick.

(4) The results of the hospital class review as

referred to in paragraph (3) is used as the basis for adjustment

contract by BPJS Health with the hospital.

Article 73

(1) Standard tariffs as referred to in Article 69

is reviewed the fastest every 2 (two) years by

Minister.

(2) The Minister in reviewing the tariff standards as stated

referred to in paragraph (1) performed with

into account adequacy Tuition and

continuity of programs carried out together

with BPJS Health, the Social Security Board

National, and the minister who organized it

government affairs in the financial sector.

Article 74

Association of health facilities referred to

in Article 69 paragraph (2) letter a is determined by the Minister.

Article 75

(1) BPJS Health must pay capitation to

FKTP no later than the 15th of each current month.

(2) FKTP submits non-capitalization claims to BPJS

Periodic and complete health.

(3) BPJS ...


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(3) BPJS Health must pay FKTP


based on claims filed as
referred to in paragraph (2) and has been verified the most
no later than 5 (fifteen) working days from the claim file
declared complete.
(4) In ha! payment as referred to in
paragraph (1) and paragraph (3) fall on a holiday then
Payments at FKTP are made on weekdays
give me
(5) In ha! BPJS Health does not do
payment as referred to in paragraph (3),

BPJS Health must pay a fine to


FKTP is 1% (one percent) of the total

which must be paid for every 1 (one) month


lateness.

Article 76

(1) FKRTL submits a collective claim to BPJS


Periodic and complete health.
(2) BPJS Health must issue an official report
completeness of claim file no later than 1 0

(ten) days since the claim was submitted by FKRTL and

received by BPJS Health.


(3) In case BPJS Health does not issue
minutes of completeness of claim file in time

10 (ten) days as referred to in paragraph


(2) then the claim file is declared complete.

(4) BPJS Health is obliged to make payments


to FKRTL based on claims submitted and
has been:
a. verified as referred to in paragraph
(2) no later than 15 (fifteen) days since
publication of minutes of completeness of the file
claim; or

b. Fulfill ...
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b. fulfill the provisions as intended

in paragraph (3) no later than 15 (fifteen) days


since the fulfillment of the provisions as stated
referred to in paragraph (3).

(5) In the case of payments to FKRTL as is


referred to in paragraph (4) falls on a holiday then
Payments at FKRTL are made on weekdays
next.

(6) In the event that the Health BPJS does not do


payment as referred to in paragraph (4),
BPJS Health must pay a fine to

FKRTL that is equal to 1% (one percent) of the total

which must be paid for every 1 (one) month


lateness.

Article 77
(1) Submitting a health service financing claim

by Health Facilities to BPJS Health


period is no later than 6 (six)
month since the health service was completed.

(2) Provisions as referred to in paragraph (1)


excluded for health services which

was given by Amenities Health before


the entry into force of this Presidential Regulation.

(3) In term of term time for filing a claim


as referred to in paragraph (1) is exceeded,
the claim cannot be submitted again.
(4) In the case of payment for services

health caused due to abuse


health services carried out by the Facility
Health, Amenities Health should
refund the fees already paid
after verification is done after claiming to BPJS
Health.

(5) In ...

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(5) In the event of a lack of payment for

health service fees paid by

BPJS Health, BPJS Health should

pay the shortfall in service fees

health.

Article 78

(1) For the benefit of payment of service fees

health, BPJS Health can request a record

medical Participants in the form of a summary of medical records

to Health Facilities in accordance with the provisions

laws and regulations.

(2) Summary of medical records as intended

in paragraph (1) at least contains the patient's identity,

diagnosis, and examination and treatment history

which is charged.

(3) In case it is needed for audit purposes

Claim administration, BPJS Health can see

Participant's medical record from the Health Facility

while maintaining the confidentiality of the contents of the medical record

in accordance with statutory provisions

invitation.

(4) BPJS Kesehatan in viewing Participant medical records


as referred to in paragraph (3) must go through
the team appointed by the Health Facility.

Article 79

(1) Emergency services carried out by

Health facilities that do not collaborate

with BPJS Health get paid with

reimbursement.

(2) Costs ...

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(2) Costs referred to in paragraph (1)

billed directly by the Health Facility to

Health BPJS.

(3) Health BPJS provides payment to

Health facilities as referred to in


paragraph (2) is equivalent to the tariff in force in the region

available.

(4) Provisions more continued about procedure

reimbursement of emergency services and costs

Ambulance services are regulated by BPJS Regulations

Health after coordinate with

relevant ministries / institutions.

Article 80

(1) For certain types of services that can be

lead to abuse of service, Participant

Subject to Fee.

(2) Provisions as referred to in paragraph (1)

excluded for PBI Health Insurance Participants

and residents registered by the Government


Area.

(3) Service that could give rise to

misuse of services as intended


in paragraph (1) is service that

influenced by participants' tastes and behavior.

(4) The type of service referred to in paragraph

(1) and paragraph (3) are determined by the Minister.

Article 8 1

(1) Sort of fees for types of services that can be

give rise to abuse service

as referred to in Article 80, i.e.


as big as:

a. score...

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a. a certain nominal value every time you do

outpatient visits or face value

the maximum cost of health services

for a certain period of time; and

b. 10% (ten percent) or highest with

a certain nominal amount for hospitalization of fees

service,

paid to Health Facilities when

get service.

(2) BPJS Health pay service fees

health to Health Facilities after

minus the amount Urun Cost as is

referred to in paragraph (1).

(3) Facilities Health should inform

services are subject to a Fee Fee for Participants


before carrying out service delivery which
can lead to abuse of service.

(4) Provisions Furthermore hit establishment

service that could give rise to

misuse of service, quantity and procedure

Imposition of Fees is regulated by Regulations

Minister.

CHAPTER VII

KENDAL! QUALITY AND CONSTRAINTS! COST

MANAGEMENT OF WARRANTIES

HEALTH

Article 82

In the context of quality control and cost control

the implementation of the Health Insurance Program, Minister

set implementation policies:

a. assessment ...

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a. health technology assessment;

b. clinical considerations;

c. calculation of tariff standards; and

d. monitoring and evaluation of service delivery

Health insurance.

Article 83

(1) In set Policy as is

referred to in Article 82, the Minister and the minister

and the National Social Security Board

authorized to access and request data and


information from BPJS Health.

(2) Health BPJS must provide access and

provide data and information as is

referred to in paragraph (1) to the Minister and the minister

and the National Social Security Board.

Article 84

(1) In the framework of policy making in the field

health in the Region, BPJS Health mandatory

provide data and information to the Head

District / city Health Office and Head of Office

Health of the local province periodically every 3

( three months.

(2) Data and information as referred to in

paragraph (1) includes:

a. the number of Health Facilities cooperating

with BPJS Health;

b. membership;

c. number of visits to health facilities;

d. types of diseases; and

e. payment amount and / or claim.

Article 85 ...

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Article 85

(1) Rating technology health how

referred to in Article 82 letter a is carried out for

rate effectiveness and efficiency of use

technology or technology products in the form of methods,

medicine, or medical devices in service


health insurance program.

(2) Use of health technology assessment results

as referred to in paragraph (1) is determined by

Minister after receiving a recommendation from the Committee

Health Technology Assessment.

(3) Health Technology Assessment Committee as

referred to in paragraph (2) is formed by the Minister.

(4) Further provisions regarding technology assessment

health as referred to in paragraph (1)

governed by Ministerial Regulation.

Article 86

(1) In the framework of quality control and cost control

the implementation of the Health Insurance program, BPJS

Health develops operational techniques

health service system, quality control system

services, and service payment systems

health to improve efficiency and

effectiveness in administering the Guarantee program

Health.

(2) Technical development of operationalization as such

referred to in paragraph (1) is carried out through:

a. Health Facility credentials;

b. Participant satisfaction survey; and

c. monitoring and supervision of utilization.

(3) In. . .

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(3) In carrying out development as


referred to on paragraph
(1), BPJS Health
coordinate with relevant ministries / institutions.

Article 87

(1) Health facilities in providing services


health to Health Insurance Participants must
implementing quality control and cost control with

still pay attention to safety and security


patient and service quality.

(2) Implementation of quality control and cost control


as referred to in paragraph (1) is carried out
as a whole includes meeting standards

the quality of the Health Facility, ensuring the process


health services run according to standards
established, and monitoring of outcomes

Participant health, and cost efficiency.

Article 88
Further provisions regarding quality control and

control of Health Insurance service costs is regulated


by Ministerial Regulation.

CHAPTER VIII
INFORMATION AND SERVICES

THE HANDLING OF COMPLAINTS

Article 89
(1) Participants are entitled to get information
regarding the implementation of health insurance
as a whole concerns rights and obligations
Participants / Health Facilities / Health BPJS, and
service mechanism in Health Facilities and
Health BPJS.

(2) Participants ...

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(2) Participants have the right to complain about dissatisfaction

towards Health Insurance services which

provided by Health Facilities, and towards

BPJS Health services to the complaints unit,

both contained in the Health Facility, BPJS

Health, health services, and the Ministry

Health.

(3) Health facilities and compulsory health BPJS

provide complaint units that are managed in a manner

together or individually by the Facility

Health and Health BPJS.

(4) The complaints unit as referred to in paragraph

(2) can be in the form of:

a. the unit the controller you tu service and

handling complaint for BPJS

Health;

b. the unit complaint Public integrated / team

Health Insurance monitoring and evaluation

for the health department and the Ministry

Health; and / or

c. community complaints unit for Facilities


Health.

(5) Complaint dissatisfaction that be delivered


Participants must obtain handling and
settlement in an adequate and in a timely manner

brief and given feedback to parties who

deliver.

Article 90

Health facilities in organizing services

health must inform the availability of space

hospitalization to the community.

CHAPTER IX ...

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CHAPTER IX

DISPUTE RESOLUTION

Article 9 1

(1) In the event of a dispute related to the administration


Health Insurance between:

a. Participants with Health Facilities;

b. Participants with Health BPJS;

c. BPJS Health with Health Facilities;

a tau

d. BPJS Health with facilities associations

health,

the settlement is done by deliberation.

(2) Disputes as referred to in paragraph (1)

including complaints that have not been resolved


by the complaint unit as referred to in

Article 89.

(3) Settlement dispute in a manner discussion

as referred to in paragraph (1) involves

Head of provincial health office, head of service

Health district / city, and / or Sadan

Penga was Rumah Saki t.

(4) In the event that a dispute cannot be resolved in a manner

deliberations, disputes are resolved through the Council


Clinical Considerations, by way of mediation, or

court.

(5) How to resolve disputes through mediation or

through the court as referred to in a

paragraph (4) is carried out in accordance with the provisions

laws and regulations.

(6) Further provisions regarding the method of settlement

disputes through the Clinical Advisory Board are regulated

by Ministerial Regulation.

CHAPTER X ...
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CHAPTER X

PREVENTION AND HANDLING

KECURANGAN (FRAUD) IN

PROGRAM IMPLEMENTATION

HEALTH INSURANCE

Article 92

(1) Fraud (fraud) can be done by:

a. Participant;

b. BPJS Health;

c. Health facilities or service providers

health;

d. providers of drugs and medical devices; and

e. other stakeholders.

(2) Fraud (fraud) as referred to in

paragraph (1) includes abuse of service

health caused due to the behavior of the giver

health services.

(3) BPJS Health, district / city health office,

and FKRTL in collaboration with BPJS

Health must build a prevention system

Fraud (fraud) as referred to in

paragraph (1) through:

a. drafting Policy and guidelines

fraud prevention;

b. development of a culture of fraud prevention

(fraud);

c. development of health services which

oriented towards quality control and control


cost; and
d. the formation of a cheating prevention team

(fraud).

(4) System ...

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(4) Fraud prevention system (fraud) as

referred to in paragraph (3) is carried out systematically,

structured, and comprehensive by involving

all human resources at BPJS Health,

Amenities Health, service health

district / city, din as health provms1,

Ministry of Health, and stakeholders

the other.

Article 93

(1) Minister, Head of Provincial Health Service, Head

District / city Health Office can provide

administrative sanctions for any person or corporation

as referred to in Article 92 paragraph (1) which

committing fraud (fraud).

(2) Administrative sanctions referred to in

paragraph (1) in the form of:

a. verbal warning;

b. written warning; and / or

c. command friend loss consequence

Fraud (fraud) on the injured party.

(3) In addition to administrative sanctions as referred to


in paragraph (2), for Health BPJS officers,

health service providers, and drug providers

and medical devices may be subject to additional sanctions.

(4) Administrative sanctions referred to in

paragraph (2) does not remove the appropriate criminal sanctions

with the provisions of the legislation.

Article 94 ...

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Article 94

To increase prevention and treatment efforts

Fraud (fraud) formed a team consisting of elements

Ministry of Health, ministries / institutions, BPJS

Health, and the Corruption Eradication Commission, as well

relevant ministries / institutions.

Article 95

Further provisions regarding prevention efforts and

handling Fraud (fraud) and the imposition of sanctions

The administration is regulated by a Ministerial Regulation.

CHAPTER XI

SUPERVISION, MONITORING,

AND EVALUATION

Article 96

(1) Minister, Head of Provincial Health Service, and

Head of district / city Health Service conducts

supervision of the implementation of the program


Health insurance in accordance with the authority

each.

(2) Implementation of supervision as intended

Paragraph (1) may involve the Regulatory Body

Hospital, Hospital Board of Trustees,

health facility associations, and / or organizations

profession according to need.

(3) Implementation of supervision as intended

in paragraph (1) is carried out in a coordinated manner

relevant agencies in accordance with regulatory provisions

legislation.

Article 97 ...

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Article 97

(1) Labor inspectors in the agency that

responsible for manpower affairs

conduct an examination of the employer

that violates the provisions as intended

in Article 13 the implementation is done

in accordance with statutory provisions

invitation.

(2) BPJS Health conducts supervision and

inspection of Participants and Givers' compliance

Work in fulfilling its obligations in accordance with

the provisions of the legislation.

(3) BPJS Health in conducting supervision and

inspection of Participants and Givers' compliance

Work can work with supervisors


employment and State Attorney Attorney.

Article 98

(1) For the continuity of program implementation

Health Insurance is monitored and

evaluation.

(2) Implementation of monitoring and evaluation as

referred to in paragraph (1) is carried out on aspects of:

a. membership;

b. health services;

c. Tuition;

d. payment to Health Facilities;

e. finance;

f. organization and institution; and

g. regulation.

(3) Monitoring. . .

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(3) Monitoring and evaluation as intended

in paragraph (1) performed by Ministry

Health, Ministry of Finance, Ministry

Social, Ministry of Home Affairs, Ministry

Planning Development National / Agency

Planning Development National, Bad an

Financial Examiner, Financial Supervisory Agency

and Development, the National Social Security Council,

Financial Services Authority, and Regional Government

according to their respective authorities.


(4) Monitoring and evaluation as intended
in paragraph (1) is carried out in an integrated manner.

CHAPTER XII

LOCAL GOVERNMENT SUPPORT

Article 99

(1) Government Area Required support

the implementation of the Health Insurance program.

(2) Support Government Daer Ah as is

referred to in paragraph (1) is carried out through:

a. enhancement achievement membership in

its territory;

b. compliance payment of contributions;

c. health service improvement; and

d. other support in accordance with the provisions

statutory regulations in order

guarantee the continuity of the Guarantee program

Health.

(3) Support ...

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(3) Supporting the improvement of participation in

the area as referred to in paragraph (2)

letter a is implemented through the issuance of regulations

that requires program participation

Health Insurance in obtaining services

public.
(4) Support obedience payment Tuition
as referred to in paragraph (2) letter b

implemented through payment implementation

Contribution in the right amount and on time.

(5) Support enhancement service health

as referred to in paragraph (2) letter c

implemented through provision Amenities

Health, meeting minimum service standards,

and improving the quality of health services.

(6) Other support as referred to in

paragraph (2) letter d is implemented through contributions from

cigarette tax rights section of each region

province / district / city.

Article 100

(1) The amount of contribution referred to in

Article 99 paragraph (6) is stipulated 75% (seventy-five)

percent) of 50% (fifty percent) realization

cigarette tax receipts part of their respective rights

Provincial / district / city area.

(2) Contributions as referred to in paragraph (1)

cut straight to be transferred to

in the BPJS Health account.

(3) Provisions ...

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(3) Further provisions regarding contributions and

cutting mechanism as intended


in paragraph (1) and paragraph (2) regulated by Regulation
Minister that organize affairs

government in finance.

Article 101

(1) Regional contributions to fund the program

Health Insurance as referred to in

Article 99 paragraph (6) is budgeted as expenditure

social assistance health function on the budget

income and shopping area

province / district / city.

(2) Planning, budgeting, and

accountability contribution Area

as referred to in paragraph (1) is implemented

corresponding
with Regulation Minister that

holding government affairs in

country that set about guidelines

budgeting income and expenditure

area.

Article 102

The Regional Government organizes guarantees

Regional health must integrate it into

Health Insurance program organized by

Health BPJS.

CHAPTER XIII. . .

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CHAPTER XIII

TRANSITIONAL PROVISIONS

Article 103

At the time of Presidential Regulation m1 be in effect,

provisions regarding Non-Employee Government Employees

Country included in PPU as intended

in Article 4 paragraph (2) letters h to

stipulated Regulation Government hit

Management of Government Employees with Work Agreements.

CHAPTER XIV

CLOSING

Article 1 04

Provisions as referred to in Article 16 paragraph

(1) and paragraph (2), Article 28 paragraph (6), Article 42 paragraph (1)

up to paragraph (6), and Article 80 paragraph (4) starts

valid after 3 (three) months from the date of Regulation

This president is promulgated.

Article 105

The implementing regulations of this Presidential Regulation must

stipulated no later than 6 (six) months from

This Presidential Regulation promulgated.

Article 106 ...

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Article 106

At the time this Presidential Regulation comes into force, all

the rules legislation that is a

implementing regulations of Presidential Regulation Number 12

Year 20 13 regarding Health Insurance (Gazette

Republic of Indonesia Year 2013 Number 29)

as amended several times, most recently with

Presidential Regulation Number 28 of 2016 concerning

Third Amendment to Presidential Regulation Number 12

Year 20 13 regarding Health Insurance (Gazette

Republic of Indonesia Year 2016 Number 62),

otherwise still valid throughout the day

contrary to the provisions in the Regulations

This president.

Article 107

At the time of Presidential Regulation 1111 be in effect,

Presidential Regulation Number 12 of 2013 concerning

Guarantee Health (Sheet Country Republic

Indonesia Year 2013 Number 29) as already

several times amended, most recently by Regulation

President Number 28 of 2016 concerning Change

Third on Presidential Regulation Number 12 Year 20 13

regarding Health Insurance (Republic of Indonesia State Gazette

Indonesia Year 2016 Number 62), revoked and

declared invalid.

Article 108

Presidential Regulation 1111 comes into force on date

invited.

So that ...
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So everyone knows, ordered

invitation Regulation President lnl with

its placement in the Republic of Indonesia's Official Gazette

Indonesia.

Set in Jakarta

on September 17 2 018

PRESIDENT OF THE REPUBLIC OF INDONESIA,

signed

JOKO WIDODO

Promulgated in Jakarta

on September 18, ber 2 018

MINISTER OF LAW AND HUMAN RIGHTS

REPUBLIC OF INDONESIA,

signed

YASONNA H. LAOLY

STATE GAZETTE OF THE REPUBLIC OF INDONESIA YEAR 2 018 NUMBER 165

Copies in accordance with the original

RI CABINET SECRETARIAT

Deputy for Development

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