Terms and Conditions for Diabetes Insurance Claims, either from BPJS or Private Insurance

Terms and Conditions for Diabetes Insurance Claims, either from BPJS or Private Insurance

Terms and Conditions for Diabetes Insurance Claims, either from BPJS or Private Insurance

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If not properly addressed, diabetes can increase the mortality rate in a country. Diabetes has even become one of the chronic diseases with the largest mortality rate in Indonesia. The number of Indonesians diagnosed with diabetes from year to year has always skyrocketed. Riskesdas data reported that total diabetes cases by the end of 2013 doubled compared to 2007.

So, it is not surprising if diabetes treatment is also included in the BPJS program as a government effort to control the malignancy of the disease in Indonesia. Some private insurance companies also claim to treat diabetes policy holders. Let's find out what is funded by insurance for diabetes.

What can the BPJS pay for diabetes?

Terms and Conditions for Diabetes Insurance Claims, either from BPJS or Private Insurance

In accordance with Permenkes 28/2014, BPJS insurance covers all types of diseases. Reported on the Indonesian Jamkes page, financing the treatment of major killer diseases (one of them diabetes) is borne entirely by BPJS. That is, all funding for the treatment of diabetes in Indonesia is free if you are officially registered as a BPJS participant and follow the applicable claim rules.

This includes daily diabetes medication prescriptions, purchasing insulin and refilling, hospitalization, to diabetes gymnastics classes and nutrition education for dietary arrangements in your FASKES area.

What diabetes medications are covered by BPJS?

Terms and Conditions for Diabetes Insurance Claims, either from BPJS or Private Insurance

Diabetes medication that must be taken for life and prediabetes drugs will be borne by BPJS. However, this facility is limited to certain types of drugs.

Diabetic drugs funded in diabetes mellitus are drugs in the National Formulary List (Fornas). Fornas is a reference in giving medicines to BPJS participants. Drugs that enter the National Medicines are the most effective, safe, and affordable drugs.

If you use drugs outside of this list, then you have to pay for it yourself with personal money. But other costs outside of this drug, such as the cost of consulting a doctor, will still be paid by the BPJS.

In Fornas there is also the maximum number of drugs that can be prescribed. For example, the diabetes drug metformin 850 mg can be given a maximum of 60 tablets per month. That means, if more than this amount of metformin medicine is given in a month, then you will have to pay the remaining excess drug price.

What is the procedure for examining diabetes with BPJS?

Terms and Conditions for Diabetes Insurance Claims, either from BPJS or Private Insurance

For the examination, the stages will be the same as examining the disease in general. First you need to go first to the health center as a level 1 health facility to get a basic physical examination. Afterwards if health facility 1 assesses your condition needs to be addressed further, then a referral letter will be made for treatment to level 2 health facilities. So on.

If the lifespan of your referral letter has expired but you still need further treatment, repeat again from the first step which is going to health facility 1 to renew the referral letter. So on.

Make sure your BPJS contribution is not in arrears so that the bureaucracy is smooth during treatment.

Then, what about diabetes treatment with private insurance?

Terms and Conditions for Diabetes Insurance Claims, either from BPJS or Private Insurance

The terms and conditions of each insurance company for diabetes can vary. Basically, insurance claims for diabetes will depend on the agreement of the policy alias contract that you have made with the insurance agent at the beginning of the registration.

If the policy contract approves insurance to pay for your diabetes treatment, then don't worry. All diabetes medications and other diabetes checks will be supported by the insurance.

However, some insurance companies have a starting point not to finance cases of complications of diabetes or certain diseases caused by diabetes.

Also Read:

  • Should Diabetes Drugs Be Taken Every Day?
  • 4 Things to Look For When Choosing Insurance
  • Diabetes Cannot Be Cured, Then How To Control It?

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