In Indonesia, Social Security for Health is primarily administered under the Jaminan Kesehatan Nasional (JKN), or National Health Insurance, which is managed by BPJS Kesehatan (Badan Penyelenggara Jaminan Sosial Kesehatan)—the Health Social Security Agency.

Key Features of JKN (National Health Insurance):

1. Universal Coverage Goal

Launched in 2014, JKN aims to provide universal health coverage (UHC) for all Indonesians.

As of recent years, more than 90% of the population has been enrolled.

2. Mandatory Participation

All Indonesians are required to participate, including:

• Formal sector workers (private and government employees),
• Informal sector workers (self-employed),
• Poor and vulnerable groups (whose premiums are paid by the government).

3. Funding and Contributions

Funded through a combination of individual premiums and government subsidies.

Contribution rates depend on income levels:

• Formal sector: Employers and employees share the cost.
• Informal sector: Individuals pay their own premiums.
• Poor citizens: Fully subsidized by the government.

4. Benefit Package

Covers a wide range of services including:

• Primary care (clinic visits, basic treatments),
• Hospital services (inpatient and outpatient),
• Medications and diagnostics,
• Maternity care, surgeries, and catastrophic illness treatment.
• Services are tiered based on hospital class: Class III (basic), Class II, and Class I (better facilities).

5. Service Delivery

Members must first visit primary care providers (Puskesmas or clinics).

Referrals are required for secondary/tertiary care unless it's an emergency.

Cashless system: Members present their BPJS card to receive services.

6. Challenges

Funding deficits: The program has faced persistent financial shortfalls due to high healthcare costs.

Service quality: Overcrowding and inconsistent care standards, especially in public facilities.

Awareness and compliance: Particularly among informal sector workers.

🩺 BPJS Kesehatan (Health Social Security) Contribution Scheme – Formal Sector

💰 Total Contribution Rate: 5% of Monthly Salary

Employer pays: 4%

Employee pays: 1%

Salary Cap (Maximum Contribution Base): IDR 12 million per month

So, 5% x IDR 12 million = IDR 600,000 maximum contribution.

This is the ceiling for those earning more than IDR 12 million/month.

📊 Example Calculations

👥 Applies To:

Formal workers in the private and public sectors. Mandatory for both employer and employee.

🏥 Benefits Covered

Same as standard JKN package:

Primary care, hospital services, surgeries, medications, maternal health, etc.

No extra charge at public facilities if following referral system.

⚠️ Important Notes

Contribution is deducted from salary monthly.

Coverage includes employee + nuclear family (spouse + up to 3 children).

Additional dependents can be added but require extra premiums.