Supreme Court Affirms Diseases Caused by Drugs, Alcohol, and Hobbies are Not Covered by BPJS

As known, the Social Health Insurance Administration Body or Badan Penyelenggara Jaminan Sosial Kesehatan (“BPJS Kesehatan”) is the organizer of the health insurance. As the furtherance of the enactment of Law No. 40 of 2004 dated 19 October 2004 concerning the National Social Insurance System (“Law 40/2004”), the government issued Presidential Regulation No. 82 of 2018 dated 17 September 2018 concerning Health Insurance as lastly amended by Presidential Regulation No. 64 of 2020 dated 6 May 2020 (“PR 82/2018”). Law 40/2004 mandates that the types of diseases which are not covered by BPJS must be elaborated further through the establishment of a Presidential Regulation. PR 82/2018 regulates, among others, the types of disease which are covered by BPJS. PR 82/2018 provides certain exceptions of the diseases covered by BPJS Kesehatan.

Pursuant to Article 52 (1)(i)(j) PR 82/2018, health services which are not guaranteed includes services for health disorders caused by drug and/or alcoholic beverage dependence, deliberate self-harm, or hobbies which endanger the life of a person. This specific rule appears to be controversial for public and subsequently, a group of communities filed a request for review to the Supreme Court.

In its Decision No. 55P/HUM/2020 dated December 3, 2020 (“SC Decision 55P/2020”), the Supreme Court insists that the state’s policy of not covering diseases caused by drugs, alcoholic beverages, and hobbies is in accordance with the national laws.  Therefore, the Supreme Court rejected the request for review submitted by the applicants.

The Supreme Court considers that there are other sources of financing which are deemed sufficient to cover health services for diseases caused by drugs and/or alcoholic beverage dependency. The Supreme Court affirms that in order to avoid overlapping or duplication of sources of funding, these health services shall be excluded from the benefit package of BPJS Kesehatan.

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April 15, 2021

Please contact Johannes C. Sahetapy-Engel (jsahetapyengel@aksetlaw.com) for further information.

 

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