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February 6, 2025 | 03:53 pm
TEMPO.CO, Jakarta - Active participants of the National Health Insurance-Indonesian Healthy Card (JKN-KIS) of the Social Security Administering Body or BPJS Kesehatan can enjoy a number of health services, including for participants in the child category.
Child participants can take advantage of several predetermined health services, including emergency conditions.
The provisions for emergency conditions for JKN-KIS participants refer to the Regulation of the Minister of Health (Permenkes) Number 47 of 2018 concerning Emergency Services. So, what are the criteria for emergency conditions in children that are covered by BPJS Kesehatan?
Criteria for Emergency Conditions for Children Covered by BPJS Kesehatan
Emergency services are medical actions that are needed by emergency patients as soon as possible to save lives and prevent disability.
While emergencies are clinical conditions that require immediate medical action to save lives and prevent disability.
Based on Article 3 paragraph (2) of the Minister of Health Regulation Number 47 of 2018, there are several emergency criteria, including for JKN-KIS child participants, including:
1. Life-threatening, endangering the patient and others or the surrounding environment.
2. There is a disturbance in the airway, breathing, and circulation.
3. There is a decrease in consciousness.
4. There is a disturbance in hemodynamics or blood flow dynamics.
5. Requires immediate action.
Then, citing the JKN-KIS Participant Service Guide book downloaded from the official BPJS Kesehatan website, the determination of the fulfillment of emergency conditions is carried out by the Patient's Responsible Doctor (DPJP).
Thus, emergency conditions for JKN-KIS participants, including children, are based on the DPJP diagnosis, not the type of disease. This means that emergency actions are not specific to certain types of diseases, but refer to the DPJP's decision.
Age Limit for Children Covered by BPJS Kesehatan Parents
To note, every Indonesian citizen (WNI) is required to register themselves as participants in the BPJS Kesehatan JKN-KIS program.
Individual participants must register themselves and their family members listed on the family card (KK) as stipulated in BPJS Kesehatan Regulation Number 4 of 2014 concerning Procedures for Registration and Payment of Individual BPJS Kesehatan Participants.
Next, Presidential Regulation (Perpres) Number 82 of 2018 concerning Health Insurance states that children of wage-earning worker (PPU) segment participants who receive insurance in the JKN-KIS program must be under 21 years old or under 25 years old for children who are still undergoing formal education.
In addition, biological children, stepchildren from legitimate marriages, and legitimate adopted children of parents in the PPU category must also have the status of not or have never been married or not have their own income in order to receive health service insurance from BPJS Kesehatan.
This means that if the child is still undergoing formal education, then the participation that can be covered by parents from the PPU segment is up to the age of 25. Meanwhile, children who have reached the age of 21, but are no longer undergoing formal education, are not included as dependents in the JKN-KIS program in the PPU segment.
"Family members of PPU participants include legitimate wives/husbands, biological children, stepchildren from legitimate marriages, and legitimate adopted children, a maximum of four people," reads Article 5 paragraph 1 of Presidential Regulation Number 82 of 2018.
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