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BPJS Health provides basic protection including several diseases critical such as cancer, heart disease, stroke, and kidney failure through the National Health Insurance. However, coverage is limited, especially in terms of services, flexibility, and non-medical funding. Adding private critical illness insurance can be an important solution to maintain your financial stability when the worst happens.
Imagine an ordinary morning changing drastically when the doctor mentions the dreaded word: cancer or a sudden heart attack in your 40s. In the midst of your panic, you remember that you have BPJS.
But is that enough? This is where many people begin to realize that basic protection is often not enough when a critical illness strikes.. This article will explore the reality behind BPJS coverage, the loopholes to watch out for, and how private critical illness insurance can provide a financial shield in times of crisis.
Officially, BPJS does cover critical illnesses such as cancer, stroke, kidney failure, and heart disease. But don't be mistaken, because that doesn't mean all costs and all types of services are automatically covered.
For example:
The cost of installing a heart ring can reach IDR 80–100 million.
Bypass surgery could cost IDR 150–300 million.
Cancer therapies such as chemotherapy or intensive radiation can cost tens of millions per cycle.
BPJS only covers those listed on the "national formulary" and follows strict referral procedures. Many cancer patients have to wait in line for months just to get a therapy appointment—while their disease continues to progress.
A recent performance report from the Ministry of Health states that more than 70% of cancer patients arrive at the hospital late, often when the disease has already reached an advanced stage. This isn't just a matter of waiting time—it's also a lack of early detection and limited access to adequate facilities. Under these conditions, relying solely on BPJS can pose a significant financial risk if diagnosis is too late and treatment options are limited. Before we discuss solutions, let's first examine the actual coverage of BPJS for critical illnesses and where the gaps lie.
Imagine this: You have a stroke and need long-term care. BPJS covers the hospital costs—but what about the costs of recovering at home, follow-up therapy, or even lost income from being unable to work for months?
BPJS does not cover:
Loss of income (due to not being able to work)
Caregiver fees, assistive devices such as wheelchairs
Home adaptations for disability needs
Special drugs that are not included in the national formulary
This isn't just speculation. A systematic review of research from 2015–2020 found that approximately 75% of cancer patients experience significant financial difficulties within one year of diagnosis, due to high medical and non-medical care costs. This phenomenon is known as financial toxicity. Referring to the ASEAN Cost in Oncology survey (2014), approximately 48% of cancer patients in the Southeast Asia region reported a very severe cost burden in the first 12 months.
In the Indonesian context, with healthcare facilities largely based on the BPJS (Social Security Agency) and tiered referral access, this data confirms that without additional financial protection, patients and their families could face economic crises at the worst possible time.
Don't only realize the "gap" when your savings run out and your family starts borrowing. Let's take a deeper look. It's not just about "is it covered?" but also about how much you should actually prepare for when a crisis strikes.
Types of Disease |
Estimated Total Maintenance Costs |
Covered by BPJS? |
|---|---|---|
Cancer (stage 3–4) |
IDR 150–500 million |
Partly, depending on the referral and medication |
Stroke (hospitalization + rehab) |
IDR 100–300 million |
Some, excluding home physiotherapy |
Chronic kidney failure (annual dialysis) |
IDR 70–150 million/year |
Covered, but long queues |
Heart attack (ring + medication + rehab) |
IDR 200–400 million |
Partly, depending on the reference |
Disclaimer: Cost estimates may vary between hospitals and regions.
And what's even more worrying is that these illnesses no longer only affect the elderly. Without additional protection, the cost of critical illness treatment could fall entirely on you—and the risk is real, even for young people. According to data from Cipto Mangunkusumo Hospital (2008–2019), of 495 confirmed colorectal cancer patients. Histopathologically, approximately 41.4% were early-onset cases, or diagnosed at age under 50. This means that serious diseases such as cancer do not only attack older people, but also the productive generation can be affected.
It's not just about medical costs, but also loss of income, the cost of follow-up therapy, non-medical needs, and the burden on your family when your condition worsens. Without additional insurance like lump-sum coverage and flexible benefits, you could be facing significant financial risk in just a matter of weeks.
So, if BPJS isn't enough and the risks are imminent, what's the most logical step to protect yourself and your family financially? This is where protection from Oona plays a crucial role.
BPJS does provide basic coverage, but there are often significant gaps left uncovered—especially when critical illnesses strike and the impact is not just physical, but also financial. This is where Oona Critical Illness Insurance provides specific, focused, and practical protection for the three most deadly diseases in Indonesia: cancer, heart attacks, and strokes. For clarity, here's a comparison of the main benefits of Oona Critical Illness Insurance compared to BPJS.
Protection Features |
Oona Critical Illness Insurance |
BPJS Health |
|---|---|---|
100% Cash Compensation |
The insurance money is immediately disbursed upon diagnosis and can be used for all needs. |
Not available |
Claim Process |
No tiered referrals are necessary. A valid diagnosis from a hospital is sufficient. |
Must go through health facilities 1–3 and a complex referral system |
Response Time |
Fast and flexible, without queues for public facilities |
May be delayed due to long queues & facility quotas |
Use of Funds |
Free to use: living expenses, alternative medicine, house installments, etc. |
Limited to medical services as per provisions |
Disease Coverage |
Focus on the big 3: cancer, heart attacks, and strokes—the leading causes of death in Indonesia. |
Wider coverage but depends on referrals & facilities |
Disclaimer: Oona focuses on comprehensive coverage for three major critical illnesses. This table is for illustrative purposes only and does not replace the policy summary.
But why does Oona only focus on three diseases? Precisely because these three are the leading causes of death and disability in Indonesia.
More than 60% of critical illness cases in Indonesia stem from three main diseases: cancer, heart attacks, and strokes. According to data from WHO, three out of five deaths from non-communicable diseases in Indonesia are caused by these three diseases, making them the largest contributor to deaths among those of productive age. However, protection can only be purchased while healthy. That's why delaying treatment is the biggest mistake.
One of the most common mistakes is delaying purchasing insurance because you feel you're still healthy. Many people think, "I'll just wait until later, I'm still young." But critical illness doesn't discriminate by age. And what many don't realize is that once you're diagnosed, you're no longer eligible for coverage.
Insurance can only be purchased while you're still healthy. Once you're sick, all you can buy is time, and that's expensive.
According to WHO, non-communicable diseases (NCDs) are the leading cause of global death, responsible for approximately 73% of all deaths in Indonesia in 2018, with heart disease contributing 35%, cancer 12%, and chronic respiratory disease 6%
Other publications state that around one third of all deaths in Indonesia are caused by cardiovascular disease (including strokes and heart attacks), and in general the death rate due to NCDs continued to increase from 63% to 72% in the period 2007–2017.
Therefore, it's important to know: when should you start getting critical illness coverage? And the answer isn't when you get sick.
The best time to get protection is while you're still healthy and don't need it yet. Because when illness strikes, it's not just your physical health that's tested—it's also your financial stability.
Age 30–45 years is the most ideal phase to start having critical illness insurance from Oona.. This is when life's responsibilities become apparent, health risks begin to emerge, and premiums are still relatively low.
Reason |
Explanation |
|---|---|
Premiums are still affordable |
Lower health risks = cheaper premiums and optimal coverage value |
Risks start to increase |
Many cases of cancer, stroke, and heart disease are found in people in their 30s and 40s. |
Starting to have responsibilities |
Your house, children, and partner depend on your income and health. |
Easy to approve |
While still healthy, insurance applications are faster and without additional conditions. |
Don't wait until you have to use your child's school fees for medical expenses. Because insurance isn't about fear, it's about peace of mind. If you feel this is important but don't know where to start, here's a simple guide to taking the first step with Oona.
If you don't know where to start, follow this simple guide:
Select the type of critical illness you want to protect
Oona focuses on cancer, stroke, and heart attacks—three of the highest-risk diseases in Indonesia.
Determine the amount of compensation needed
For example, if you want emergency funds of at least IDR 200 million when diagnosed with cancer, adjust the coverage value to that need.
Compare premiums based on age and health profile
Oona offers flexible premium options, starting from IDR 100 thousand per month, depending on age and benefits.
Apply easily online
No hassle, no long process via the official Oona website.
Protect yourself now with Oona Critical Illness Insurance.
BPJS is a good first step. But to face the realities of critical illness—high costs, fast response times, and the constant demands of life—you need more than just basic coverage.
Oona presents a modern solution: specific, responsive, and flexible. Because the most important thing is not just to survive, but to live with dignity.
Don't delay decisions that could save your and your family's future. Check critical illness insurance options from Oona now.
