Implementation of the social health insurance based on the National Social Security Acf/SJSN (Law No. 4012004) was delegated to PT ASKES by the Ministry of Health, to manage health care program for the poor since January 2005. There were 36 million poor people covered by the program at the first semester. The study design was cross-sectional with collection of qualitative and quantitative data to describe the implementation program at Puskesmas. The total samples were 800 respondents with health cards chosen randomly from 4 districts/city in 4 provinces with different level of development (based on Indonesian Human Development Index). There were Karangasem District, Bali; Padang City, West Sumatra; Ende District, East Nusa Tenggara and Lebak District, Banten. Total samples analyzed were 796 household/respondents. About 69% respondents, used askeskin cards at Puskesmas, which increased utilization of the card after 2nd period of the program (after July 2005). About 15% respondents visited health centres without health cards, 15% did not visit the health centres because lack of transportation budget. About 94% of health cards were distributed appropriately to the poor: 74% classified as very poor. 13% classified as poor and 7% classified as nearly poor. About 80% respondents had general clinic services and 30% had MCH services and only 7% visited dentist. They were served 50% by doctor. 45% by midwives and 20% by the nurses. About 20% respondents with health cards still shared budget for medicines. About 85% respondents were satisfied with Puskesmas services. We recommend that safe guarding mechanism should be Implementing with all stakeholders, and socialization to health providers to the poor should be provided much more. Besides the standard implementation program should have several revisions.