OJK Mandates Co-Payment for Health Insurance Claims Starting 2026
Main Takeaways
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JAKARTA, investortrust.id — Indonesia’s Financial Services Authority (OJK) has introduced a new rule requiring health insurance customers to pay a minimum of 10% of their claim value, marking a significant policy shift that ends the era of full (100%) coverage. The measure, effective from January 1, 2026, is part of OJK’s newly issued Circular Letter No. 7 of 2025 on Health Insurance Product Providers.
Under the new rules, insurers must implement a co-payment scheme for both outpatient and inpatient hospital services, according to Ogi Prastomiyono, Chief Executive for Insurance, Guarantee, and Pension Fund Supervision at OJK. He announced the regulation during the financial authority’s monthly board meeting press conference on Monday, June 2, 2025.
Ogi explained that the co-payment mechanism is intended to distribute healthcare costs more equitably between insurers and policyholders. The circular stipulates that customers—either policyholders, insured individuals, or participants—must cover at least 10% of the submitted claim value.
The new rules set a maximum co-payment limit of Rp 300,000 ($18.60) per outpatient claim and Rp 3 million ($186) per inpatient claim. However, insurers may offer higher limits if agreed upon in advance with customers.
“The regulation aims to encourage cost efficiency, especially as rising medical inflation outpaces general inflation,” Ogi said. “We hope this will help mitigate long-term healthcare costs, both in national healthcare schemes and commercial insurance systems.”
Industry Response and Premium Impact
The Indonesian Life Insurance Association (AAJI) welcomed the new regulation, viewing it as an opportunity to improve the governance and sustainability of the insurance sector.
“This policy responds to the industry’s challenges, particularly in controlling claims costs, clarifying benefits, and protecting public rights,” said AAJI Chairman Budi Tampubolon at the association’s Q1 2025 press conference in Jakarta on Wednesday, June 4.
Budi noted that co-payment is not new and has long been practiced in various countries, including Indonesia. With the regulation taking effect, insurers are expected to adjust their premium structures to reflect the reduced coverage burden.
“Actuaries will establish different pricing models, comparing full 100% coverage and the new 90% scheme. This should make premiums more affordable for consumers,” he said.
While policyholders may still face premium increases upon renewal, Budi expressed optimism that the hikes would be more moderate than in previous years. “There’s a strong possibility that the renewal premium increases will be more manageable,” he added.