The Financial Services Authority (OJK) will implement new regulations from January 1, 2026, requiring commercial health insurance products to adopt a co-payment scheme, coordinate benefits with the National Health Insurance program, and establish a Medical Advisory Board to oversee service quality.
The Financial Services Authority of Indonesia (OJK) has issued Circular Letter No. 7/SEOJK.05/2025, effective January 1, 2026, introducing new regulations for commercial health insurance products, excluding the National Health Insurance (JKN) managed by BPJS Kesehatan. The regulations aim to enhance long-term health service financing efficiency amid ongoing global medical inflation.
A key feature is the mandatory co-payment scheme requiring policyholders to bear at least 10% of each claim, capped at Rp300,000 for outpatient and Rp3,000,000 for inpatient care. This applies to indemnity or managed care insurance products, with microinsurance exempted. Additionally, the rules mandate a coordination of benefits mechanism to integrate private insurance with JKN services, improving coverage coordination.
Insurers must also establish a Medical Advisory Board composed of qualified medical professionals with access to reliable digital health data to oversee service quality and risk management. These measures are designed to promote prudent insurance practices, curb benefit overutilization, and strengthen governance, digital transformation, and consumer protection in Indonesia’s health insurance sector. The regulation reflects OJK’s efforts to ensure sustainability and transparency while safeguarding policyholders amid rising medical costs.
