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View all search resultsOJK backtracks, makes health insurance co-payments optional
Initially introduced to address rising medical costs over time, the co-payment scheme allowed insurers and policyholders to jointly bear medical expenses.
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Serving the public: A local resident walks past the Papua office of the Financial Services Authority (OJK) in Jayapura on Oct. 27. The OJK has opened branch offices across the country to speed up its services to the public. (Antara/Indrayadi TH)
T
he Financial Services Authority (OJK) has formally reversed course on co-payment rules, issuing a new regulation that requires insurers to offer products without co-payment features, now rebranded as “risk-sharing.” The move marks a U-turn from a circular released in May last year that had made such schemes mandatory across all insurance products.
“Insurance companies are required to provide health insurance products without risk-sharing features, but they may also offer products with risk-sharing in the form of co-payment and/or deductibles, as long as they comply with prudential principles and the provisions stipulated in the regulation,” said Ogi Prastomiyono, the OJK’s head of insurance, guarantee and pension funds, at a press conference on Friday.
For products that include co-payment features, policyholders may be required to bear 5 percent of the total claim amount. The regulation caps the co-payment at Rp 3 million (US$178) per inpatient claim and Rp 300,000 per outpatient claim.
This is lower than the previous regulation, which required policyholders to pay a minimum of 10 percent of bills, with the same cap applied to both inpatient and outpatient services.
“For annual deductibles, they may be set at a certain amount as long as it is agreed upon by the company and the policyholder and clearly stated in the insurance policy,” Ogi added.
OJK Regulation No. 36/2025, which was promulgated on Dec. 22 last year, will take effect on March 22. At the same time, Circular No. 7/2025, which made co-payment features mandatory, will be deemed no longer applicable.
New insurance products must comply with the new regulation, while existing health insurance products must be adjusted within one year of the regulation’s promulgation date.
