New OJK Regulation Requires 10% Co-Payment for Health Insurance Claims

TEMPO.CO, Jakarta - The Financial Services Authority (OJK) has introduced a series of new regulations governing health insurance products, which will take effect on January 1, 2026. These rules are detailed in OJK Circular Letter (SEOJK) Number 7 of 2025 on the Implementation of Health Insurance Products.

Ismail Riyadi, Acting Head of the Department of Literacy, Financial Inclusion, and Communication at OJK, clarified that the provisions apply specifically to commercial health insurance and do not cover the National Health Insurance (JKN) program managed by BPJS Kesehatan.

“Through these provisions, the OJK encourages the efficiency of long-term health service financing, amid the continued global medical inflation trend,” said Ismail in an official statement on Thursday, June 5, 2025.

SEOJK 7/2025 introduces several key requirements, including the adoption of a co-payment scheme, a coordination of benefits mechanism, and the establishment of a Medical Advisory Board. Below are the highlights:

Co-Payment Scheme

Health insurance products are now required to implement a risk-sharing system, or co-payment, where policyholders must cover at least 10 percent of each claim.

• For outpatient care, the maximum co-payment is set at Rp300,000 per claim.

• For inpatient services, the cap is Rp3,000,000 per claim.

This provision applies only to insurance products that follow indemnity or managed care principles. Microinsurance products are excluded.

Coordination of Benefits

The new rules also mandate that health insurance products include a coordination of benefits feature. This allows integration between private insurance coverage and services under the JKN program operated by BPJS Kesehatan.

Medical Advisory Board

Insurance providers must form a Medical Advisory Board consisting of qualified medical professionals, including licensed doctors, and must have access to reliable digital health data.

This board is expected to assist insurers in assessing the effectiveness of services delivered by their health facility partners.

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