Insurance policyholders in Indonesia will be required to cover at least 10% of the total outpatient or inpatient claims incurred at medical facilities, according to new rules set by the Financial Services Authority (OJK) to implement risk-sharing between insurers and policyholders. The new stipulation will come into effect from 1 January 2026.
This rule only applies to commercial health insurance products and not to the National Health Insurance (JKN) scheme. These rules are detailed in OJK Circular Letter (SEOJK) Number 7 of 2025 on the Implementation of Health Insurance Products and was issued on 19 May 2025.
According to a news report published in https://www.jakartadaily.id OJK executive head for insurance, guarantee, and pension fund supervision Ogi Prastomiyono gave this information during a press briefing on 2 June 2025.
According to the new rule health insurance products will also include a coordination of benefits feature. This will allow integration between private insurance coverage and services under the JKN programme operated by BPJS Kesehatan.
OJK Financial Inclusion and Communication department acting head of the literacy M Ismail Riyadi said this regulation is intended to promote the use of higher-quality medical services and drug services.
"It will encourage affordable or more affordable health insurance premiums because premium increases can be better mitigated," said Mr Riyadi in an official statement released by OJK and quoted by the media.
Other stipulations in the regulations include:
The maximum co-payment will be limited to IDR300,000 ($18.45) per claim submission for outpatient care and IDR3,000,000 per claim submission for inpatient care to limit out-of-pocket expenses.
Insurers, including Shariah insurance companies can, however, offer higher caps with customer consent, as documented in policy terms. The co-payment rule will not apply to micro health insurance products.
Co-payment only applies to health insurance products with an indemnity principle and health insurance products with a managed care health service scheme. Risk sharing is excluded for microinsurance products.
Health insurance policies acquired before 1 January 2026 will still be considered valid after that date and can continue until the insurance period ends in accordance with the policy terms.
For health insurance products that have automatic renewal features and approved by the OJK before the new regulation comes into effect, insurers are required to adjust them to comply with the co-payment requirement no later than 31 December 2026.