The Financial Services Authority (OJK) has officially issued a regulation (POJK Number 36 of 2025), which allows health insurance customers to opt for co-payments in their policies and lowers the risk-sharing (co-payment ) limit borne by the insured to 5%.
The regulation, titled “Strengthening the Health Insurance Ecosystem” will come into force on 22 March 2026, states the OJK.
Through the new regulation, which was issued in December 2025, the regulator aims to strengthen governance, risk management, and effective supervision in order to protect the interests of policyholders, insured parties, or participants. In addition, it promotes collaboration among stakeholders within the healthcare ecosystem and ensures the stability of a competitive industry.
OJK seeks to address challenges in managing medical costs and to ensure the sustainability of the national health insurance industry.
Co-payment
Insurance companies are required to provide health insurance product options without a risk-sharing feature.
If customers choose products with a risk-sharing feature, the regulation limits the proportion of risk borne by customers to 5% of the total claim amount. OJK caps the maximum amount payable by customers under this scheme at IDR300,000 ($17.80) per outpatient claim and IDR3,000,000 per inpatient claim.
With the new regulation, the authorities walk back an unpopular mandatory requirement for private health insurance customers to pay at least 10% of every claim. The co-payment was proposed in a bid to contain raising medical costs.
Insurers and customers can also set a certain annual amount (deductible) that is mutually agreed upon and then stated in the insurance policy.
Insurers that already offer health insurance products prior to 22 March 2026 must adjust their products no later than one year from 22 December 2025, the promulgation date of the regulation. Likewise, companies that are already operating health insurance businesses must obtain renewed approval from OJK regarding the fulfillment of capabilities no later than one year from 22 December 2025.