Optional Health Insurance Co-Payments Introduced In Indonesia

Indonesia’s Financial Services Authority (OJK) has formally issued POJK Number 36 of 2025, a landmark regulation that allows health insurance policyholders to choose whether or not to include co-payments in their coverage. Under this framework, the insured’s maximum financial liability per claim is capped at 5% of the total claim amount. The regulation, officially titled “Strengthening the Health Insurance Ecosystem”, is set to take effect from 22 March 2026.

The OJK stated that the regulation is aimed at enhancing governance, strengthening risk management, and ensuring effective supervision within the health insurance sector. By doing so, it seeks to protect the interests of policyholders, participants, and beneficiaries, while promoting collaboration among stakeholders and maintaining the stability of a competitive insurance market. Additionally, the measure addresses the persistent challenge of rising healthcare costs and aims to ensure the long-term sustainability of Indonesia’s national health insurance system.

Key Provisions on Co-Payments

Under the new regulation, insurers must provide health insurance products without mandatory risk-sharing features, giving customers the flexibility to opt for co-payment arrangements. If policyholders choose a plan with co-payments, the insured’s share cannot exceed 5% of any claim, with maximum limits set at IDR 300,000 ($17.80) per outpatient claim and IDR 3,000,000 ($178) per inpatient claim.

Previously, private health insurance policies required policyholders to pay at least 10% of each claim, a provision widely viewed as unpopular. The new regulation abolishes this mandatory requirement while allowing mutually agreed annual deductibles, which must be explicitly stated in the insurance policy.

Existing insurers have a one-year period from the regulation’s promulgation on 22 December 2025 to align their products with the new rules. Similarly, companies already operating in the health insurance sector must seek renewed approval from OJK regarding operational capabilities within the same timeframe.

In summary, the regulation represents a major reform in Indonesia’s health insurance sector, balancing affordability, risk management, and sustainability. By offering greater flexibility and consumer protection, it strengthens the insurance industry’s resilience while ensuring that healthcare financing remains competitive and consumer-centric.