Jakarta. The Financial Services Authority (OJK) will require health insurance policyholders to bear at least 10 percent of medical claim costs starting January 1, 2026.

The regulation, aimed at creating a fairer insurance ecosystem, is detailed in Circular Letter No. 7/SEOJK.05/2025 on the Implementation of Health Insurance Products, issued on May 19, 2025.

Under the new co-payment scheme, customers will be responsible for a portion of both outpatient and inpatient medical bills. The policy applies only to new insurance policies issued on or after January 1, 2026. Existing policies that do not include co-payment clauses will remain unaffected unless renewed under the new framework.

To limit out-of-pocket expenses, OJK’s regulation sets maximum co-payment amounts at Rp 300,000 ($18.5) per outpatient claim and Rp 3,000,000 per inpatient claim.  Insurers may offer higher caps with customer consent, as documented in policy terms. The co-payment rule will not apply to micro health insurance products.

According to Firdaus Djaelani, Honorary Board Member of the Indonesian General Insurance Association (AAUI), the regulation was designed to stabilize the national health insurance market. “Since the COVID-19 pandemic, claim volumes have fluctuated dramatically, anywhere from 50 percent to 200 percent,” Firdaus said during the Investor Market Today program on Wednesday.

“Insurance pricing must be fair to both parties: customers and providers. This policy introduces a shared responsibility model that will encourage more prudent claims behavior,” he added.

Firdaus stressed that co-payment discourages minor, unnecessary claims that could burden the system. “If someone has to pay 10 percent of the cost, they’re more likely to think twice before rushing to the hospital for minor symptoms,” he said. “Insurance should be a safeguard, not a substitute for healthy living.”

According to Firdaus, Indonesia’s new policy aligns with practices in neighboring ASEAN countries. “Co-payment models are already in place in Malaysia and Singapore,” he said.

In Malaysia, starting September 1, 2024, consumers can choose between new lower-premium medical plans with co-payment or traditional plans without it. Bank Negara Malaysia mandates a minimum 5 percent co-payment or RM500 deductible on new products. Some services, including emergency care and treatment for critical illnesses, are exempt from co-payment.

In Singapore, all citizens are enrolled in MediShield Life, a national health insurance scheme that requires both a deductible (S$1,500–3,000) and coinsurance, which ranges from 3 to 10 percent based on treatment cost. Caps are applied to protect patients from excessive bills, and private insurers may also offer supplemental plans with similar co-payment features.

In Indonesia, Firdaus warned that if claim ratios continue to exceed 90 percent, many insurers could stop offering health coverage altogether. “This measure is crucial for the long-term sustainability of the insurance industry,” he concluded.

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