Indonesia’s Financial Services Authority (OJK) has formally introduced a new regulation, POJK Number 36 of 2025, which allows health insurance customers to opt for co-payments in their policies while capping the insured’s financial responsibility at 5%. The regulation, officially titled “Strengthening the Health Insurance Ecosystem”, is set to take effect on 22 March 2026.
The OJK stated that the regulation aims to reinforce governance, enhance risk management, and ensure effective supervision within the health insurance sector. By doing so, the authority seeks to protect the interests of policyholders, insured parties, and participants, while promoting collaboration among stakeholders and maintaining the stability of a competitive healthcare insurance industry.
The new framework addresses long-standing challenges in managing rising medical costs and is intended to ensure the sustainability of Indonesia’s national health insurance system.
Key Provisions on Co-Payment
Under the regulation, insurance providers must offer health insurance products without mandatory risk-sharing features. Customers may choose policies that include a co-payment option, but the insured’s share of any claim cannot exceed 5% of the total claim amount. Maximum co-payments are capped at IDR 300,000 ($17.80) per outpatient claim and IDR 3,000,000 per inpatient claim.
The reform effectively reverses a previously unpopular requirement that private health insurance customers pay at least 10% of every claim—a measure initially introduced to curb rising medical expenses. Additionally, insurers and policyholders may mutually agree on a deductible, specifying an annual maximum amount for co-payments, which must be clearly stated in the insurance policy.
Existing insurance providers have a one-year window from the promulgation date (22 December 2025) to adjust their products in compliance with the new regulation. Companies already operating in the health insurance sector are also required to obtain renewed OJK approval regarding operational capabilities within the same period.
The OJK emphasised that these measures will promote affordable and flexible insurance coverage, strengthen consumer protection, and ensure that healthcare financing remains sustainable for both providers and policyholders.
| Aspect | Details | Notes/Impact |
|---|---|---|
| Regulation | POJK Number 36 of 2025 | Strengthening the Health Insurance Ecosystem |
| Effective Date | 22 March 2026 | Applies to new and existing health insurance products |
| Co-Payment Optionality | Customers may choose risk-sharing policies | Insured can opt out |
| Co-Payment Limit | 5% of total claim | IDR 300,000 per outpatient, IDR 3,000,000 per inpatient |
| Deductible | Mutually agreed annual maximum | Must be specified in policy |
| Compliance Deadline | 22 December 2026 (one year from promulgation) | Applies to existing insurers and products |
This regulation marks a significant step forward in Indonesia’s health insurance sector, balancing affordability, risk management, and industry sustainability while giving consumers more flexibility and protection.