Indonesia’s Financial Services Authority (OJK) has formally issued POJK Number 36 of 2025, a landmark regulation that makes co-payments in health insurance policies optional for consumers. Under this new framework, the insured’s maximum financial liability per claim is limited to 5% of the total claim amount. The regulation, officially titled “Strengthening the Health Insurance Ecosystem”, will come into effect on 22 March 2026.
The OJK has emphasised that the regulation aims to enhance governance, improve risk management, and ensure effective supervision within the health insurance sector. The framework is designed to safeguard the interests of policyholders, participants, and beneficiaries, while promoting stakeholder collaboration and maintaining the stability of a competitive insurance industry. Additionally, the measure seeks to address the long-standing challenge of rising healthcare costs and to ensure the sustainability of Indonesia’s national health insurance system.
Key Provisions on Co-Payments
Under the new regulation, insurers must offer health insurance products without mandatory risk-sharing. Policyholders may choose plans with a co-payment option; however, the insured’s share cannot exceed 5% of any claim. Maximum co-payment amounts are 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 considered unpopular. The new regulation removes this compulsory condition while allowing mutually agreed annual deductibles, which must be clearly specified in the insurance policy.
Existing insurers have a one-year window from the regulation’s promulgation date of 22 December 2025 to align their products with the new requirements. Companies already operating in the health insurance sector must also obtain renewed OJK approval regarding operational capabilities within the same period.
| Aspect | Details | Notes / Impact |
|---|---|---|
| Regulation | POJK Number 36 of 2025 | Strengthening the Health Insurance Ecosystem |
| Effective Date | 22 March 2026 | Applies to both new and existing products |
| Co-Payment Optionality | Optional for policyholders | Consumers may opt in or out |
| Co-Payment Limit | 5% of total claim | Outpatient: IDR 300,000; Inpatient: IDR 3,000,000 |
| Deductible | Mutually agreed annual maximum | Must be explicitly stated in policy |
| Compliance Deadline | 22 December 2026 | Applies to existing insurers and products |
In summary, this regulation represents a significant step forward for Indonesia’s health insurance sector. By balancing affordability, risk management, and industry sustainability, it provides consumers with greater flexibility and protection, while ensuring the health insurance industry remains competitive, resilient, and consumer-centric.