{
    "success": true,
    "data": {
        "id": 1620825,
        "msgid": "co-payment-insurance-rules-set-to-show-impact-mid-year-1773759331",
        "date": "2026-03-17 20:40:02",
        "title": "Co-Payment Insurance Rules Set to Show Impact Mid-Year",
        "author": "",
        "source": "CNBC",
        "tags": "",
        "topic": "Regulation",
        "summary": "Indonesia's Financial Services Authority predicts that new regulations on co-payment and risk-sharing in health insurance (POJK 36\/2025) will begin showing measurable impact from the second quarter of 2026 as the industry adjusts its business processes. The rules mandate co-payment mechanisms and Medical Advisory Boards to manage the rising costs of health insurance claims, which increased 9.1% in 2025 to Rp26.74 trillion despite ongoing challenges from medical inflation and high healthcare service utilisation.",
        "content": "<p>Jakarta \u2014 The Financial Services Authority (OJK) predicts that the\nimplementation of the new regulatory framework POJK 36\/2025 on\nstrengthening the health insurance ecosystem will begin to show its\neffects in the middle of this year.<\/p>\n<p>Ogi Prastomiyono, Head of Insurance Supervision, Guarantee and\nPension Fund at OJK, stated that based on January 2026 data, the claims\nratio for health insurance business lines stood at 40.85% for life\ninsurance and 17.75% for general insurance, which overall remains at a\ncontrolled level.<\/p>\n<p>\u201cRegarding the implementation of the Health Insurance Ecosystem POJK,\nwhich was enacted on 22 December 2025 and takes effect after three\nmonths, its impact is estimated to begin appearing gradually from the\nsecond quarter of 2026, in line with adjustments to business processes\nacross the industry,\u201d Ogi said in a written response.<\/p>\n<p>Key provisions in this POJK include the implementation of co-payment\nor risk sharing as a measure to anticipate a surge in health insurance\nclaims. Additionally, the POJK requires health insurance companies to\nestablish a Medical Advisory Board (MAB).<\/p>\n<p>Going forward, medical inflation is expected to remain one of the\nprimary challenges for health insurance. The industry also faces high\nutilisation of healthcare services and the need to strengthen risk\nmanagement and claims control.<\/p>\n<p>\u201cIn recent years, there have been companies that have adjusted their\nmarketing strategies for health insurance products. However, with the\nstrengthening of governance through the Health Insurance Ecosystem POJK,\nthis sector is expected to develop more healthily,\u201d he explained.<\/p>\n<p>The Indonesia Life Insurance Association (AAJI) noted that throughout\n2025, the life insurance industry paid out total claims and benefits of\nRp146.73 trillion to approximately 9.59 million beneficiaries.<\/p>\n<p>This claims value declined 7.8% compared to 2024, primarily driven by\na decline in surrender claims of around 19%. This condition indicates a\ntendency for policyholders to maintain their policies as a form of\nlong-term protection.<\/p>\n<p>From the health insurance sector, claims payments for these products\nincreased 9.1% with a total value of Rp26.74 trillion, for both\nindividual and group products.<\/p>",
        "url": "https:\/\/jawawa.id\/newsitem\/co-payment-insurance-rules-set-to-show-impact-mid-year-1773759331",
        "image": ""
    },
    "sponsor": "Okusi Associates",
    "sponsor_url": "https:\/\/okusiassociates.com"
}