Co-Payment Insurance Rules Set to Show Impact Mid-Year
Jakarta — The Financial Services Authority (OJK) predicts that the implementation of the new regulatory framework POJK 36/2025 on strengthening the health insurance ecosystem will begin to show its effects in the middle of this year.
Ogi Prastomiyono, Head of Insurance Supervision, Guarantee and Pension Fund at OJK, stated that based on January 2026 data, the claims ratio for health insurance business lines stood at 40.85% for life insurance and 17.75% for general insurance, which overall remains at a controlled level.
“Regarding the implementation of the Health Insurance Ecosystem POJK, which was enacted on 22 December 2025 and takes effect after three months, its impact is estimated to begin appearing gradually from the second quarter of 2026, in line with adjustments to business processes across the industry,” Ogi said in a written response.
Key provisions in this POJK include the implementation of co-payment or risk sharing as a measure to anticipate a surge in health insurance claims. Additionally, the POJK requires health insurance companies to establish a Medical Advisory Board (MAB).
Going forward, medical inflation is expected to remain one of the primary challenges for health insurance. The industry also faces high utilisation of healthcare services and the need to strengthen risk management and claims control.
“In recent years, there have been companies that have adjusted their marketing strategies for health insurance products. However, with the strengthening of governance through the Health Insurance Ecosystem POJK, this sector is expected to develop more healthily,” he explained.
The Indonesia Life Insurance Association (AAJI) noted that throughout 2025, the life insurance industry paid out total claims and benefits of Rp146.73 trillion to approximately 9.59 million beneficiaries.
This claims value declined 7.8% compared to 2024, primarily driven by a decline in surrender claims of around 19%. This condition indicates a tendency for policyholders to maintain their policies as a form of long-term protection.
From the health insurance sector, claims payments for these products increased 9.1% with a total value of Rp26.74 trillion, for both individual and group products.