Prudential Indonesia Appreciates OJK's Decision on Waiting Periods
Jakarta (ANTARA) - Prudential Indonesia and Prudential Syariah welcome and appreciate the Financial Services Authority’s (OJK) decision regarding changes to the waiting periods stipulated in OJK Regulation (POJK) Number 36 of 2025 on Strengthening the Health Insurance Ecosystem.
Under these provisions, OJK sets a maximum waiting period of 30 calendar days for general benefits from the effective protection period (except in cases of accidents).
Chief Health Officer of Prudential Indonesia, Yosie William Iroth, stated that this provision means that customers/participants who are new to a health insurance policy cannot yet submit claims for general benefits in the first 30 days since the policy becomes active (except in cases of accidents).
“This regulation will ensure a balance of benefits for customers/participants and support the strengthening of the health insurance ecosystem,” she said in her statement in Jakarta on Tuesday.
The clarity and standardisation of waiting periods, she continued, provide a stronger foundation for the industry to design increasingly relevant products centred on societal needs.
Additionally, OJK has shortened the waiting period for critical, chronic illnesses, or special conditions from the previous 12 months to a maximum of six months (except for supplementary health insurance PAYDI).
With this provision, benefits for critical, chronic illnesses or special conditions stated in the new insurance policy can be claimed after passing a waiting period of at most six months since the policy takes effect (except for supplementary health insurance PAYDI).
Regarding this, Yosie mentioned several simple steps that customers/participants need to take to better understand waiting periods, namely to understand the policy provisions and status from the beginning.
She explained that waiting periods can cause concern because they impact the financial condition of customers/participants; therefore, they are advised to re-read the policy contents, especially the sections explaining benefits and waiting period provisions, including the types of health services that have waiting periods and their durations.
Additionally, it is important to ensure the effective date of the policy because the waiting period is calculated from when the policy is officially active, not from when the first premium or contribution is paid; this only applies to certain insurance products.
Recording the protection start date can help avoid misunderstandings when submitting claims and build realistic expectations regarding usable benefits.
Then, ensuring premium payments are made on schedule during the waiting period; customers/participants need to pay premiums or contributions on time according to the schedule stated in the policy.
“This discipline is important to ensure protection continues without administrative disruptions that could affect the continuity of benefits in the future,” she said.
Customers/participants also need to ensure the policy is not in lapsed status (policy becoming inactive because premiums/contributions are not paid until the grace period expires) so that protection remains active until the end of the policy/protection term.
This includes maintaining funds in the account for auto-debit methods to avoid payment failures or making premium/contribution payments via transfer to the insurance company’s account every payment period.
The next step, she continued, is managing documents and proactively planning protection.
Customers/participants are advised to keep all medical documents neatly to facilitate the claims process.
Completeness of documents can speed up the review process and minimise additional requests. To avoid missing important information, customers/participants are also advised to update contact details and personal information periodically.
In addition, monitoring policy status through customer service or official agents regularly can help ensure there are no administrative issues that could potentially affect protection.
The final step is planning protection to address waiting periods.
At this stage, customers/participants can evaluate whether the benefits they have are already aligned with their current health condition, lifestyle, and future financial plans.
“With proper planning and comprehensive understanding, waiting periods can be seen as part of the process of building peace of mind and financial readiness ahead,” she said.
By understanding the indirect benefits of waiting periods, she added, in the future, customers/participants can maintain a balance between premium/contribution risks and sustainable claimable benefits.