Indonesia's Financial Services Authority mandates 10% co-payment and new governance and systems requirements for commercial health insurance products

Indonesia's Financial Services Authority (OJK) issued a new circular letter governing the administration of commercial health insurance products, setting tighter expectations for prudential practice, risk management and consumer protection while aiming to support long-term healthcare cost efficiency amid rising medical inflation. Insurers, sharia insurers and sharia units offering health insurance must adjust product features to include a co-payment of at least 10% of each outpatient or inpatient claim, capped at IDR 300,000 per outpatient claim and IDR 3,000,000 per inpatient claim, and provide for coordination of benefits where services are delivered under the National Health Insurance (JKN) scheme administered by BPJS Kesehatan. Firms must also have adequate expertise including qualified doctors to conduct medical analysis and utilization review, establish a Medical Advisory Board, and maintain information systems that enable digital data exchange with healthcare facilities. The requirements apply to commercial health insurance products and do not apply to the JKN scheme itself. The circular letter takes effect on 1 January 2026. Existing coverage remains valid until the end of the coverage period, while automatically renewable products approved or reported to OJK before the effective date must be aligned with the new rules by 31 December 2026.