OJK Officially Revises Health Insurance Regulations, 100 Percent Claims No Longer Allowed

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Indonesia's OJK has introduced new health insurance regulations requiring a minimum 10% copayment, ending 100% claim coverage and strengthening coordination with BPJS Kesehatan.

Indonesia's Financial Services Authority (OJK) has officially issued a new circular governing the implementation of health insurance products. The new regulation introduces several significant changes that policyholders need to understand.

One of the most notable provisions is the implementation of a copayment scheme. Under the new rule, policyholders are required to bear at least 10 percent of the total value of any health insurance claim submitted to the insurance company.

As a result, policyholders will no longer be able to receive reimbursement for 100 percent of their medical expenses. A portion of the treatment costs must now be paid by the insured in accordance with the minimum copayment requirement set out in the OJK circular.

The policy is part of OJK's broader effort to strengthen the sustainability of Indonesia's health insurance industry. In recent years, insurance companies have experienced a significant increase in health insurance claims, leading to higher claim expenses and greater financial pressure on the sector.

In addition to introducing the copayment requirement, OJK also mandates that all health insurance products include a Coordination of Benefits (CoB) feature. This mechanism enables insurance companies to coordinate benefit payments with other healthcare coverage providers, including Indonesia's National Health Insurance program, BPJS Kesehatan.

Through the Coordination of Benefits system, health insurance benefits can be integrated with those provided by BPJS Kesehatan in accordance with applicable regulations. The objective is to improve the efficiency of healthcare financing while preventing overlapping benefit payments.

Furthermore, the circular requires insurance companies to prepare and provide claim performance reports for each policyholder. These reports are expected to improve transparency, provide a clear record of policyholders' claim histories, and support better risk assessment and policy management.

With the implementation of these new regulations, the public is encouraged to review their insurance policies carefully, particularly the provisions regarding copayment and the Coordination of Benefits mechanism. Policyholders are also advised to consult their insurance providers if they require further clarification on how the new rules may affect their coverage and benefits.

OJK expects these regulatory changes to promote a healthier, more transparent, and sustainable health insurance industry while maintaining a fair balance between the interests of insurance companies and the protection of policyholders.

Source: Compiled from information regarding OJK's Circular on the Implementation of Health Insurance Products based on the material provided by the user.