The Financial Services Authority (OJK) has approved Circular SEOJK No. 7/2025, which changes the rules for commercial health insurance sold in Indonesia by companies licensed by the OJK. The reform does not affect the state scheme JKN (BPJS Kesehatan) and does not apply to foreign policies issued outside the country.
The aim of the changes is to make private healthcare funding more sustainable and transparent.
Who Will Be Affected
- Indonesian citizens and expatriates who have taken out voluntary health insurance with insurance companies registered in Indonesia.
- Employees of companies whose employer provides local corporate policies.
Policies from international insurance companies, purchased abroad and not under OJK's control, remain outside the regulation.
Key New Requirements
- Co-financing. The client pays at least 10% of each claim. The co-payment limit is up to 300,000 rupiah for outpatient visits and 3,000,000 rupiah for hospitalizations. The rule does not apply to microinsurance and direct service payment products.
- Compatibility with BPJS Kesehatan. Commercial policies must align with state insurance and cover expenses that JKN does not reimburse.
- Medical Advisory Board. Every insurer is required to establish an internal expert group of doctors and medical data specialists. The board will assess the effectiveness of treatment, the quality of partner clinics, and the transparency of payments.
What It Means for Clients
- More predictable rates: part of the risk is transferred to the insured, which means premiums rise more slowly.
- Increased transparency: decisions on payments are made not only by underwriters but also by independent medical experts within the company.
- Double protection: expenses not covered by JKN can be compensated for by a commercial policy without bureaucracy.
Timeline
- Effective date – 1 January 2026.
- Insurers have time to adapt until 31 December 2026.
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