OJK Officially Delays Health Insurance SEOJK Regulations, Analysts Weigh In

Best for you.CO.ID - JAKARTA The Financial Services Authority (OJK) has officially postponed the provisions outlined in OJK Circula...

Best for you.CO.ID - JAKARTA The Financial Services Authority (OJK) has officially postponed the provisions outlined in OJK Circular Letter (SEOJK) Number 7 of 2025 regarding the Implementation of Health Insurance Products, which was originally scheduled to take effect on January 1, 2026. This postponement coincides with the preparation of an OJK Regulation (POJK) concerning Strengthening the Health Insurance Ecosystem.

In response to this, Insurance Analyst and Lecturer at the Master of Management Program, Faculty of Economics and Business, Gadjah Mada University (UGM), Kapler Marpaung said that the changed co-payment regulation, now in the form of a Financial Services Authority Regulation (POJK), is merely like changing clothes. He opines that essentially, the regulation regarding co-payment in health insurance should not require an SE (Regulation of the Minister of Finance), let alone a POJK.

Kapler explained that co-payment is merely a rule agreed upon by the parties within the national insurance industry, which can be facilitated through the Indonesian General Insurance Association (AAUI), the Indonesian Life Insurance Association (AAJI), and the Indonesian Sharia Insurance Association (AASI). If any member violates this, he said, OJK could use the mutual agreement to impose sanctions on the violating insurance company.

"Because, sanctions against financial services institutions are not only due to the company violating insurance sector regulations, but also for breaching mutual agreements. In such cases, OJK can also impose sanctions," he said to Best for you on Friday (5/7).

Furthermore, Kapler stated that the most important issue regarding co-payment is the formulation or definition of co-payment itself. He noted that based on SEOJK 7/2025, there is no regulation yet concerning the mechanism for implementing co-payment or the definition of co-payment.

"Therefore, the public becomes confused about co-payment, especially since many people talk about it according to their own understanding or preferences. Some say that co-payment will be applied after the deductible is implemented. If so, the cost borne by the public will become even greater," he said.

In addition, Kapler added that there are also those who say that co-payment is not the same as deductible (self-risk), when in fact co-payment is essentially the same as deductible. Therefore, he feels it's reasonable that the release of SEOJK 7/2025 has actually confused the public.

"I suggest we no longer use the term co-payment, just use the term 'risiko sendiri' (self-risk), a term already well known to the general public, as in motor vehicle insurance and fire insurance," he said.

Therefore, Kapler stated that what needs to be done by the industry and OJK currently is not to issue a POJK as a replacement for the SEOJK.

He considered the most important thing to be explaining the conditions of the national and global health insurance markets to the public by presenting premium and claim statistics from the past five years.

"Besides that, explaining the reasons for the increase in health insurance claims. Because, it's not only due to many health insurance participants getting sick and seeking treatment, but there are other factors as well, such as medical inflation," he said.

Kapler said that the industry and OJK also need to explain the steps insurance companies must take in order to continue selling health insurance products. Additionally, explaining the roles of doctors, hospitals, pharmacies, clinics, laboratories, and other healthcare facilities. Moreover, he also mentioned that community involvement is greatly needed in reducing the claim ratio.

Previously, Acting Head of the Department of Literacy, Financial Inclusion, and Communication of the OJK Ismail Riyadi stated that the preparation of the new POJK regulation was conducted as a follow-up to the OJK Working Meeting with Commission XI of the House of Representatives on June 30, 2025.

She also stated that the preparation of the Regulation on Financial Sector Policies (POJK) will be consulted with the House of Representatives' Commission XI. The provisions regarding strengthening the health insurance ecosystem will take effect once the POJK is issued.

"With this, it can provide a stronger legal basis and more comprehensive regulatory coverage," he said in an official statement on Thursday (3/7).

Ismail added that the preparation of the POJK aims to ensure better governance and prudent principles in the implementation of health insurance products. At the same time, he said the POJK is also expected to provide real benefits for all parties within the health insurance ecosystem, from the public as policyholders/insured individuals, insurance companies, to healthcare service facilities.

"OJK will also continue to strengthen coordination and communication with all stakeholders to create a fair, transparent, and sustainably growing health insurance ecosystem," said Ismail.