DPR and OJK Postpone Controversial Health Insurance Co-Payment Scheme

TEMPO.CO, Jakarta - Commission XI of the House of Representatives (DPR) and the Financial Services Authority (OJK) have officially agreed to postpone the implementation of Circular Letter Number 7 of 2025, which concerns health insurance product implementation. This regulation, originally set to take effect on January 1, 2026, mandates a co-payment scheme, requiring policyholders to bear 10 percent of their claim liability.

Mukhamad Misbakhun, Chairperson of Commission XI, urged the OJK to replace the circular with an OJK Regulation (POJK). "OJK will postpone the implementation of the circular until the POJK is enacted," he said during a meeting with OJK officials at the Parliament Complex in Senayan on Monday, June 30, 2025.

The joint liability scheme would require policyholders to cover at least 10 percent of their total claim, with a maximum limit of Rp300,000 for outpatient care and Rp3 million for inpatient care.

After the OJK drafts the new regulation, Commission XI plans to reconvene with the authorities and involve the insurance industry and other key stakeholders. "This needs to be regulated more holistically and comprehensively, not just from one side," Misbakhun emphasized.

Ogi Prastomiyono, Chief Executive of the Insurance, Guarantee, and Pension Fund Supervisory Agency of OJK, confirmed that his agency would comply with the DPR's request. "We will follow. This is a suggestion from Commission XI, which supervises us," he said.

Ogi explained that Circular Letter Number 7 of 2025 was issued at the request of the insurance industry. However, OJK also has a vested interest, as the current state of the insurance sector is deemed "unhealthy." "Both [the insurance industry and OJK]. OJK also has an interest because this is not healthy if left alone," Ogi added.

He noted that the current health insurance claim ratio is nearing 100 percent, with an average reaching 40 percent. "The premiums paid are already quite high. This is a step to improve the health insurance ecosystem," he stated.

A Tempo report on June 22, 2025, revealed that the insurance industry association had long lobbied the OJK to implement a co-payment scheme. According to three industry insiders, this pressure intensified after insurance companies were overwhelmed by a surge in claims following the COVID-19 pandemic, further exacerbated by medical inflation and rising healthcare costs.

Eric Hermawan, a member of Commission XI of the DPR, also urged the OJK to postpone the co-payment scheme until 2027. He argued that the policy primarily benefits insurance companies, and importantly, the DPR was not consulted during its formulation. "The DPR was not involved. From my perspective, this should be postponed," he asserted.

The Golkar Party politician further criticized the OJK for its lack of public involvement in formulating the policy. He believes the regulation requires a review with an approach that prioritizes the public's interests. "There should be a people’s approach. The people should be asked if they want co-payments. The industry benefits [from this]," he concluded.

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