The risk sharing scheme depends on the policies of each insurance company by considering the risk profile and loss ratio that can be negotiated with customers. Even without SEOJK or POJK, every insurance company is free to offer co-payment to customers, if approved, because insurance is an agreement between the two parties, the insured and the insurer, which according to paragraph 1 of article 1338 of the Civil Code applies as a law for the parties who are bound.
Postponement - Previously, the results of the Working Meeting between Commission XI of the DPR and the Chairman of the Board of Commissioners of OJK and Members of the Board of Commissioners of Insurance on Monday (30/6/2025) agreed to postpone the implementation of SEOJK Number 7 of 2025 concerning Health Insurance Products starting January 2025. This SEOJK regulates, among other things, the risk-sharing sch
This decision allows for more public aspirations to be accommodated (meaningful participation). On the other hand, not every OJK policy formulation in the form of POJK and SEOJK should involve the DPR, especially those related to general industrial regulation and supervision.
However, the SEOJK on co-payment is directly related to the interests of consumers in general, especially health insurance customers, so the DPR as a working partner of the OJK needs to be involved. Variable cost co-payments should only be charged when a claim occurs, instead of a fixed cost premium increase every time a health insurance policy is purchased or extended. Basically, co-payments also function as additional premiums when a claim occurs.
In addition, there is also an alternative option for regulators by limiting the scope of coverage guarantees, such as specific diseases, the age of the insured, or only covering outpatient care and excluding inpatient care.
The spirit of SEOJK No. 7/2025, actually weakens and makes consumers of health product insurance the scapegoat. This is considering the reason behind the regulation is intended to reduce fraudulent practices carried out by consumers, over-utility, and high inflation in the health sector.
(1) The alleged fraudulent practices, for example, were not only carried out by consumers, but also involved stakeholders in the health sector. However, only consumers were accused and burdened with a 10 percent co-payment.
(2) The alleged over-utilization by consumers can also be mitigated by making stricter prerequisites, for example, it must be accompanied by detailed health history data through health check results. This indicates that over-utilization occurs due to loose regulations when consumers will become health insurance participants.
(3) Regarding inflation in the health sector, which is said to reach 12.5 percent, it should be the duty and responsibility of regulators, even the government, to intervene. However, consumers should not be used as a shield to lower this high inflation
However, the SEOJK on co-payment is directly related to the interests of consumers in general, especially health insurance customers, so the DPR as a working partner of the OJK needs to be involved. Variable cost co-payments should only be charged when a claim occurs, instead of a fixed cost premium increase every time a health insurance policy is purchased or extended. Basically, co-payments also function as additional premiums when a claim occurs.
In addition, there is also an alternative option for regulators by limiting the scope of coverage guarantees, such as specific diseases, the age of the insured, or only covering outpatient care and excluding inpatient care.
The spirit of SEOJK No. 7/2025, actually weakens and makes consumers of health product insurance the scapegoat. This is considering the reason behind the regulation is intended to reduce fraudulent practices carried out by consumers, over-utility, and high inflation in the health sector.
(1) The alleged fraudulent practices, for example, were not only carried out by consumers, but also involved stakeholders in the health sector. However, only consumers were accused and burdened with a 10 percent co-payment.
(2) The alleged over-utilization by consumers can also be mitigated by making stricter prerequisites, for example, it must be accompanied by detailed health history data through health check results. This indicates that over-utilization occurs due to loose regulations when consumers will become health insurance participants.
(3) Regarding inflation in the health sector, which is said to reach 12.5 percent, it should be the duty and responsibility of regulators, even the government, to intervene. However, consumers should not be used as a shield to lower this high inflation
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