Indonesia health rules impose 5% co-pay on claims

Outpatient charges will be capped at about $16.9 per case.

Indonesia’s life insurance industry has backed new health insurance rules covering co-payments, deductibles, premium reviews and insurers’ medical and digital capabilities.

The Indonesian Life Insurance Association, or AAJI, said it supports the implementation of Financial Services Authority Regulation No. 36 of 2025, which is intended to strengthen the country’s health insurance system amid rising medical inflation, higher healthcare use and increasing premiums.

Under the rules, policyholders must pay 5% of each claim, capped at $16.9 (Rp300,000) for outpatient treatment and $169.1 (Rp3m) for inpatient treatment.

Deductibles will also be applied annually rather than to each individual event.

Insurers may review or reprice premiums no more than once a year, while waiting periods must not exceed six months. Companies must also strengthen their medical expertise, medical advisory boards and information systems.

AAJI said the changes are intended to help control healthcare costs and support premium stability rather than reduce policy benefits.

The association is also encouraging closer coordination between private insurers, Indonesia’s national health insurer BPJS Kesehatan and other healthcare funding providers.