Health insurance participants must be responsible for 10%treatment costs, the DPR will call OJK

Wednesday, June 11, 2025 – 19:35 Wib

Yakarta, alive -The House of Representatives (DPR) revealed that it would summon the Financial Services Authority (OJK) related to health insurance participants must assume the cost (Cup) of at least 10 percent of the presentation of total value claims.

The president of the Commission of the Chamber of Representatives XI, admitted Mukhamad Misbakhun, the copagy policy had never been discussed with the DPR. For this reason, the XI House of Representatives commission will call OJK to ask the reasons for the decision.

“We want, later I will invite other leaders, I will schedule a meeting with OJK to find out the base, reasons and arguments why OJK plans this,” Misbakhun said in the PBNU building, Central Yakarta, Wednesday, June 11, 2025.

Misbakhun said, according to the information he obtained, the current insurance claim payment exploded. So that this exerts pressure on the health of the insurance industry.

“Do not allow (insurance rules) to press the industry, about the confidence in the insurance industry that we are currently trying to reconstruct the consumer’s confidence in the insurance industry,” he said.

“Because when people buy insurance policies there are agreements in the policy, which should be adequate enough not to publish the cup rules. Why is it necessary? The policy must be a bilateral commercial relationship between the head of the policy and the insurance company,” he added.

Misbakun also said that the reason why OJK issued specific rules with respect to copayment. He considered that the authority must prepare rules to build a healthy insurance industry, provide protection to consumers and carry out supervision tasks.

“Well, we will ask why the rules were born suddenly. Although this specific one should not go there,” he added.

Previously, the Financial Services Authority (OJK) issued a circular letter (SEOJK) number 7 of 2025, with respect to the implementation of health insurance products. In that it is written that health insurance products must have a scheme of Cagation or Risk Distribution.

Regarding the regulation, health insurance products must apply the distribution of risk (co -payments) assumed by the head of the policy, the insured or the participants at least 10 percent of the total presentation of claims.

For the maximum presentation of RP claims. 300,000 for presentation of claims for outpatient care and RP. 3 million by presentation of claims by hospitalized patients.

“Insurance companies, Sharia insurance companies and Sharia units in insurance companies can apply the maximum limit to which reference is made in the numbers 3 letters A and B provided that they remember between insurance companies, Sharia insurance companies and Sharia units in insurance companies with policy holders, insured or participants and have been established in the policy Insurance, “the OJK wrote.

Although the health insurance product is combined with another insurance in the benefit coordination system, the risk distribution value is at least 10 percent of the total claims presentation is calculated from the total presentation of claims that are obligations of the insurance company.

This rule explains that co -payments only apply to health insurance products with the compensation principle (compensation) and health insurance products with administered care (managed care). However, copagos are excluded for micro insurance products.

In addition, the insurance company has the authority to review and establish premiums and remuneration (revelation) at the time of the extension of the insurance policy depending on the history of claims of policy holders, insured or participants.