OJK Regulation Tightens Digital and Medical Standards

The Financial Services Authority (Otoritas Jasa Keuangan – “OJK”) is finalizing a more strategic regulation on the organization of health insurance products, which has been previously regulated under Circular of OJK No. 7/SEOJK.05/2025 of 2025 (“SEOJK 7/2025”). The Draft Regulation of OJK on Strengthening the Health Insurance Ecosystem (“RPOJK on Health Insurance”) is targeted to be issued no later than 1 January 2026.

“It also regulates the mechanism for Coordination Between Insurance Providers (Koordinasi Antar Penyelenggara Jaminan – “KAPJ”), as well as encourages healthcare facilities to provide medical services in accordance with clinical pathways and medical efficacy,” said Ogi Prastomiyono, Chief Executive of Insurance, Guarantee, and Pension Fund Supervision of the OJK, to Hukumonline.

Other substantive provisions that will be regulated in the RPOJK on Health Insurance include the requirement for insurance companies offering health insurance products to have digital capabilities, medical capabilities, a Medical Advisory Board (Dewan Penasihat Medis – “DPM”), and utilization review mechanisms. OJK also reduces the maximum participant liability limit under the risk-sharing or co-payment scheme in health insurance, from the previous 10% to 5%.

“This risk-sharing scheme is exempted in emergency conditions caused by accidents or critical illnesses as stated in the insurance policy,” he added.