Co-Payment Scheme Could Cut Health Insurance Premiums by Up to 5%, Says AAUI
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JAKARTA, investortrust.id – Indonesia’s general insurance association expects that a mandatory co-payment system, set to take effect next year, could lower health insurance premiums by as much as 5%, depending on how policyholders adapt to the new rules.
Wayan Pariama, Deputy Chair of Technical Affairs at the General Insurance Association of Indonesia (AAUI), said that shifting from a full-coverage claim model to one involving shared costs could ease premium prices. The estimate follows new rules under the Financial Services Authority’s (OJK) Circular Letter No. 7 of 2025, which regulates the operation of health insurance products.
"Co-payment products are certainly cheaper. By how much, we still can't say definitively," Wayan said during a briefing on the general insurance industry’s performance for the first quarter of 2025, held in Jakarta on Friday, June 13.
He estimated that the introduction of co-payment requirements may drive premiums down by 3% to 5%, but stressed that actual outcomes would depend heavily on how policyholders use healthcare services.
“If we had to put a number on it, maybe it's in that 3% to 5% range. But I wouldn't go so far as to call it aggressive,” he added.
Despite the potential for lower prices, the effect may not be immediately visible in existing products, Wayan cautioned. Current premium levels remain influenced by historical risk profiles and claim ratios from previous years.
“Will premiums fall from current levels? Not necessarily, because current rates reflect past risk. If the claims ratio has been high, premiums are already set to rise,” he explained. “Still, with co-payment, any increase may not be as steep.”
Under the new rules—known formally as Surat Edaran Otoritas Jasa Keuangan (SEOJK) No. 7/2025—policyholders must cover at least 10% of their medical bills out-of-pocket when filing claims, starting January 1, 2026. The regulation caps these payments at Rp 300,000 ($18.60) per outpatient claim and Rp 3 million ($186) per inpatient claim, though insurers may impose higher limits with the consent of the policyholder.
The policy marks a shift in the health insurance market toward greater risk-sharing between insurers and customers, a move regulators hope will improve product sustainability and reduce moral hazard.