Co-Payment

These sources consist of several excerpts providing information and opinions regarding the use of co-payment in insurance policies. The initial documents introduce the concept of co-payment, explaining that even after paying premiums, customers must still make additional payments during a claim, and clarifying the specific rules set by the Financial Services Authority (OJK) which mandate policyholders cover 10% of costs, up to set maximum limits. Subsequent information explains why co-payment exists, noting it is designed to prevent unnecessary claims and manage rising healthcare premiums, according to industry executives. The documents then detail the responses of insurance companies, like Allianz and Prudential, which actively utilize co-payment schemes to manage costs and prevent overutilization, while consumer groups argue the rule reduces consumer rights and discourages participation. Finally, the sources address the potential delay or cancellation of the co-payment regulation due to political pressure concerning public involvement and industry debate.

What is Co-payment

The primary subject addressed in the source material is the concept of co-payment (often referred to as co-payment or co-payment in the text) within the realm of insurance. This concept is introduced by highlighting a common confusion among policyholders: that they have already paid their premiums yet still have to pay when making a claim. Understanding this mechanism is crucial for the insured.

The Regulatory Definition

Co-payment refers to rules issued by the Financial Services Authority (Otoritas Jasa Keuangan or OJK). These rules stipulate that insurance policies will cover 90% of the cost, while the insured party is responsible for bearing the remaining 10%. Furthermore, the rules establish specific maximum limits for the insured's contribution: up to Rp 300 thousand for outpatient treatment and up to Rp 1 million for inpatient treatment.

Why (The Rationale and Necessity)

Controlling Claims

According to the Executive Director of the Association of Indonesian Life Insurance (Direktur Eksekutif Asosiasi Asuransi Jiwa Indonesia), the co-payment arrangement is specifically designed to manage or control claims that are unnecessary. This suggests that the regulatory intent behind the policy is to introduce a measure of caution into the claim process.

Addressing Premium Inflation

The Head of the Executive Regulator for Insurance, Guarantee, and Pension Funds at OJK emphasized that the requirement for co-payment is necessary to address the continuously spiking health premiums. Insurance companies further support this rationale, noting that co-payment is seen as a positive step toward reducing instances of overutilization of health services, which contributes to the rising cost of health insurance.

Who (The Stakeholders and Responders)

Regulators and Industry Leaders

Multiple key figures and institutions are involved in this topic. The OJK is the body that issued the co-payment rules. Representatives from insurance companies, such as Hasina Jusuf of Allianz and Yosie William Iroth of Prudential, have actively responded to the co-payment scheme in the media. Prudential's representative, Yosie William Iroth, is noted to have already responded to the co-payment scheme up to 12 times across various media platforms.

Consumer Groups and Political Figures

The policy has also elicited strong responses from consumer groups and political figures. Tulus Abadi of the Empowered Consumer Forum (Forum Konsumen Berdaya) has stated in various media outlets that this rule diminishes the rights of the insured. Politically, Eric Hermawan, a Member of House of Representative Commission XI, responded critically, citing a concern that the public was not involved in the rule-making process.

When and Where (Timeline and Context)

Timeline and Geographical Context

The co-payment discussion is situated within the context of Indonesian regulations and institutions, involving the OJK and the DPR. The regulatory action specifically revolves around the SE OJK Number 7 of 2023. However, due to public and political responses, this implementation has been challenged, and the co-payment mandate has been postponed until at least 2027.

How (Implementation and Reaction)

How Insurance Companies View It

Insurance companies, like Allianz, have been among the most active responders to the co-payment scheme, often communicating through media. According to Hasina Jusuf of Allianz, patterns of service utilization are what drive premium increases. Therefore, they view the co-payment rule as beneficial for curtailing the overutilization that leads to continually escalating healthcare costs.

How Consumer Groups View It 

The consumer perspective, as represented by Tulus Abadi, differs significantly. He argued that the rule reduces the rights of the insured. Furthermore, he warned that this policy could actually reduce consumer interest in taking out insurance policies. Abadi suggested that placing the burden on the policyholder could unintentionally position the insurance company as the party that benefits from the situation, rather than the party bearing the responsibility.

How Implementation Was Challenged

The implementation of the co-payment rule faced immediate challenges, particularly concerning the perception that the public was not adequately involved in the creation of the policy. This concern, raised by Eric Hermawan, contributed to the decision to revoke and postpone the implementation of SE OJK Number 7 of 2023. Whether the rule will ultimately be postponed further or canceled remains a point of future interest.