{"id":7572,"date":"2025-07-05T23:05:36","date_gmt":"2025-07-05T16:05:36","guid":{"rendered":"https:\/\/ligaasuransi.com\/?p=7572"},"modified":"2025-07-07T08:46:42","modified_gmt":"2025-07-07T01:46:42","slug":"pojk-terbaru-cost-sharing-asuransi-kesehatan-wajib-10-apa-dampaknya-bagi-anda","status":"publish","type":"post","link":"http:\/\/ligaasuransi.com\/en\/pojk-terbaru-cost-sharing-asuransi-kesehatan-wajib-10-apa-dampaknya-bagi-anda\/","title":{"rendered":"Latest POJK! Mandatory Health Insurance Cost Sharing 10% \u2013 What Impact Does It Have on You?"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">Hello Insurance League Friends! Welcome back to the education channel trusted<\/span><b> insurance with<\/b><span style=\"font-weight: 400;\"> us, the best place to discuss everything about<\/span><b>Health Insurance<\/b><span style=\"font-weight: 400;\">, risk management, and the latest regulations from OJK. This time, we will review the new rules that have attracted quite a lot of attention, namely the obligation cost<\/span><b> sharing 10%<\/b><span style=\"font-weight: 400;\"> in <\/span><b>commercial health insurance<\/b><span style=\"font-weight: 400;\">. What does this policy mean? How does it affect individual participants, companies, and hospitals? And what does it look like?<\/span><b>An important role <\/b><a href=\"https:\/\/lngrisk.co.id\/\"><b>insurance broker<\/b> <\/a><span style=\"font-weight: 400;\">in helping you adapt to these changes? Come on, read more in this article!<\/span><\/p>\n<p>&nbsp;<\/p>\n<h3><b>New Regulation: Mandatory Health Insurance Cost Sharing 10%<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">In May 2025, OJK issued<\/span><b>SEOJK 7\/SEOJK.05\/2025<\/b><span style=\"font-weight: 400;\"> which obliges all participants of commercial<\/span><b> health insurance<\/b><span style=\"font-weight: 400;\"> to bear a minimum<\/span><b> cost sharing fee 10%<\/b><span style=\"font-weight: 400;\">of the total cost of medical services. This regulation is expected to increase transparency, prevent abuse of insurance benefits, and maintain the long-term financial stability of insurance companies.<\/span><\/p>\n<h3><b>What is Cost Sharing in Health Insurance?<\/b><\/h3>\n<p><b>Cost sharing is<\/b><span style=\"font-weight: 400;\"> a system in which insurance participants share part of the costs of service health. There are three forms of cost sharing that are commonly used:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Deductible<\/b><span style=\"font-weight: 400;\">: initial costs paid out of pocket before insurance covers the rest.<\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><b>Co-payment<\/b><span style=\"font-weight: 400;\">: fixed fee per medical service visit.<\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><b>Co-insurance<\/b><span style=\"font-weight: 400;\">: percentage of the total cost (example: 10%) paid by the participant.<\/span><span style=\"font-weight: 400;\"><\/p>\n<p><\/span><\/li>\n<\/ul>\n<h3><b>Why did OJK issue this Cost Sharing Regulation?<\/b><\/h3>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Increasing transparency and fairness in<\/b><span style=\"font-weight: 400;\"> the health insurance system.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Controlling moral hazard<\/b><span style=\"font-weight: 400;\">, namely excessive use of medical services.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Maintaining the financial sustainability of insurance companies in<\/b><span style=\"font-weight: 400;\"> order to continue to pay claims in the long term.<\/span><span style=\"font-weight: 400;\">\n<p><\/span><\/li>\n<\/ol>\n<h3><b>Impact on Individuals, Companies and Service Providers<\/b><\/h3>\n<p><b>For individual participants:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Must start taking personal costs into account when seeking medical treatment.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Can no longer rely on full claims from insurance.<\/span><span style=\"font-weight: 400;\">\n<p><\/span><\/li>\n<\/ul>\n<p><b>For companies\/HR:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">It is necessary to socialize this change to employees to prevent misunderstandings.<\/span><span style=\"font-weight: 400;\">\n<p><\/span><\/li>\n<\/ul>\n<p><b>For hospitals &amp; service providers:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The claims system needs to be adjusted to automatically calculate participants&#8217; share of costs.<\/span><span style=\"font-weight: 400;\">\n<p><\/span><\/li>\n<\/ul>\n<h3><b>Benefits of Cost Sharing for Insurance Participants<\/b><\/h3>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Premiums are more affordable because the risk is shared.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Participants are wiser and more responsible in using health services.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Reducing the potential for abuse of insurance benefits.<\/span><span style=\"font-weight: 400;\">\n<p><\/span><\/li>\n<\/ul>\n<h3><b>Risks and Disadvantages of Cost Sharing<\/b><\/h3>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Additional costs when accessing health services.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Uncertainty regarding the amount of personal costs.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Obstacles for participants with limited funds during emergencies.<\/span><span style=\"font-weight: 400;\">\n<p><\/span><\/li>\n<\/ul>\n<h3><b>Tips for Dealing with These Changes<\/b><\/h3>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Study and understand the contents of your policy, especially the sections <\/span><b>co-payment<\/b><span style=\"font-weight: 400;\">, <\/span><b>deductible<\/b><span style=\"font-weight: 400;\">, and claim limits.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Discuss with your<\/span><b> insurance broker to<\/b><span style=\"font-weight: 400;\"> understand the benefit structure.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Use <\/span><b>feature Coordination of Benefit (CoB)<\/b><span style=\"font-weight: 400;\">with BPJS to reduce personnel costs.<\/span><span style=\"font-weight: 400;\">\n<p><\/span><\/li>\n<\/ul>\n<h3><b>What is Coordination of Benefits (CoB)?<\/b><\/h3>\n<p><b>CoB<\/b><span style=\"font-weight: 400;\"> is a cooperation mechanism between <\/span><b>BPJS Health and private insurance<\/b><span style=\"font-weight: 400;\">, where both share the claim burden according to the portion of benefits.<\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><span style=\"font-weight: 400;\"> Example:<\/span><span style=\"font-weight: 400;\"><br \/>\n<\/span><span style=\"font-weight: 400;\">If the hospital costs IDR 10 million, BPJS covers IDR 6 million, private insurance covers IDR 3 million, and the participant pays<\/span><b>co-payment Rp1 jute<\/b><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><b>Conditions in order CoB walk:<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Participants must be registered in the CoB system.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The hospital has integrated CoB.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Participants must bring their BPJS card and insurance card when seeking treatment.<\/span><span style=\"font-weight: 400;\">\n<p><\/span><\/li>\n<\/ul>\n<h3><span style=\"font-weight: 400;\">The Important Role of Insurance Brokers in the Cost Sharing System<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">As a strategic partner, <\/span><a href=\"https:\/\/lngrisk.co.id\/\"><b>insurance broker<\/b><\/a><span style=\"font-weight: 400;\"> have a critical role in helping clients navigate regulatory changes:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Analyze client needs and risk profile.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Develop health insurance programs according to the latest regulations.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Provide comprehensive education to HR and participants.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Monitor the claims process to ensure it runs smoothly.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Conduct annual reviews of benefits to remain efficient and competitive.<\/span><span style=\"font-weight: 400;\">\n<p><\/span><\/li>\n<\/ul>\n<h3><b>Conclusion<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">SEOJK Regulation 7\/2025 has stipulated that<\/span><b>10% cost sharing on health insurance is now mandatory<\/b><span style=\"font-weight: 400;\">. It is important to understand these changes so that participants, companies, and service providers can adapt well.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If you are evaluating a health insurance program for employees or need a recommendation for a policy with optimal benefits,<\/span><b>consult with a trusted <\/b><a href=\"https:\/\/lngrisk.co.id\/\"><b>insurance broker<\/b><\/a><span style=\"font-weight: 400;\"> such as L&amp;G Insurance Broker.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Click the link below to <\/span><b>FREE consultation and<\/b><span style=\"font-weight: 400;\"> don&#8217;t forget to LIKE, SHARE, and SUBSCRIBE to the Liga Asuransi channel for other important information!<\/span><\/p>","protected":false},"excerpt":{"rendered":"<p>Hello Insurance League Friends! Welcome back to the education channel trusted insurance with us, the best place to discuss everything aboutHealth Insurance, risk management, and the latest regulations from OJK. This time, we will review the new rules that have attracted quite a lot of attention, namely the obligation cost sharing 10% in commercial health [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":7573,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"video","meta":{"footnotes":""},"categories":[59,1243],"tags":[184,1238,1237],"class_list":{"0":"post-7572","1":"post","2":"type-post","3":"status-publish","4":"format-video","5":"has-post-thumbnail","7":"category-asuransi-kesehatan","8":"category-ligaasuransi-tv","9":"tag-asuransi-kesehatan","10":"tag-co-payment-asuransi-kesehatan","11":"tag-pojk-asuransi-kesehatan","12":"post_format-post-format-video"},"post_mailing_queue_ids":[],"_links":{"self":[{"href":"http:\/\/ligaasuransi.com\/en\/wp-json\/wp\/v2\/posts\/7572","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/ligaasuransi.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/ligaasuransi.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/ligaasuransi.com\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"http:\/\/ligaasuransi.com\/en\/wp-json\/wp\/v2\/comments?post=7572"}],"version-history":[{"count":3,"href":"http:\/\/ligaasuransi.com\/en\/wp-json\/wp\/v2\/posts\/7572\/revisions"}],"predecessor-version":[{"id":7582,"href":"http:\/\/ligaasuransi.com\/en\/wp-json\/wp\/v2\/posts\/7572\/revisions\/7582"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/ligaasuransi.com\/en\/wp-json\/wp\/v2\/media\/7573"}],"wp:attachment":[{"href":"http:\/\/ligaasuransi.com\/en\/wp-json\/wp\/v2\/media?parent=7572"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/ligaasuransi.com\/en\/wp-json\/wp\/v2\/categories?post=7572"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/ligaasuransi.com\/en\/wp-json\/wp\/v2\/tags?post=7572"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}