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One of the topics that is increasingly crucial today is Employee Health Insurance. Amidst the dynamics of regulation and challenges of the modern workforce, health insurance is no longer just a facility, but a strategic investment to maintain productivity, loyalty, and business sustainability.
Through our articles, including in-depth reviews of scheme-payment of employee insurance, you will find practical and relevant insights that can be directly applied to company policies and personal decisions. We believe that the right protection starts with accurate information.
Let’s explore our content, and improve your understanding together. Liga Asuransi — your partner in the world risk management and employee health insurance.
Amidst increasing corporate awareness of the importance of employee well-being, health insurance has become one of the most crucial amenities in a modern compensation package. For many workers,employee health insurance is not just a complement, but a real symbol of the company’s concern for the health of individuals and their families.
However, entering 2025, the world of employee health insurance in Indonesia is experiencing important changes.Financial Services Authority (OJK) has published OJK Circular Letter Number 7 of 2025 which regulates the mandatory scheme co-payment—namely the division of medical costs between participants and insurance providers. This rule is a major concern, especially for the health department.Human Resources (HR)who holds responsibility for managing employee insurance programs.
Interestingly, scheme-payment is actually not a new thing in the world. Countries such as the United States, Japan, and most European countries have long implemented it as a step to encourage wiser use of health services. In Indonesia, the implementation of this system is an important milestone to balance long-term benefits with the company’s financial sustainability.
So what exactly is a co-payment?schemeThis will burden employees? How should HR respond to this change with a smart strategy?
This article will review in depth the definition, mechanisms, impacts, and strategic solutions for implementing co-payment in employee health insurance, especially from an HR perspective.
What’s that Co-payment In Health Insurance?
Co-payment is a cost-sharing scheme in health insurance services, where participants (in this case, employees)pay part of the total medical expenses, while the rest is covered by the insurance company. This concept is actually already commonly applied in various developed countries, and is now starting to be adopted more widely in Indonesia, especially after the issuance of the latest OJK regulations.
Simple example:
For example, an employee undergoes outpatient treatment with a total bill of Rp1.000.000. If the insurance policy stipulates a schemeco-payment 20%, for:
- Employees pay Rp. 200,000
- Insurance covers Rp. 800,000
So, co-payment does not mean that the insurance does not pay, but the employee participates in part as a form of shared responsibility.
How is it different from a full coverage system?
On the system full coverage, all costs are fully covered by insurance (or the company), without any contribution from employees. This system is indeed convenient for participants, but in the long term it has the potential to trigger abuse of benefits (overutilization), such as going to the doctor without an urgent reason just because it is “free”.
The main objectives of implementing co-payment:
- Reducing moral hazard, namely irresponsible behavior in using health services
- Encourage employees to be wiser and more selective in using insurance benefits
- Stabilizing insurance claims burden, so that the company can continue to provide benefits in the long term
In other words, co-payment is a form of system that encourages awareness and shared responsibility between employees, companies, and insurance providers. But how is this rule legally required? Let’s discuss it in the next section.
New OJK Regulation 2025 on Co-Payment
In 2025, the Financial Services Authority (OJK) introducedOJK Circular Letter Number 7 of 2025, which requires health insurance products to implement scheme co-payment. This policy aims to strengthen the health protection system and maintain the sustainability of health insurance in Indonesia.
What is regulated in SEOJK No. 7/2025?
This Circular requires all health insurance companies to cover most of the medical costs, but with more transparent and controlled cost sharing. In the scheme co-payment, workThe insured or insurance participant is required to pay a certain percentage of the total costs incurred when receiving medical services, both for outpatient and inpatient care.
Some important points of this regulation include:
- Obligation to implement the scheme co-payment by insurance companies to reduce excessive claims costs.
- Value limits co-payment, which is set by each insurance company, usually ranges from 10%-30% of medical costs.
- Applicable implementation for employees at all levels of the company, so that health insurance becomes more evenly distributed and accountable.
Direct Impact on Employees and Companies
For employees, this regulation means that they must be prepared to bear some of the medical costs, even though insurance still covers the largest share. On the other hand, insurance companies must provide more efficient solutions to manage and structure the scheme co-payment right.
For companies that provide insurance benefits to employees,HRneed to prepare an effective communication strategy so that employees understand this new system. A clear understanding of co-payment will avoid confusion when having to pay for health costs.
How Schemas Work Co-Payment in the field?
Although it sounds simple in concept, implementing co-payment in the field involves several stages and detailed understanding, both from the employee and HR side. When someone uses employee health insurance, there are two main things that determine: the type of health facility visited and the claims mechanism used.
- Accessing Health Services
Employees can choose to seek treatment at:
- Panel facilities (clinics/hospitals that have collaborated directly with insurance companies)
- Non-panel facilities(general clinic/hospital outside partner network)
- Payment System in Panel Facility
If you seek treatment at the panel, the system is usually cashless, just show your insurance card. But, with the co-payment scheme:
- Permanent employees must pay part of the fee right away, according to the applicable percentage.
- For example: Outpatient costs IDR 500,000 → Co-payment 20% → Employee pays IDR 100,000 directly on the spot, the rest is covered by insurance.
- Reimbursement System in Non-Panel Facilities
If seeking treatment outside the network:
- Employee pay all fees in advance
- Then submit reimbursement claim
- Insurance only replaces a certain amount value minus co-payment, according to the benefit ceiling
For example: Inpatient costs Rp. 8,000,000,co-payment 10% → Employees are paid back Rp. 7,200,000
- Additional Case Examples
An employee performs a minor operation (e.g. cyst removal) at a total cost of Rp12 million. With the scheme co-payment 15%, employees bear Rp1,800,000, the rest is covered by insurance. These costs can be paid directly at the panel facility or claimed back if through a non-panel.
This scheme also applies to additional benefits such as dental and optical insurance, although often with different maximum limits and co-payment percentages.
By understanding this workflow, HRcan create a guide to using benefits that is easier to understand and prevent confusion in the field.
Advantages and Disadvantages of Co-Payment
Implementation co-payment in employee health insurance not just an administrative decision, but a long-term policy strategy. This system has positive aspects in terms of efficiency, but also carries risks if not communicated and managed well. Here are the advantages and disadvantages from various perspectives:
✅ Co-Payment Benefits
- Prevent Abuse (Moral Hazard)
With the contribution of costs, employees tend to be more selective in using medical services. This can prevent overuse of services just because they are “free.” - Maintaining Insurance Fund Stability
Co-payments help companies and insurance providers maintain healthy claims ratios. This is important to ensure that benefit programs remain sustainable and premiums do not skyrocket each year. - Promoting Shared Awareness and Responsibility
This scheme fosters an understanding that health services are both a right and a responsibility, so that all parties are encouraged to be wise in their use. - Preferred by Insurance Companies
From the insurance side,co-payment facilitating the management of claims risk and enabling them to offer more competitive premiums to client companies.
❌ Lack of Co-Payment
- Additional Financial Burden for Employees
Especially for employees with low to middle incomes or those who have family responsibilities,co-payment can be a new burden that is quite noticeable. - Declining Satisfaction with Benefits
Employees who are accustomed to full coverage plans may view co-payments as “cutting rights,” if not explained openly. - Potential Treatment Delay
In some cases, employees may delay seeking treatment due to the costs involved, which can actually worsen the condition and increase long-term medical costs. - Need Additional Control Mechanism
A maximum limit on co-payments per year or a payment ceiling is needed so as not to burden employees disproportionately, especially in cases of serious or recurring illness.
Impact of Co-Payment Implementation on HR & HR Division
For the Human Resources (HR) division, the implementation of the scheme co-payment not just technical changes, but also concerning employee expectation management, policy communication, And talent retention strategy. When this scheme comes into effect, HR is at the forefront in ensuring the transition runs smoothly and does not affect productivity or job satisfaction.
- Benefit Policy Adjustment
HR needs to update employee benefits policy documents, including:
- Employee benefit handbook
- SOP reimburse dan co-payment
- Onboarding materials for new employees
The old policy that stated “100% of medical expenses are covered” must be updated to reflect a new, more realistic scheme.
- Internal Education and Transparent Communication
Co-payments have the potential to cause resistance if not explained properly. HR should:
- Hold a socialization session or town hall
- Provide FAQs and written guides
- Opening a Q&A channel (e.g. via HRBP or internal platform)
Transparency is essential to maintaining employee trust in the company.
- Adaptive Insurance Partner Selection
HR also needs to be more selective in choosing an insurance provider. Responsive partners with user-friendly claim systems will be very helpful in implementing co-payment without causing frustration for employees.
- Periodic Monitoring and Feedback
After co-payment enforced, HR is advised to:
- Monitor insurance benefit usage data
- Record complaints or obstacles from employees
- Conduct annual evaluations and renegotiate with the insurance company if necessary.
HR Strategy in Dealing with This New Rule
Apply co-payment in employee health insurance not just following regulations, but also concerning managing employee communications, expectations and retention. HR has a strategic role to ensure that these changes do not create resistance or decrease job satisfaction. Here are some strategies that can be applied practically:
- Proactive Socialization and Communication
Changes in the benefits system must be communicated gradually and clearly. Use the approach:
- Visual infographics (insurance usage flow + co-payment)
- Open Q&A session (town hall or via HRBP)
- Example-based written guides (FAQs, cost simulations, etc.)
The goal is to build understanding, not just announce changes.
- Partner with an Insurance Broker or Consultant
HR can collaborate with professionals such as insurance brokers to:
- Designing an optimal benefits package
- Provide training or workshops to employees
- Act as an intermediary in negotiations with insurance companies
With the support of a neutral third party, this adjustment can be carried out more objectively and transparently.
- Employee Data Analysis and Segmentation
Don’t apply a uniform schema to all. Use internal data to create a relevant schema based on:
- Age and marital status
- Insurance usage history
- Type of work (operational vs administrative)
- Annual Review & Audit
Evaluate benefit usage and co-payment effectiveness periodically. Use the HRIS dashboard to monitor:
- Claims trends
- Provider performance
- Employee feedback
Regular audits help HR develop sustainable long-term strategies and remain competitive in attracting talent.
Need Help Drawing Up a SchemeCo-PaymentEffective?
Transition to system co-payment can feel complicated, especially for HR who have to manage employee expectations while ensuring regulatory compliance. This is where the role of L&G Insurance Broker becomes very important. As an experienced insurance broker, L&G help companies put together employee health insurance packages that are comprehensive, efficient, and in accordance with the latest OJK regulations.
With the support of a team of experts and a wide network of trusted insurance providers, L&G is ready to assist HR from the process of needs analysis, benefit design, to employee education. Make this process easier and more professional with L&G.
Implementation of the scheme co-payment in employee health insurance not just about sharing the burden of costs, but reflecting the evolution of the benefits system towards transparency, efficiency, and shared responsibility. In the context of the latest OJK regulations, this step is important to create a health protection system that is more resilient to spikes in claims and economic changes.
For HR, the main challenge is how to bridge the gap between new policies and employee expectations that are formed from the old system. This is where HR’s ability as a communicator, educator, and policy designer is tested. Today’s HR is no longer just an administrative manager, butan welfare guardian of the organization.
With the right communication strategy, data transparency, and the support of professional insurance partners, co-payments can be integrated as part of a healthy and fair system, without sacrificing employee satisfaction.
🔎 Want to redesign your employee insurance system to comply with the latest regulations?
📞 Get in touch L&G Insurance Broker Of 0811-8507-773— a trusted partner for modern, flexible, and regulatory-compliant employee risk management and benefits solutions.
