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Reading: BPJS Health Clarification regarding Employees Using Private Insurance: And 7 of the Latest and Most Complete Insurance News
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LigaAsuransi > Blog > Ulas Berita > BPJS Health Clarification regarding Employees Using Private Insurance: And 7 of the Latest and Most Complete Insurance News
Ulas Berita

BPJS Health Clarification regarding Employees Using Private Insurance: And 7 of the Latest and Most Complete Insurance News

Intan Aulia
By Intan Aulia
Published Monday January 27th, 2025
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17 Min Read
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Table of Content
OJK Prepares New Rules to Improve Health Insurance Governance in 2025AAJI Encourages Optimization of e-KYC for Convenience and Security for Life Insurance CustomersOJK Revokes PT Berdikari Insurance’s Business License, Company Must LiquidateOJK Prepares New Rules for Health Insurance Products, BPJS Health Needs Private Insurance SupportOJK Affirms that Insurance Companies Must Comply with POJK 20/2023 Requirements for Credit and Suretyship Insurance Products21 Diseases that are not covered by BPJS Health in 2025AAUI’s Steps to Be Responsive to the Constitutional Court’s Decision: Uniformization of Insurance Policies to Minimize Claim Disputes

Liga Asuransi – The insurance industry in Indonesia continues to be an important concern, both in terms of regulatory development and efforts to improve better governance. In the last few months, various significant events and policies have influenced this sector, starting from the OJK’s plan to introduce new regulations in the health insurance sector to firm steps to revoke the business permits of problematic insurance companies. This article summarizes a number of the latest and most relevant news that can provide an in-depth picture of the dynamics of the insurance industry in Indonesia, including clarification from BPJS Health regarding the use of private insurance by employees and encouragement of optimizing e-KYC technology to increase customer security. Check out the full review below.

OJK Prepares New Rules to Improve Health Insurance Governance in 2025

The Financial Services Authority (OJK) is preparing major steps to strengthen the governance of the health insurance industry in Indonesia. In this effort, the OJK plans to issue new regulations regarding health insurance products in the first or second quarter of 2025. This plan was announced by the Chief Executive of the OJK Insurance, Guarantee and Pension Fund Supervision (KE PPDP), Ogi Prastomiyono, in Jakarta.

“OJK will ask for comments on the draft regulations from the public and industry players to ensure these regulations are relevant and comprehensive,” said Ogi.

Main Focus of New Regulations

This regulation will cover several important points, including:

  1. Company Criteria: Determine which companies can market health insurance products.
  2. Product Types and Conditions: Develop guidelines for types of health insurance products and their requirements.
  3. Risk Management: Encourage the implementation of better risk management in health insurance companies.
  4. Benefits Coordination Feature: Ensure coordination of benefits with BPJS Health.
  5. Medical Council: Establishment of a medical advisory board as part of corporate governance.
  6. Cooperation with Other Parties: Arrangement of cooperation agreements to support insurance company operations.

Positive Trends and the Drive for Improvement

Based on OJK data as of November 2024, the ratio of health insurance claims for life insurance and general insurance shows a decline. This is an indication of improvements in this business line. However, OJK still emphasizes the importance of maintaining quality service to consumers.

“OJK hopes that this positive trend will continue in 2025 so that people can continue to enjoy the benefits of health insurance,” added Ogi.

OJK also noted that health insurance and critical illness insurance have become flagship products in the life insurance sector. These products provide the financial protection that people really need, especially against the risk of death and critical illness.

Strengthening Governance and Risk Prevention

To maintain the resilience of the life insurance sector, OJK continues to monitor and encourage companies to implement good business practices. One of the main focuses is strengthening the underwriting process to avoid the risk of fraud and non-disclosure. OJK also emphasizes the application of the principle of “utmost good faith” in risk selection, thereby creating fairness for customers.

“Strengthening underwriting is one of the important points in the draft OJK Circular (SE) regarding health insurance. “This will help increase public trust in the insurance industry in Indonesia,” stressed Ogi.

Hope for the Future

With the new regulations currently being formulated, OJK hopes that the governance of the health insurance industry in Indonesia can be better and more transparent. This step is expected to not only increase public confidence in the insurance industry, but also ensure optimal protection for customers.

The active role of the community and industry players in providing responses to this draft regulation is very important to create a healthier and more sustainable insurance ecosystem.

Source: https://www.antaranews.com/berita/4602902/ojk-segera-terbitkan-aturan-produk-asuransi-kesehatan 

 

AAJI Encourages Optimization of e-KYC for Convenience and Security for Life Insurance Customers

The Indonesian Life Insurance Association (AAJI) calls on the life insurance industry to start optimizing the use of e-KYC (electronic Know Your Customer) in various customer transactions. For example, the claim payment process can now be done online, which of course requires e-KYC as a data verification step.

In comparison, when people make transactions at banks, such as opening an account or carrying out other transactions, they are usually asked to answer questions such as the maiden name of their biological mother. This question is one form of verification in the traditional KYC process. In the world of banking and financial technology, verification via KYC is a vital process to ensure customer data is valid and is actually carried out by the account owner, not by other parties or criminals.

What is KYC and e-KYC?

In general, KYC and e-KYC have the same goal, namely verifying customer data. However, the difference lies in how the process is carried out:

  1. Traditional KYC: Verification is carried out manually by submitting physical documents such as KTP, SIM, or passport. Customers or prospective customers must be present in person.
  2. e-KYC: Verification is carried out digitally, such as uploading an identity card or other document to a certain portal. This process is equipped with facial or fingerprint scanning, so customers can complete verification from anywhere and at any time.

Benefits of e-KYC for Customers

Implementing e-KYC in life insurance companies provides a number of important benefits for customers, including:

  1. Personal Data Security: e-KYC protects customers’ personal data from theft or misuse by irresponsible parties. According to a survey by the Indonesian Internet Service Providers Association (APJII), data leak cases increased from 7.96 percent in 2023 to 20.97 percent in 2024. This condition highlights the importance of data protection in the digital ecosystem.
  2. Ease of Access to Financial Services: With e-KYC, customers can access financial services more easily and flexibly, without having to come directly to the insurance company office. This process speeds up transaction times and provides a more convenient experience.
  3. Safer and Precise Data Management: e-KYC ensures that customer data is processed appropriately and only for appropriate purposes, thereby minimizing the risk of misuse. This step increases trust between customers and insurance companies.

Implementation of e-KYC by Insurance Companies

Prudential Indonesia is one of the life insurance companies that has optimized e-KYC in its services. With this step, Prudential is encouraging the creation of a safer and more trusted digital ecosystem, in line with digital transformation that continues to develop in various industries, including insurance.

According to AAJI, e-KYC optimization not only creates security and comfort for customers, but also supports the life insurance industry in building a more efficient and transparent system. Thus, digital transformation through e-KYC will be an important foundation for the future of insurance in Indonesia.

Conclusion

In the ever-growing digital era, implementing e-KYC has become an urgent need to ensure the security, comfort and efficiency of financial services. The life insurance industry, through guidance from AAJI, is now moving towards optimizing e-KYC to protect customers and build stronger trust amidst data security challenges.

Source : https://money.kompas.com/read/2025/01/24/090000126/industri-asuransi-jiwa-perlu-optimalkan-adopsi-e-kyc-apa-itu- 

 

OJK Revokes PT Berdikari Insurance’s Business License, Company Must Liquidate

The Financial Services Authority (OJK) officially revoked the business license of PT Berdikari Insurance, a general insurance company, through Decision of Members of the OJK Board of Commissioners Number KEP-11/D.05/2025 dated 17 January 2025. This decision was announced on the OJK’s official website and is a step regulators are firm in supervising the insurance industry.

Prohibitions and Obligations After Permit Revocation

Head of the OJK Insurance, Guarantee and Pension Fund Licensing, Special Inspection and Quality Control Department, Asep Iskandar, explained that after the revocation of this permit, PT Berdikari Insurance was no longer allowed to carry out business activities in the general insurance sector. Additionally, the company also:

  1. Transferring or Reducing Assets is prohibited: Shareholders, directors, board of commissioners and employees of PT Berdikari Insurance are prohibited from taking actions that could reduce or lower the value of the company’s assets.
  2. Cessation of All Operational Activities: Both the head office and branch offices must stop all operational activities.

Steps that Companies Must Take

PT Berdikari Insurance is required to fulfill a number of obligations as part of the liquidation process, including:

  1. Preparation of Closing Balance Sheet: Companies must prepare and submit a closing balance sheet to the OJK no later than 15 days from the date of permit revocation.
  2. General Meeting of Shareholders (GMS): A GMS must be held no later than 30 days after the revocation of the business license to decide on the dissolution of the PT Berdikari Insurance legal entity and form a liquidation team.
  3. Cooperation in the Liquidation Process: After the liquidation team is formed, all shareholders, directors, board of commissioners and company employees are required to provide the required data, information and documents. They are also prohibited from obstructing the liquidation process.

Previous Sanctions: Restrictions on Business Activities (PKU)

Prior to the revocation of this business license, PT Berdikari Insurance had received a Business Activity Restriction (PKU) sanction from the OJK. This sanction was given because the company was deemed to have violated a number of provisions in the insurance sector.

“The imposition of PKU sanctions is a series of supervision processes carried out by OJK,” said Acting Head of the OJK Literacy, Financial Inclusion and Communications Department, M. Ismail Riyadi, on September 13 2024.

OJK’s Commitment to Insurance Industry Governance

OJK’s firm step in revoking PT Berdikari Insurance’s business license shows the regulator’s commitment to ensuring good governance in the insurance industry. The mandatory liquidation process also aims to protect consumer interests and maintain the stability of the financial industry.

With this decision, OJK hopes that other insurance companies can increase compliance with regulations, as well as strengthen risk management and transparency in their operations.

Source : https://www.tempo.co/ekonomi/ojk-cabut-izin-usaha-asuransi-umum-pt-berdikari-insurance-1197684 

 

OJK Prepares New Rules for Health Insurance Products, BPJS Health Needs Private Insurance Support

The Financial Services Authority (OJK) officially revoked the business license of PT Berdikari Insurance, a general insurance company, through Decision of Members of the OJK Board of Commissioners Number KEP-11/D.05/2025 dated 17 January 2025. This decision was announced on the OJK’s official website and is a step regulators are firm in supervising the insurance industry.

Prohibitions and Obligations After Permit Revocation

Head of the OJK Insurance, Guarantee and Pension Fund Licensing, Special Inspection and Quality Control Department, Asep Iskandar, explained that after the revocation of this permit, PT Berdikari Insurance was no longer allowed to carry out business activities in the general insurance sector. Additionally, the company also:

  1. Transferring or Reducing Assets is prohibited: Shareholders, directors, board of commissioners and employees of PT Berdikari Insurance are prohibited from taking actions that could reduce or decrease the value of the company’s assets.
  2. Cessation of All Operational Activities: Both the head office and branch offices must stop all operational activities.

Steps that Companies Must Take

PT Berdikari Insurance is required to fulfill a number of obligations as part of the liquidation process, including:

  1. Preparation of Closing Balance Sheet: Companies must prepare and submit a closing balance sheet to the OJK no later than 15 days from the date of permit revocation.
  2. General Meeting of Shareholders (GMS): A GMS must be held no later than 30 days after the revocation of the business license to decide on the dissolution of the PT Berdikari Insurance legal entity and form a liquidation team.
  3. Cooperation in the Liquidation Process: After the liquidation team is formed, all shareholders, directors, board of commissioners and company employees are required to provide the required data, information and documents. They are also prohibited from obstructing the liquidation process.

Previous Sanctions: Restrictions on Business Activities (PKU)

Prior to the revocation of this business license, PT Berdikari Insurance had received a Business Activity Restriction (PKU) sanction from the OJK. This sanction was given because the company was deemed to have violated a number of provisions in the insurance sector.

“The imposition of PKU sanctions is a series of supervision processes carried out by OJK,” said Acting Head of the OJK Literacy, Financial Inclusion and Communications Department, M. Ismail Riyadi, on September 13 2024.

OJK’s Commitment to Insurance Industry Governance

OJK’s firm step in revoking PT Berdikari Insurance’s business license shows the regulator’s commitment to ensuring good governance in the insurance industry. The mandatory liquidation process also aims to protect consumer interests and maintain the stability of the financial industry.

With this decision, OJK hopes that other insurance companies can increase compliance with regulations, as well as strengthen risk management and transparency in their operations.

Source : https://www.cnbcindonesia.com/market/20250123121819-17-605420/ini-bocoran-aturan-kerja-sama-bpjs-asuransi-swasta 

 

OJK Affirms that Insurance Companies Must Comply with POJK 20/2023 Requirements for Credit and Suretyship Insurance Products

The Financial Services Authority (OJK) officially revoked the business license of PT Berdikari Insurance, a general insurance company, through Decision of Members of the OJK Board of Commissioners Number KEP-11/D.05/2025 dated 17 January 2025. This decision was announced on the OJK’s official website and is a step regulators are firm in supervising the insurance industry.

Prohibitions and Obligations After Permit Revocation

Head of the OJK Insurance, Guarantee and Pension Fund Licensing, Special Inspection and Quality Control Department, Asep Iskandar, explained that after the revocation of this permit, PT Berdikari Insurance was no longer allowed to carry out business activities in the general insurance sector. Additionally, the company also:

  1. Transferring or Reducing Assets is prohibited: Shareholders, directors, board of commissioners and employees of PT Berdikari Insurance are prohibited from taking actions that could reduce or lower the value of the company’s assets.
  2. Cessation of All Operational Activities: Both the head office and branch offices must stop all operational activities.

Steps that Companies Must Take

PT Berdikari Insurance is required to fulfill a number of obligations as part of the liquidation process, including:

  1. Preparation of Closing Balance Sheet: Companies must prepare and submit a closing balance sheet to the OJK no later than 15 days from the date of permit revocation.
  2. General Meeting of Shareholders (GMS): A GMS must be held no later than 30 days after the revocation of the business license to decide on the dissolution of the PT Berdikari Insurance legal entity and form a liquidation team.
  3. Cooperation in the Liquidation Process: After the liquidation team is formed, all shareholders, directors, board of commissioners and company employees are required to provide the required data, information and documents. They are also prohibited from obstructing the liquidation process.

Previous Sanctions: Restrictions on Business Activities (PKU)

Prior to the revocation of this business license, PT Berdikari Insurance had received a Business Activity Restriction (PKU) sanction from the OJK. This sanction was given because the company was deemed to have violated a number of provisions in the insurance sector.

“The imposition of PKU sanctions is a series of supervision processes carried out by OJK,” said Acting Head of the OJK Literacy, Financial Inclusion and Communications Department, M. Ismail Riyadi, on September 13 2024.

OJK’s Commitment to Insurance Industry Governance

OJK’s firm step in revoking PT Berdikari Insurance’s business license shows the regulator’s commitment to ensuring good governance in the insurance industry. The mandatory liquidation process also aims to protect consumer interests and maintain the stability of the financial industry.

With this decision, OJK hopes that other insurance companies can increase compliance with regulations, as well as strengthen risk management and transparency in their operations.

Source : https://finansial.bisnis.com/read/20250122/215/1833959/ojk-siapkan-sanksi-bagi-perusahaan-kurang-modal-jual-asuransi-kredit-dan-suretyship 

 

21 Diseases that are not covered by BPJS Health in 2025

The Financial Services Authority (OJK) officially revoked the business license of PT Berdikari Insurance, a general insurance company, through Decision of Members of the OJK Board of Commissioners Number KEP-11/D.05/2025 dated 17 January 2025. This decision was announced on the OJK’s official website and is a step regulators are firm in supervising the insurance industry.

Prohibitions and Obligations After Permit Revocation

Head of the OJK Insurance, Guarantee and Pension Fund Licensing, Special Inspection and Quality Control Department, Asep Iskandar, explained that after the revocation of this permit, PT Berdikari Insurance was no longer allowed to carry out business activities in the general insurance sector. Additionally, the company also:

  1. Transferring or Reducing Assets is prohibited: Shareholders, directors, board of commissioners and employees of PT Berdikari Insurance are prohibited from taking actions that could reduce or decrease the value of the company’s assets.
  2. Cessation of All Operational Activities: Both the head office and branch offices must stop all operational activities.

Steps that Companies Must Take

PT Berdikari Insurance is required to fulfill a number of obligations as part of the liquidation process, including:

  1. Preparation of the Closing Balance Sheet: Companies must prepare and submit a closing balance sheet to the OJK no later than 15 days from the date of permit revocation.
  2. General Meeting of Shareholders (GMS): A GMS must be held no later than 30 days after the revocation of the business license to decide on the dissolution of the PT Berdikari Insurance legal entity and form a liquidation team.
  3. Cooperation in the Liquidation Process: After the liquidation team is formed, all shareholders, directors, board of commissioners and company employees are required to provide the required data, information and documents. They are also prohibited from obstructing the liquidation process.

Previous Sanctions: Restrictions on Business Activities (PKU)

Prior to the revocation of this business license, PT Berdikari Insurance had received a Business Activity Restriction (PKU) sanction from the OJK. This sanction was given because the company was deemed to have violated a number of provisions in the insurance sector.

“The imposition of PKU sanctions is a series of supervision processes carried out by OJK,” said Acting Head of the OJK Literacy, Financial Inclusion and Communications Department, M. Ismail Riyadi, on September 13 2024.

OJK’s Commitment to Insurance Industry Governance

OJK’s firm step in revoking PT Berdikari Insurance’s business license shows the regulator’s commitment to ensuring good governance in the insurance industry. The mandatory liquidation process also aims to protect consumer interests and maintain the stability of the financial industry.

With this decision, OJK hopes that other insurance companies can increase compliance with regulations, as well as strengthen risk management and transparency in their operations.

Source : https://finansial.bisnis.com/read/20250124/215/1834428/silahkan-bayar-sendiri-21-penyakit-ini-tak-ditanggung-bpjs-kesehatan-tahun-2025 

 

AAUI’s Steps to Be Responsive to the Constitutional Court’s Decision: Uniformization of Insurance Policies to Minimize Claim Disputes

A number of insurance experts expressed high appreciation for the quick steps taken by the Indonesian General Insurance Association (AAUI) in responding to the decision of the Constitutional Court (MK) regarding Article 251 of the Commercial Code (KUHD). The recently passed Constitutional Court decision changes the way insurance companies handle claims, where insurance claims can no longer be canceled unilaterally even if there is a violation of the principle of good faith in the agreement.

With this decision, the claim cancellation process must involve an agreement between both parties or through court to resolve the dispute. This move aims to provide greater fairness for consumers and strengthen transparency in the insurance industry.

General Insurance Policy Adjustment by AAUI

As a follow-up to the Constitutional Court’s decision, AAUI stated that within the next month, the association will carry out socialization regarding adjustments and uniformity of general insurance policy standards for its members. Wahyudin Rahman, Risk Management Practitioner and General Chair of the Indonesian Insurance Writers Community (Kupasi), expressed his support for the AAUI initiative. Wahyudin believes that the very diverse types of insurance policies require fast and precise steps to minimize the potential for claim disputes in court.

“Unifying this policy is important to ensure that all AAUI members can adapt to the Constitutional Court’s decision regarding Article 251 of the Criminal Code. “This is a joint step agreed to improve the quality of insurance industry governance,” said Wahyudin.

Updates Regarding Policy Terms and Conditions

One of the significant changes in this adjustment is the elimination of policy terms and conditions that relate to the obligation to provide information, information or material facts from the policy holder or insured, which was previously based on Article 251 of the Commercial Code.

Apart from that, there are also important changes in the Insurance Coverage Application Letter (SPPA), which has now been replaced with the General Insurance Application Letter (SPAU). This SPAU will be an integral part of the new insurance policy, so that if a dispute occurs, the SPAU can provide stronger legal force in the trial process.

Insurance Observer Supports AAUI’s Steps

Abitani Taim, Insurance Observer and Chair of the College of Risk Management and Insurance (STIMRA), also assessed that AAUI’s decision to emphasize the obligation to convey material facts or Duty of Disclosure it’s very correct. “SPAU must be an inseparable part of the policy. “If there is fraud or error in filling out the SPAU, the insurance company has the right to reject the claim without having to cancel the policy in its entirety,” said Abitani.

Coordinate with OJK for Further Steps

Currently, AAUI is also intensively coordinating with the Financial Services Authority (OJK) to ensure that the proposed standard insurance policy adjustment draft can become a reference for all insurance products in Indonesia. OJK Deputy Commissioner for Insurance, Guarantee and Pension Fund Supervision, Iwan Pasila, added that OJK has scheduled a meeting with industry associations in the near future to discuss corrective steps that need to be taken.

“We will meet with industry associations this Friday to discuss the steps that need to be taken. “After the meeting, we will provide further updates,” said Iwan.

Adjustments Leading to Improvement of the Insurance Industry

AAUI’s step to adjust this policy is not only a response to the Constitutional Court’s decision, but is also an opportunity to increase transparency and trust in the insurance industry. By unifying policies, it is hoped that claim disputes can be minimized and insurance companies can work more clearly in accordance with applicable legal provisions.

This step also sends an important message to consumers that they have stronger legal protection when dealing with insurance companies, as well as ensuring that every claim submitted can be processed in a fair and transparent manner.

Source : https://finansial.bisnis.com/read/20250121/215/1833307/aaui-lakukan-penyeragaman-polis-asuransi-umum-pengamat-sebut-sudah-disepakati-anggota 

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