Aturan Baru OJK: Peserta Asuransi Wajib Tanggung 10 Persen Klaim Biaya Berobat | Narasi Daily
Ketentuan ini diatur dalam Surat Edaran OJK (SEOJK) Nomor 7 Tahun 2025 tentang Penyelenggaraan Produk Asuransi Kesehatan.“Dalam SEOJK tersebut, diatur bahwa produk asuransi kesehatan harus memiliki fitur skema co-payment untuk layanan rawat jalan dan rawat inap di rumah sakit,” ujar Kepala Eksekutif Pengawas Perasuransian, Penjaminan, dan Dana Pensiun OJK, Ogi Prastomiyono, dalam konferensi pers pada Senin (2/6/2025).
Aturan ini akan berlaku mulai 1 Januari 2026 untuk semua produk asuransi kesehatan, baik konvensional maupun syariah, yang menggunakan skema ganti rugi (indemnity) dan pelayanan kesehatan terkelola (managed care).
Melalui ketentuan ini, peserta asuransi diwajibkan menanggung sebagian biaya klaim, dengan minimal 10 persen dari total klaim.
Adapun batas minimum yang harus dibayarkan peserta adalah Rp300 ribu untuk rawat jalan dan Rp3 juta untuk rawat inap dalam satu kali klaim. Namun, batas tersebut dapat lebih tinggi jika disepakati antara perusahaan asuransi dan pemegang polis, serta tercantum dalam polis.
| Narasi Daily
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