POJK 36/2025 on Health Insurance and the Role of Third Party Administrators
The issuance of POJK 36/2025 on Health Insurance marks a new chapter in the management of health insurance in Indonesia. This regulation is not merely an administrative requirement, but a strong signal from the regulator that governance, transparency, and the quality of healthcare services must become top priorities for insurance companies.
Understanding and promptly adapting to POJK 36/2025 is a strategic step that directly impacts business sustainability and corporate reputation.
Why Is POJK 36/2025 So Crucial?
POJK 36/2025 regulates various key aspects, including health benefit management, claims processes, cost control, as well as data transparency and reporting. Its objective is clear: to create a sustainable, fair, and participant-focused health insurance ecosystem. For insurance companies, compliance with POJK 36/2025 is not only about avoiding regulatory sanctions, but also about:
- Increasing trust from customers and business partners
- Maintaining financial stability for health insurance companies
- Strengthening Good Corporate Governance (GCG)
- Enhancing corporate image as a compliant and responsible insurer
In today’s era of information transparency, companies that fail to comply with regulations will lose market trust more quickly.
Implementing POJK 36/2025 Through the Medical Advisory Board
Within the context of POJK 36/2025, the Medical Advisory Board (MAB) or Dewan Penasihat Medis (DPM), is not merely a formal structure. It plays a critical role in ensuring that all medical policies, claims decisions, and health benefit management are conducted in a manner that is:
- Objective and independent
- Based on evidence-based medicine
- Oriented toward optimal insurance services
For policyholders, the presence of a Medical Advisory Board is expected to bring positive outcomes such as fairer medical decisions, more transparent claims processes, and improved quality of healthcare services.
What Are the Positive Impacts of POJK 36/2025 for Insurance Companies?
Implementing a Medical Advisory Board provides direct benefits to insurance companies, including:
#1 Improved service quality and policyholder experience
Consistent medical decisions help reduce disputes, complaints, and case escalations.
#2 Healthier medical cost control
The MAB evaluates medical procedures from a clinical perspective, not just administrative, helping to reduce inappropriate claims without compromising service quality.
#3 Increased trust from providers and regulators
Decisions supported by the MAB enhance the company’s credibility in the eyes of hospitals and regulators.
#4 Stronger positioning as a responsible insurer
Compliance with POJK 36/2025 becomes part of brand positioning, not just a regulatory obligation.
Challenges in Implementing MAB in Practice
Despite its clear benefits, building and operating an effective MAB is not easy. Many insurance companies face challenges such as:
- Limited internal medical resources
- Increased operational burden when managed manually
- The need for medical insights across various cases and trends
Without adequate systems and experience, an internal MAB risks delivering minimal impact.
Strategic Collaboration with an Experienced TPA to Comply with POJK 36/2025
This is where collaboration with an experienced Third Party Administrator (TPA) becomes both important and strategic. TPAs act as enablers for the Medical Advisory Board by providing the infrastructure, data, and processes needed to ensure medical functions run effectively.
As an experienced TPA, we take a proactive approach in supporting insurance companies in implementing Medical Advisory Boards in line with POJK 36/2025. This support includes the involvement of medical professionals across various fields, such as surgery, cardiology, endocrinology, pediatrics, neurology, and other healthcare disciplines.
Global Excel Indonesia, as part of the Canada-based Global Excel Management group, brings over 25 years of international experience, global infrastructure, and expertise to support insurance companies in:
- Providing structured claims and medical utilization data for MAB needs
- Supporting clinical analysis backed by experienced medical professionals
- Ensuring claims processes and medical recommendations align with POJK 36/2025
- Improving service consistency without compromising efficiency
This collaboration allows the Medical Advisory Board to focus on strategic decision-making without being burdened by administrative processes. Partnering with Global Excel Indonesia is a strategic step, especially as the company has established direct agreements with various partners across multiple countries, supporting global standards in service delivery and medical governance. Learn more about direct agreements here.
Service Quality Cannot Wait
POJK 36/2025 is a strategic opportunity. With a well-functioning Medical Advisory Board and the support of an experienced TPA like Global Excel Indonesia, insurance companies can enhance policyholder service quality while strengthening their reputation as compliant, responsible, and future-ready organizations in the health insurance industry. Contact us at +62 21 5084 5400 or email sales@globalexcel.co.id for a consultation regarding MAB services to support compliance with POJK 36/2025.
Disclaimer:
Implementation approaches, including the use of a Medical Advisory Board, are subject to policies and regulations set by OJK. POJK 36/2025 requires insurance companies to ensure the presence of a Medical Advisory Board and adequate governance in the provision of health insurance products.
Reference:
https://www.ojk.go.id/id/regulasi/Pages/POJK-36-Tahun-2025-Penguatan-Ekosistem-Asuransi-Kesehatan.aspx
