Medical Advisory Board: Why Is It Becoming Increasingly Essential for Health Insurance Companies?
Rising healthcare costs, growing claims complexity, and increasing demands for service quality are driving health insurance companies to strengthen their medical governance. Under these conditions, decision-making can no longer rely solely on administrative and financial considerations it demands an objective, independent medical perspective.
Consequently, the presence of a Medical Advisory Board (MAB) is becoming increasingly vital to support risk management, healthcare cost containment, and service quality enhancement for policyholders.
What Is a Medical Advisory Board (MAB)?
A Medical Advisory Board (MAB) is an independent panel of experts that provides professional advice, insights, or clinical evaluations regarding medical services delivered by healthcare providers.
In health insurance operations, the MAB functions as a crucial bridge, helping insurers understand the underlying clinical context of medical procedures, treatment plans, and adherence to clinical pathways. With an MAB in place, decisions surrounding underwriting, procedure approvals, and claims evaluation can be executed objectively, rationally, and grounded in evidence-based medicine.
Medical Advisory Board as a Relevant Strategic Imperative
The critical role of the MAB has now been officially reinforced by Indonesia’s Financial Services Authority (OJK). Under POJK Regulation No. 36 of 2025 on Strengthening the Health Insurance Ecosystem (enforced as of March 22, 2026), OJK explicitly mandates that companies operating health insurance lines must possess three core capabilities:
- Adequate Medical Capabilities.
- Adequate Digital Capabilities via robust information systems.
- Adequate Medical Advisory Board (MAB) capabilities.
Furthermore, this regulation obligates insurers to conduct comprehensive utilization reviews executed by qualified doctors and health insurance specialists to maintain service quality while controlling healthcare expenditures. It also promotes the integrated implementation of Coordination of Benefits (COB).
Benefits of a Medical Advisory Board for Insurance Companies
Having an MAB delivers significant strategic benefits for the corporate governance and operational efficiency of health insurance providers:
Supporting Healthcare Service Governance:
Ensures that healthcare management policies and operational workflows incorporate relevant clinical insights aligned with evolving medical practices.
Providing an Objective Medical Perspective:
Delivers independent medical opinions on complex or high-risk claims, thereby minimizing potential disputes with policyholders and healthcare facilities.
Supporting the Utilization Review Process:
Empowers internal medical teams and physicians to evaluate healthcare service utilization efficiently and accurately.
Assisting in Healthcare Cost Containment:
Prevents potential over-servicing or over-charging through rigorous evaluation of medical necessity.
Keeping Pace with Medical Advancements:
Anticipates rapid shifts in medical technology, new treatment modalities, and adaptively updates claim approval criteria.
TPA Solutions for Delivering Medical Advisory Board Capabilities
Building and managing an in-house Medical Advisory Board requires substantial capital investment ranging from recruiting multi-disciplinary specialist physicians and providing digital infrastructure to managing ongoing clinical operations.
To address this challenge, POJK 36/2025 opens avenues for strategic collaboration with Third-Party Administrators (TPAs) and external MAB service providers. Partnering with an experienced TPA allows insurers to access ready-to-deploy medical governance and MAB functions on a plug-and-play basis. This seamlessly integrates with day-to-day operations from claim administration and provider management to utilization reviews without the burden of excessive operational overhead.
Global Excel Indonesia: Trusted TPA Partner with Unmatched Value
With over 25 years of industry experience, Global Excel Indonesia is ready to serve as a strategic partner for health insurance companies seeking to satisfy POJK 36/2025 regulatory standards and strengthen their medical governance ecosystem. Key Advantages of Global Excel Indonesia:
Professional Medical Team:
Backed by experienced in-house physicians and an independent network of medical experts skilled in conducting comprehensive clinical evaluations.
Proven B2B Track Record:
A strong history of collaborating with leading insurance providers to manage health claims operations and clinical risk.
Extensive Provider Network:
Directly connected to over 8,000 healthcare providers and supported by a robust global operational infrastructure.
Integrated Digital & Technological Systems:
Reliable digital platforms designed for real-time utilization monitoring, claim data integration, and seamless COB (KAPJ) execution.
Prepare Your POJK 36/2025 Compliance Strategy with Us
With POJK 36/2025 in effect, ensure your insurance company is fully equipped with required medical capabilities and a Medical Advisory Board. Contact Global Excel Indonesia by phone at +62 21 5084 5400 or email sales@globalexcel.co.id to consult on Medical Advisory Board (MAB) solutions and strengthen your healthcare service management.
Disclaimer:
The mode of implementation, including the utilization of a Medical Advisory Board, is subject to the policies and regulations set forth by OJK. POJK 36/2025 requires insurance companies to ensure adequate Medical Advisory Board capabilities and proper governance in managing health insurance products.
References:
https://www.ojk.go.id/id/regulasi/Pages/POJK-36-Tahun-2025-Penguatan-Ekosistem-Asuransi-Kesehatan.aspx