Latest OJK Regulation: The Importance of the Medical Advisory Board for Insurance Companies
The health insurance industry is entering a new era with the issuance of Financial Services Authority Regulation (POJK) No. 36 of 2025 concerning the Strengthening of the Health Insurance Ecosystem. This regulation not only governs health insurance products but also strengthens medical capabilities, governance, healthcare cost management, and collaboration among stakeholders across the healthcare ecosystem.
For insurance companies, understanding and preparing for the implementation of POJK 36/2025 early on is a vital step toward ensuring regulatory compliance while maintaining long-term business sustainability.
Latest OJK Regulation Regarding the Medical Advisory Board
A Medical Advisory Board (MAB) is an independent panel of specialist physicians, senior medical professionals, and healthcare management experts tasked with providing objective clinical insights, evaluations, and recommendations to health insurance providers.
The MAB serves as a “medical bridge” that helps insurance companies understand the clinical context behind medical procedures, treatment complexities, and adherence to clinical pathways. With an MAB in place, decision-making processes regarding underwriting, medical treatment approvals, and claim assessments become significantly more accurate and medically sound.
Latest OJK Regulation Related to MAB (POJK 36 of 2025)
The critical role of the MAB is no longer just an internal operational preference—it has been formally mandated by Indonesia’s Financial Services Authority (OJK). Under POJK Regulation No. 36 of 2025 on Strengthening the Health Insurance Ecosystem (which comes into full effect on March 22, 2026), OJK explicitly requires companies operating health insurance lines to possess three core capabilities:
- Adequate Medical Capabilities.
- Adequate Digital Capabilities via robust information systems.
- Adequate Medical Advisory Board (MAB) capabilities.
Through this regulation, OJK encourages insurance companies to execute comprehensive utilization reviews to ensure that all healthcare services provided to policyholders align with actual medical necessity, maintain quality standards, and remain cost-efficient.
Latest OJK Regulation and Its Strategic Value for Insurance Companies
Having a Medical Advisory Board delivers several key strategic benefits for managing health insurance portfolios, including:
#1 Claim Cost Containment:
Assists in scrutinizing medical necessity and validating procedures or treatments to prevent potential over-servicing or over-charging.
#2 Clinical & Legal Risk Mitigation:
Provides independent medical opinions on complex or high-risk claims, minimizing potential disputes with healthcare facilities and policyholders.
#3 Strengthening Clinical Governance:
Helps establish internal medical guidelines and evidence-based criteria for claim approvals.
#4 Enhancing Policyholder Trust:
Ensures policyholders receive quality, proportional care that complies with established medical standards.
TPA Solutions for Implementing Medical Advisory Board Capabilities
Building, recruiting, and managing an in-house Medical Advisory Board independently poses a significant operational challenge for insurance companies. Beyond high capital investment, sourcing specialist doctors across various medical disciplines requires an extensive professional network and specialized administrative management.
Consequently, POJK 36/2025 opens doors for strategic collaboration with Third-Party Administrators (TPAs) and external MAB service providers. Partnering with a TPA enables insurance companies to immediately leverage ready-to-use MAB infrastructure and networks without incurring heavy operational overhead.
Global Excel Indonesia: Trusted TPA Partner for POJK 36/2025 Compliance
As a trusted Third-Party Administrator (TPA) in Indonesia, Global Excel Indonesia is ready to support health insurance companies in satisfying the capability standards mandated by OJK, particularly regarding the provision of Medical Advisory Board (MAB) services and cost containment strategies.
Why Choose Global Excel Indonesia?
Expert Medical Team & Panel Support: Backed by an experienced team of doctors and independent expert medical panels specialized in clinical evaluations and utilization reviews.
Integrated Digital Ecosystem: Equipped with advanced digital information systems that streamline claim data analysis, real-time utilization monitoring, and Coordination of Benefits (COB / KAPJ).
Measurable Cost Containment Solutions: Our comprehensive approach helps curb medical inflation without compromising the quality of care provided to insured members.
Regulatory Readiness (POJK 36/2025): Helps your organization make seamless operational and clinical governance adjustments ahead of the March 2026 regulatory deadline.
Do not wait until the regulatory deadline arrives. Strengthen your company’s health insurance ecosystem and clinical governance with the right TPA partner. Contact Global Excel Indonesia at +62 21 5084 5400 or email sales@globalexcel.co.id for a detailed consultation regarding Medical Advisory Board (MAB) solutions and enhancing your health insurance capabilities.
Disclaimer:
The mode of implementation, including the utilization of a Medical Advisory Board, is subject to the policies and directives established by OJK. POJK 36/2025 mandates 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