POJK 36 of 2025: What Insurance Companies Need to Know About the Medical Advisory Board
The issuance of Financial Services Authority Regulation (POJK) No. 36 of 2025 concerning the Strengthening of the Health Insurance Ecosystem marks a significant paradigm shift in health insurance management in Indonesia. This regulation reinforces that health insurance management is no longer merely about administration and claim payments; it requires robust medical governance to ensure service quality and healthcare cost sustainability.
One key provision receiving dedicated attention in POJK 36 of 2025 is the mandate for health insurance companies to possess adequate Medical Advisory Board (MAB) capabilities. With enforcement beginning on March 22, 2026, insurance companies must understand the critical role of the MAB and the operational steps required to achieve compliance.
What Is a Medical Advisory Board (MAB)?
A Medical Advisory Board (MAB) is an independent panel comprising specialist physicians, senior medical professionals, and healthcare management experts. The MAB is tasked with delivering objective clinical insights, evaluations, and recommendations to health insurance providers.
The MAB functions as a “medical bridge” helping insurers navigate the clinical context of medical procedures, treatment complexities, and adherence to established clinical pathways. With an MAB in place, decisions regarding underwriting, treatment approvals, and claim eligibility can be executed accurately and grounded in evidence-based medicine.
OJK Regulations and Provisions Related to MAB (POJK 36 of 2025)
The importance of the MAB has now been officially mandated by Indonesia’s Financial Services Authority (OJK). Under POJK Regulation No. 36 of 2025 on Strengthening the Health Insurance Ecosystem (effective 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.
Additionally, POJK 36/2025 mandates the execution of Utilization Reviews by qualified doctors and health insurance specialists to ensure healthcare services are delivered according to quality standards, medical necessity, and cost efficiency. The regulation also accelerates the integration of Coordination of Benefits (COB / KAPJ).
Collaboration with Healthcare Ecosystem Partners
POJK 36 of 2025 encourages insurance companies to strengthen their operational ecosystem through strategic partnerships with key stakeholders, including:
- Third-Party Administrators (TPAs)
- Healthcare facilities (providers)
- BPJS Kesehatan and other social security administrators
- Digital service providers
Dedicated Medical Advisory Board service providers
In essence, insurance companies are not required to build all mandatory capabilities in-house. Collaborating with strategic partners who possess the requisite experience, clinical resources, and infrastructure serves as a more cost-effective strategy to achieve regulatory compliance while enhancing overall service quality.
Global Excel Indonesia: Trusted TPA Partner for POJK 36/2025 Compliance
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 standards specifically in providing Medical Advisory Board (MAB) capabilities that positively impact claims SLA performance. Key Advantages of Global Excel Indonesia:
#1 Reliable Medical Team
Supported by a professional team of in-house doctors experienced in conducting comprehensive clinical evaluations and utilization reviews.
#2 Extensive & Integrated Global Network
Connected to over 8,000 healthcare providers worldwide and backed by robust global operational infrastructure.
#3 Advanced Digital Systems & Technology
Equipped with digital platforms that enable real-time utilization monitoring, claim data analytics, and seamless Coordination of Benefits (COB / KAPJ) integration.
#4 Measurable Cost Efficiency Solutions
Our holistic approach helps insurers mitigate medical inflation while safeguarding the quality of care provided to insured members.
Prepare Your POJK 36/2025 Compliance Strategy with Us
With POJK 36/2025 going into effect in March 2026, ensure your insurance company is equipped with the necessary MAB capabilities and medical governance required by law. Contact Global Excel Indonesia at +62 21 5084 5400 or email sales@globalexcel.co.id to consult on Medical Advisory Board (MAB) solutions and strengthen your healthcare ecosystem.
Disclaimer:
The mode of implementation, including the utilization of a Medical Advisory Board, is subject to the policies and regulatory directives set forth 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