IRDAI 2024 Clause 19 Statutory Compliance
CIO Jurisdiction: Bengaluru
Award Ref: CIO/BEN/2024
Bengaluru Health Insurance Claim Deduction & Cashless Discharge Scorecard
Statutory transparency metrics for network tertiary care in Bengaluru, Karnataka • Ombudsman: Bengaluru
Total Hospital Billed
₹250,000
Arbitrary TPA Cut
₹48,500
Legally Recoverable
₹48,500
Deterministic Math Comparison: TPA Cut vs. IRDAI May 2024 Statutory Math
| Line Item / Disputed Component | Billed (₹) | TPA Cut (₹) | Statutory Approved (₹) | Recoverable Overcharge (₹) | IRDAI Statutory Reference |
|---|---|---|---|---|---|
| Bengaluru Average Proportionate Cut | ₹95,000 | ₹23,500 | ₹95,000 | ₹23,500 | IRDAI Clause 19 |
| Bengaluru OT Consumables Cut | ₹21,000 | ₹12,800 | ₹21,000 | ₹12,800 | IRDAI Annexure-1 |
Verbatim IRDAI Circulars & Statutory Citations
City Ombudsman Centre — Bengaluru
Jeevan Soudha Bldg, JP Nagar, Bengaluru
Citation: Insurance Ombudsman Rules 2017
Frequently Asked Questions (Pan-India & Vernacular Legal Guidance)
Which hospitals in Bengaluru have the lowest reported cashless deduction variance?
Hospitals that adhere strictly to IRDAI May 2024 Clause 19 and refrain from levying unbundled administrative MRD fees achieve over 88% first-pass clean settlement in Bengaluru.
Statutory Redressal Jurisdiction: Council for Insurance Ombudsmen (Bengaluru)
Address: Jeevan Soudha Building, PID No. 57-27-N-19, Ground Floor, 24th Main Road, JP Nagar, 1st Phase, Bengaluru - 560078
States & UTs Covered: Karnataka