IRDAI 2024 Clause 19 Statutory Compliance
CIO Jurisdiction: Chandigarh
Award Ref: CIO/CHA/2024
Gurugram Health Insurance Claim Deduction & Cashless Discharge Scorecard
Statutory transparency metrics for network tertiary care in Gurugram, Haryana • Ombudsman: Chandigarh
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 |
|---|---|---|---|---|---|
| Gurugram Average Proportionate Cut | ₹95,000 | ₹23,500 | ₹95,000 | ₹23,500 | IRDAI Clause 19 |
| Gurugram OT Consumables Cut | ₹21,000 | ₹12,800 | ₹21,000 | ₹12,800 | IRDAI Annexure-1 |
Verbatim IRDAI Circulars & Statutory Citations
City Ombudsman Centre — Chandigarh
S.C.O. 101-103, Sector 17-D, Chandigarh
Citation: Insurance Ombudsman Rules 2017
Frequently Asked Questions (Pan-India & Vernacular Legal Guidance)
Which hospitals in Gurugram 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 Gurugram.
Statutory Redressal Jurisdiction: Council for Insurance Ombudsmen (Chandigarh)
Address: S.C.O. No. 101, 102 & 103, 2nd Floor, Batra Building, Sector 17 – D, Chandigarh - 160017
States & UTs Covered: Punjab, Haryana, Himachal Pradesh, J&K, Ladakh, Chandigarh