IRDAI 2024 Clause 19 Statutory Compliance
CIO Jurisdiction: Guwahati
Award Ref: CIO/GUW/2024
Guwahati Health Insurance Claim Deduction & Cashless Discharge Scorecard
Statutory transparency metrics for network tertiary care in Guwahati, Assam • Ombudsman: Guwahati
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 |
|---|---|---|---|---|---|
| Guwahati Average Proportionate Cut | ₹95,000 | ₹23,500 | ₹95,000 | ₹23,500 | IRDAI Clause 19 |
| Guwahati OT Consumables Cut | ₹21,000 | ₹12,800 | ₹21,000 | ₹12,800 | IRDAI Annexure-1 |
Verbatim IRDAI Circulars & Statutory Citations
City Ombudsman Centre — Guwahati
Jeevan Nivesh, S.S. Road, Guwahati
Citation: Insurance Ombudsman Rules 2017
Frequently Asked Questions (Pan-India & Vernacular Legal Guidance)
Which hospitals in Guwahati 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 Guwahati.
Statutory Redressal Jurisdiction: Council for Insurance Ombudsmen (Guwahati)
Address: Jeevan Nivesh, 5th Floor, Near Panbazar overbridge, S.S. Road, Guwahati - 781001
States & UTs Covered: Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland, Tripura