IRDAI 2024 Clause 19 Statutory Compliance
CIO Jurisdiction: Bhopal
Award Ref: CIO/BHO/2024
Gwalior Health Insurance Claim Deduction & Cashless Discharge Scorecard
Statutory transparency metrics for network tertiary care in Gwalior, Madhya Pradesh • Ombudsman: Bhopal
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 |
|---|---|---|---|---|---|
| Gwalior Average Proportionate Cut | ₹95,000 | ₹23,500 | ₹95,000 | ₹23,500 | IRDAI Clause 19 |
| Gwalior OT Consumables Cut | ₹21,000 | ₹12,800 | ₹21,000 | ₹12,800 | IRDAI Annexure-1 |
Verbatim IRDAI Circulars & Statutory Citations
City Ombudsman Centre — Bhopal
117, Zone-II, M.P. Nagar, Bhopal
Citation: Insurance Ombudsman Rules 2017
Frequently Asked Questions (Pan-India & Vernacular Legal Guidance)
Which hospitals in Gwalior 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 Gwalior.
Statutory Redressal Jurisdiction: Council for Insurance Ombudsmen (Bhopal)
Address: 1st Floor, 117, Zone-II, Maharana Pratap Nagar, Bhopal - 462011
States & UTs Covered: Madhya Pradesh & Chhattisgarh