IRDAI 2024 Clause 19 Statutory Compliance
CIO Jurisdiction: Jaipur
Award Ref: CIO/JAI/2024
Jaipur Health Insurance Claim Deduction & Cashless Discharge Scorecard
Statutory transparency metrics for network tertiary care in Jaipur, Rajasthan • Ombudsman: Jaipur
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 |
|---|---|---|---|---|---|
| Jaipur Average Proportionate Cut | ₹95,000 | ₹23,500 | ₹95,000 | ₹23,500 | IRDAI Clause 19 |
| Jaipur OT Consumables Cut | ₹21,000 | ₹12,800 | ₹21,000 | ₹12,800 | IRDAI Annexure-1 |
Verbatim IRDAI Circulars & Statutory Citations
City Ombudsman Centre — Jaipur
Jeevan Nidhi – II Bldg, Bhawani Singh Marg, Jaipur
Citation: Insurance Ombudsman Rules 2017
Frequently Asked Questions (Pan-India & Vernacular Legal Guidance)
Which hospitals in Jaipur 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 Jaipur.
Statutory Redressal Jurisdiction: Council for Insurance Ombudsmen (Jaipur)
Address: Jeevan Nidhi – II Bldg., Ground Floor, Bhawani Singh Marg, Jaipur - 302005
States & UTs Covered: Rajasthan