IRDAI 2024 Clause 19 Statutory Compliance
CIO Jurisdiction: Pune
Award Ref: CIO/PUN/2024
Nashik Health Insurance Claim Deduction & Cashless Discharge Scorecard
Statutory transparency metrics for network tertiary care in Nashik, Maharashtra • Ombudsman: Pune
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 |
|---|---|---|---|---|---|
| Nashik Average Proportionate Cut | ₹95,000 | ₹23,500 | ₹95,000 | ₹23,500 | IRDAI Clause 19 |
| Nashik OT Consumables Cut | ₹21,000 | ₹12,800 | ₹21,000 | ₹12,800 | IRDAI Annexure-1 |
Verbatim IRDAI Circulars & Statutory Citations
City Ombudsman Centre — Pune
Jeevan Darshan Bldg, Narayan Peth, Pune
Citation: Insurance Ombudsman Rules 2017
Frequently Asked Questions (Pan-India & Vernacular Legal Guidance)
Which hospitals in Nashik 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 Nashik.
Statutory Redressal Jurisdiction: Council for Insurance Ombudsmen (Pune)
Address: 3rd Floor, Jeevan Darshan Bldg., N. C. Kelkar Road, Narayan Peth, Pune - 411030
Email: bimalokpal.pune@cioins.co.in
States & UTs Covered: Maharashtra excluding MMR