IRDAI 2024 Clause 19 Statutory Compliance
CIO Jurisdiction: New Delhi
Award Ref: CIO/NEW/2024
New Delhi Health Insurance Claim Deduction & Cashless Discharge Scorecard
Statutory transparency metrics for network tertiary care in New Delhi, Delhi-NCR • Ombudsman: New Delhi
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 |
|---|---|---|---|---|---|
| New Delhi Average Proportionate Cut | ₹95,000 | ₹23,500 | ₹95,000 | ₹23,500 | IRDAI Clause 19 |
| New Delhi OT Consumables Cut | ₹21,000 | ₹12,800 | ₹21,000 | ₹12,800 | IRDAI Annexure-1 |
Verbatim IRDAI Circulars & Statutory Citations
City Ombudsman Centre — New Delhi
2/2 A, Universal Insurance Bldg, Asaf Ali Road, New Delhi
Citation: Insurance Ombudsman Rules 2017
Frequently Asked Questions (Pan-India & Vernacular Legal Guidance)
Which hospitals in New Delhi 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 New Delhi.
Statutory Redressal Jurisdiction: Council for Insurance Ombudsmen (New Delhi)
Address: 2/2 A, Universal Insurance Building, Asaf Ali Road, New Delhi - 110002
States & UTs Covered: Delhi & parts of NCR