IRDAI 2024 Clause 19 Statutory Compliance
CIO Jurisdiction: Pune
Award Ref: CIO/PUN/2024
Pimpri-Chinchwad Health Insurance Claim Deduction & Cashless Discharge Scorecard
Statutory transparency metrics for network tertiary care in Pimpri-Chinchwad, 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 |
|---|---|---|---|---|---|
| Pimpri-Chinchwad Average Proportionate Cut | ₹95,000 | ₹23,500 | ₹95,000 | ₹23,500 | IRDAI Clause 19 |
| Pimpri-Chinchwad 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 Pimpri-Chinchwad 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 Pimpri-Chinchwad.
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