IRDAI 2024 Clause 19 Statutory Compliance
CIO Jurisdiction: Chennai
Award Ref: CIO/CHE/2024
Vellore Health Insurance Claim Deduction & Cashless Discharge Scorecard
Statutory transparency metrics for network tertiary care in Vellore, Tamil Nadu • Ombudsman: Chennai
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 |
|---|---|---|---|---|---|
| Vellore Average Proportionate Cut | ₹95,000 | ₹23,500 | ₹95,000 | ₹23,500 | IRDAI Clause 19 |
| Vellore OT Consumables Cut | ₹21,000 | ₹12,800 | ₹21,000 | ₹12,800 | IRDAI Annexure-1 |
Verbatim IRDAI Circulars & Statutory Citations
City Ombudsman Centre — Chennai
Fatima Akhtar Court, Anna Salai, Teynampet, Chennai
Citation: Insurance Ombudsman Rules 2017
Frequently Asked Questions (Pan-India & Vernacular Legal Guidance)
Which hospitals in Vellore 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 Vellore.
Statutory Redressal Jurisdiction: Council for Insurance Ombudsmen (Chennai)
Address: Fatima Akhtar Court, 4th Floor, 453, Anna Salai, Teynampet, Chennai - 600018
States & UTs Covered: Tamil Nadu, Puducherry