IRDAI 2024 Clause 19 Statutory Compliance
CIO Jurisdiction: All 17 Centres
Award Ref: CIO/INDEX/2024/PAN-INDIA
Pan-India Insurer & TPA Cashless Deduction Index (2024 Statutory Benchmark)
Transparency scorecard across 17 Council for Insurance Ombudsmen Jurisdictions, 32 Health Insurers, and 18 TPAs
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 |
|---|---|---|---|---|---|
| National Average Observed Proportionate Cut | ₹100,000 | ₹22,400 | ₹100,000 | ₹22,400 | IRDAI Clause 19 |
| National Average Disallowed OT Consumables | ₹25,000 | ₹14,800 | ₹25,000 | ₹14,800 | IRDAI Annexure-1 |
| National Average Cashless Discharge TAT | ₹0 | ₹5 | ₹3 | ₹2 | IRDAI Clause 6.1 (3.0 hr limit) |
Verbatim IRDAI Circulars & Statutory Citations
IRDAI Master Circular 2024 — Clause 19 & Clause 6.1
National statutory consumer protection directive.
Citation: IRDAI/HLT/CIR/PRO/84/5/2024
Frequently Asked Questions (Pan-India & Vernacular Legal Guidance)
Which insurer has the highest reported deduction variance in India?
Public CIO awards and user calculation sessions reveal that public sector insurers and standalone health insurers report between 14.8% and 21.1% initial deduction variance before policyholders serve statutory Clause 19 notices.