IRDAI 2024 Clause 19 Statutory Compliance
CIO Jurisdiction: All 17 Centres
Award Ref: CIO/INSURER/PARAMOUNT-TPA/2024
Paramount Health Services & Insurance TPA Cashless Claim Deductions — IRDAI 2024 Statutory Audit
IRDAI Reg: TPA-002 • Average Deduction Variance: 18.4% • Average Discharge TAT: 5.1 hrs
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 |
|---|---|---|---|---|---|
| Proportionate scaling on Titanium Knee Joint / Stent | ₹100,000 | ₹25,000 | ₹100,000 | ₹25,000 | Clause 19: Fixed MRP implants protected |
| Disallowed OT sterile supplies & consumable packs | ₹20,000 | ₹12,000 | ₹20,000 | ₹12,000 | Annexure-1: Essential operative supplies |
| Discharge approval delay holding fee (>3.0 hrs) | ₹4,000 | ₹4,000 | ₹0 | ₹4,000 | Clause 6.1: Holding fees cannot be billed |
Verbatim IRDAI Circulars & Statutory Citations
IRDAI Master Circular 2024 — Clause 19 & 6.1
Paramount Health Services & Insurance TPA is statutorily bound by IRDAI Master Circular Ref: IRDAI/HLT/CIR/PRO/84/5/2024.
Citation: IRDAI Regulatory Enforcement
Frequently Asked Questions (Pan-India & Vernacular Legal Guidance)
Can Paramount Health Services & Insurance TPA deduct money from implants or pharmacy if I chose a higher room category?
No. Under IRDAI Master Circular 2024 Clause 19, Paramount Health Services & Insurance TPA can ONLY proportionately reduce associated room charges like doctor consultation. Implants, stents, medicines, and ICU fees are strictly protected.