IRDAI 2024 Clause 19 Statutory Compliance
CIO Jurisdiction: All 17 Centres
Award Ref: CIO/TPA-CODE/NME/2024
TPA Rejection Code NME — Blanket Non-Medical Expenses Cut
Statutory Defense under IRDAI Health Insurance Circular 2024 • Legal Ground: Non-Medical Deduction
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 |
|---|---|---|---|---|---|
| Disputed line items under Code NME | ₹80,000 | ₹32,000 | ₹80,000 | ₹32,000 | IRDAI Health Insurance Circular 2024 |
Verbatim IRDAI Circulars & Statutory Citations
Statutory Defense — IRDAI Health Insurance Circular 2024
When a policyholder possesses a Consumables Protect / Non-Medical Rider, 100% of non-medical line items must be reimbursed by the insurer.
Citation: IRDAI Master Circular dated May 29, 2024
Frequently Asked Questions (Pan-India & Vernacular Legal Guidance)
Is TPA deduction code NME legally challengeable?
Yes. When a policyholder possesses a Consumables Protect / Non-Medical Rider, 100% of non-medical line items must be reimbursed by the insurer. You can serve the ReclaimBill 2-Page statutory notice to overturn this deduction immediately.