IRDAI 2024 Clause 19 Statutory Compliance
CIO Jurisdiction: All 17 Centres
Award Ref: CIO/TPA-CODE/PPN/2024
TPA Rejection Code PPN — GIPSA Preferred Provider Network Package Overbilling
Statutory Defense under GIPSA PPN Network Agreement & IRDAI Directives • Legal Ground: PPN / Tariff Overbilling
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 PPN | ₹80,000 | ₹32,000 | ₹80,000 | ₹32,000 | GIPSA PPN Network Agreement & IRDAI Directives |
Verbatim IRDAI Circulars & Statutory Citations
Statutory Defense — GIPSA PPN Network Agreement & IRDAI Directives
Network hospitals are bound by agreed PPN tariffs and contractually prohibited from passing tariff differences to cashless policyholders.
Citation: IRDAI Master Circular dated May 29, 2024
Frequently Asked Questions (Pan-India & Vernacular Legal Guidance)
Is TPA deduction code PPN legally challengeable?
Yes. Network hospitals are bound by agreed PPN tariffs and contractually prohibited from passing tariff differences to cashless policyholders. You can serve the ReclaimBill 2-Page statutory notice to overturn this deduction immediately.