Nirman Bhawan, New Delhi
Dated 27th December, 2011
Subject: Renewal of Family Planning Insurance Scheme w.e.f 1st January, 2012-reg
The Family Planning Insurance Scheme (FPIS) was adopted as a National Policy complying with the directions of Hon’ble Supreme court to extend benefits to the acceptors of sterilization and was implemented form 29th November, 2005. This insurance policy was being serviced by ICICI Lombard General Insurance Company from 1.1.2011 to 31.12.2011 and has again been renewed with the ICICI Lombard General Insurance Company for a period from 01st January, 2012 to 31st December 2012. The coverage under the renewed Policy is as under:
|Death following Sterilization (inclusive of death during process of sterilization operation) in hospital or within 7 days from the date of discharge from the hospital||Rs. 2 lakhs|
|Death following Sterilization within 8 – 30 days from the date of discharge from the hospital.||Rs. 50,000/-|
|Failure of Sterilisation||Rs. 30,000/-|
|Cost of treatment in hospital and upto 60 days arising out of Complication following sterilization operation (inclusive of complication during process of sterilization operation) from the date of discharge.||Actual not exceeding Rs. 25,000/-.|
|Indemnity Insurance per Doctor/facility but not more than 4 cases in a year.||Upto Rs. 2 Lakh per claim|
Total liability of the Insurance Company shall not exceed Rs. 25 crore in a year under Section-I and Rs. 1.00 crore under Section-II.
2. The covered incidences detected in respect of sterilization done w.e.f. 1st January, 2012 shall be filed with State Coordinator of the ICICI Lombard General Insurance Company under renewed Policy- 2012.
3. All claims under the expired Policy – 2011 for covered incidences detected during the period 1st Jan, 2011 to 31st December, 2011 have to be filed with the State Coordinator of the ICICI Lombard General Insurance Company. If not already done, the concerned District Officers may be instructed to file the claims within 90 days of the detection of the incidence under expired Policy-2011. For claims filed under the expired Policy-2011 after 31st March, 2012 and refused by the ICICI Lombard General Insurance Company on this count, the respective CMO /CDMO / CDHMO / DMO / DHO / Joint Director designated for this purpose at the district level shall be held responsible, as there is no provision under Government budget or under the new policy for settlement of such claims. Any court case due to non-filing of claims after 31st March, 2012 would also be the responsibility of the designated district officials.
4. Further, to create awareness for the Scheme, it has also been decided to create awareness through wall painting across the country in all districts and Sub-Division Hospitals. Design as approved by the Ministry, would be got painted by the State in the local language of the state. The funds under IEC in NRHM may be used for this as was done in the preceding year 2011
5. As per directions of Hon’ble Supreme Court, the information regarding number of sterilization done and claims respect of failure, complication and deaths needs to complied on quarterly basis at District and State level. Accordingly, I would request you to kindly instruct the State Nodal Officer for this Scheme to provide above information in the prescribed proforma by 15th of the month for each quarter to this Ministry.
6. Family Planning Insurance Manual-2012 is updated and shall be hosted shortly on the website of this Ministry at mohfw.nic.in under Family Welfare Activities.
7. For proper co-ordination & monitoring of this scheme in your State, a Senior Officer from the Directorate of Family Welfare may be appointed to liaison with Insurer and District officials. The contact details of the State Nodal Officer may be furnished to us at the earliest.