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FAMILY PLANNING INSURANCE SCHEME in INDIA Dr.Sujnanendra Mishra. M.D. Patnagarh
Government of India, Ministry of Health & Family Welfare “ Manual for Family Planning Insurance Scheme. December,2005 . Dr. Sujnanendra Mishra MD PRESENTLY IMPLEMENTED THROUGH  ICICI LOMBARD GENERAL INSURANCE COMPANY  since January 2008
Summary ,[object Object],Dr. Sujnanendra Mishra MD ,[object Object]
The Central Government released funds to states and Union Territories(U.T.) at the rate of Rs. 300 per tubectomy;Rs 200 per Vasectomy and Rs 20 per IUD Insertion. The staes/U.T. had the flexilibility to decide the amount of apportionment among various components, provided minimum amount of Rs.150 was paid to the acceptors of Tubectomy/Vasectomy and Rs 60 per Tubectomy,Rs 25 per Vasectomy and Rs 20 per IUD insertion was used by the medical facility towards drugs and dressings . Dr. Sujnanendra Mishra MD
[object Object],Dr. Sujnanendra Mishra MD
[object Object],[object Object],[object Object],[object Object],Dr. Sujnanendra Mishra MD
Any liability in excess of the above limit was to be born by the state/ U.T./ NGO/ Voluntary organization concerned from their own resources. ,[object Object],Dr. Sujnanendra Mishra MD
Dr. Sujnanendra Mishra MD revised rates are as follows :
[object Object],Dr. Sujnanendra Mishra MD
Sterilisation procedures and norms for bringing out uniformity with regard of  sterilisation  procedures by ,[object Object],Dr. Sujnanendra Mishra MD
[object Object],[object Object],Dr. Sujnanendra Mishra MD
4. Setting up of Quality Assurance Committee(QAC) for ensuring enforcement of pre and post  operative guidelines regarding sterilization procedures . ,[object Object],Dr. Sujnanendra Mishra MD
New Initiative: Family Planning Insurance Scheme ,[object Object],Dr. Sujnanendra Mishra MD
Government has done away with ex-gratia payment because of its complicated nature and introduced present Family Planning Insurance Scheme. ,[object Object],Dr. Sujnanendra Mishra MD
Section II .  provide indemnity cover to the doctor/ health facility performing sterilization procedures , ,[object Object],[object Object],[object Object],Dr. Sujnanendra Mishra MD
Section I  REVISED SCHEME  W.E.F.  1st JANUARY, 2008: Dr. Sujnanendra Mishra MD
Failure of Sterilization Operation ,[object Object],Dr. Sujnanendra Mishra MD
NO NEED FOR SEPARATE APPLICATION FOR INSURANCE ,[object Object],Dr. Sujnanendra Mishra MD
Section II ,[object Object],Dr. Sujnanendra Mishra MD
Liability of the Insurance Company under Section II would be limited to four cases of negligence in respect of every doctor/health facility in a year.. Dr. Sujnanendra Mishra MD
Liability of the Insurance Company under this section would be limited to four cases of negligence in respect of every doctor, beyond which the doctor/ health facility concerned would be himself/herself responsible for his/her lapse, apart from any other action that may be taken by the Government against the doctor/health facility. Dr. Sujnanendra Mishra MD
[object Object],Dr. Sujnanendra Mishra MD
Settlement of cases not covered under the Family Planning Insurance Scheme: ,[object Object],Dr. Sujnanendra Mishra MD #  operations conducted before coming into force of this insurance scheme,  # case not covered under the National Protocol, case already pending in the courts etc.
NEW APPLICATION FORM ,[object Object],Dr. Sujnanendra Mishra MD
APPLICATION FOR STERILISATION OPERATION AND INFORMED CONSENT FORM ,[object Object],Dr. Sujnanendra Mishra MD
(j) That if I/my wife gets pregnant after failure of sterilization operation and is unable to get the pregnancy aborted within two weeks, then I will not be entitled to claim any compensation over and above the compensation under Family Planning Insurance Scheme from any court of law in this regard or any compensation for upbringing the child. Dr. Sujnanendra Mishra MD
4. EXCLUSIONS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Dr. Sujnanendra Mishra MD
Exclusions under Section I ,[object Object],[object Object],[object Object],[object Object],Dr. Sujnanendra Mishra MD
xiii) Death or medical complications resulting directly or indirectly from procedures for medical termination of pregnancy or during childbirth. ,[object Object],[object Object],[object Object],[object Object],Dr. Sujnanendra Mishra MD
Vii)  Services rendered by the doctor while in the influence of intoxicants or narcotics or drugs. Dr. Sujnanendra Mishra MD
Exclusions under Section II ,[object Object],[object Object],[object Object],[object Object],[object Object],Dr. Sujnanendra Mishra MD
[object Object],[object Object],[object Object],[object Object],[object Object],Dr. Sujnanendra Mishra MD
[object Object],[object Object],[object Object],[object Object],[object Object],Dr. Sujnanendra Mishra MD
QUALITY ASSURANCE COMMITTEE ,[object Object],Dr. Sujnanendra Mishra MD
QUALITY ASSURANCE COMMITTEE  Dr. Sujnanendra Mishra MD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],Dr. Sujnanendra Mishra MD
Terms of reference of the Committee ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Dr. Sujnanendra Mishra MD
Dr. Sujnanendra Mishra MD Claim Forms: The Insurance Company will ensure that all forms required for submitting claims under the Scheme are made available with all medical facilities conducting sterilisation procedures, Office of CMOs/QACs, etc. in local language along with their English version.
[object Object],Dr. Sujnanendra Mishra MD
[object Object],[object Object],[object Object],[object Object],Dr. Sujnanendra Mishra MD
[object Object],[object Object],[object Object],Dr. Sujnanendra Mishra MD
Monthly Report: ,[object Object],Dr. Sujnanendra Mishra MD
[object Object],Dr. Sujnanendra Mishra MD
Monthly Report Form (To be submitted by District level QAC/State level QAC.) Dr. Sujnanendra Mishra MD
Monthly Report Form (To be submitted by District level QAC/State level QAC.) ,[object Object],[object Object],[object Object],[object Object],Dr. Sujnanendra Mishra MD
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Dr. Sujnanendra Mishra MD
[object Object],[object Object],[object Object],[object Object],Dr. Sujnanendra Mishra MD
[object Object],Dr. Sujnanendra Mishra MD
Shortfalls  ,[object Object],[object Object],[object Object],[object Object],[object Object],Dr. Sujnanendra Mishra MD
SECTION II ,[object Object],Dr. Sujnanendra Mishra MD
THANK YOU

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sterilisation operation insurance india

  • 1. FAMILY PLANNING INSURANCE SCHEME in INDIA Dr.Sujnanendra Mishra. M.D. Patnagarh
  • 2. Government of India, Ministry of Health & Family Welfare “ Manual for Family Planning Insurance Scheme. December,2005 . Dr. Sujnanendra Mishra MD PRESENTLY IMPLEMENTED THROUGH ICICI LOMBARD GENERAL INSURANCE COMPANY since January 2008
  • 3.
  • 4. The Central Government released funds to states and Union Territories(U.T.) at the rate of Rs. 300 per tubectomy;Rs 200 per Vasectomy and Rs 20 per IUD Insertion. The staes/U.T. had the flexilibility to decide the amount of apportionment among various components, provided minimum amount of Rs.150 was paid to the acceptors of Tubectomy/Vasectomy and Rs 60 per Tubectomy,Rs 25 per Vasectomy and Rs 20 per IUD insertion was used by the medical facility towards drugs and dressings . Dr. Sujnanendra Mishra MD
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  • 8. Dr. Sujnanendra Mishra MD revised rates are as follows :
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  • 16. Section I REVISED SCHEME W.E.F. 1st JANUARY, 2008: Dr. Sujnanendra Mishra MD
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  • 20. Liability of the Insurance Company under Section II would be limited to four cases of negligence in respect of every doctor/health facility in a year.. Dr. Sujnanendra Mishra MD
  • 21. Liability of the Insurance Company under this section would be limited to four cases of negligence in respect of every doctor, beyond which the doctor/ health facility concerned would be himself/herself responsible for his/her lapse, apart from any other action that may be taken by the Government against the doctor/health facility. Dr. Sujnanendra Mishra MD
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  • 26. (j) That if I/my wife gets pregnant after failure of sterilization operation and is unable to get the pregnancy aborted within two weeks, then I will not be entitled to claim any compensation over and above the compensation under Family Planning Insurance Scheme from any court of law in this regard or any compensation for upbringing the child. Dr. Sujnanendra Mishra MD
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  • 30. Vii) Services rendered by the doctor while in the influence of intoxicants or narcotics or drugs. Dr. Sujnanendra Mishra MD
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  • 38. Dr. Sujnanendra Mishra MD Claim Forms: The Insurance Company will ensure that all forms required for submitting claims under the Scheme are made available with all medical facilities conducting sterilisation procedures, Office of CMOs/QACs, etc. in local language along with their English version.
  • 39.
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  • 44. Monthly Report Form (To be submitted by District level QAC/State level QAC.) Dr. Sujnanendra Mishra MD
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