Family Planning Indemnity Scheme

What is the Family Planning Indemnity Scheme in Goa?

Family Planning Indemnity Scheme (FPIS) is a national scheme of the Family Planning Division, Ministry of Health and Family Welfare, implemented in Goa by the National Health Mission and the Directorate of Health Services, Government of Goa, through the State and District Quality Assurance Committees.

The scheme compensates a person, or the family of a person, who suffers a bad outcome after a sterilisation operation, and separately indemnifies the doctor or health facility that performed it. It replaced the National Family Planning Insurance Scheme, which had run since 25 November 2005, with effect from 1st April 2013, and it is funded through State Programme Implementation Plans rather than through an insurance policy, so no acceptor pays a premium.

The scheme exists because of a Supreme Court direction. In Ramakant Rai v. Union of India, Civil Writ Petition No. 209/2003, decided on 1 March 2005, the Court directed the Union and the states to lay down norms of compensation for persons sterilised, and to prescribe uniform standards and criteria for empanelment of doctors conducting sterilisation procedures. FPIS is the instrument that carries out those directions.

Key features

• All India coverage, applied in Goa through the state health system.
• Covers all persons undergoing sterilisation in a public health facility, and in non-government and private facilities empanelled or accredited with the District Health Authority.
• The Consent Form filled at the time of the operation, countersigned at the medical facility, is the proof of coverage.
• Claims are decentralised to state and district level.
• Doctors and facilities are covered separately under Section II for not more than 4 cases a year.
• No premium, no enrolment, and no separate registration by the acceptor.

What are the four heads of compensation?

The scheme is structured into sections, and the Ministry's published manual sets out the limits as follows:

A note on the amounts. The Ministry's Family Planning Indemnity Scheme manual of October 2013, and its second edition of 2016, both set the limits at Rs 2 lakh under Section I-A, Rs 50,000 under Section I-B, Rs 30,000 under Section I-C, actuals not exceeding Rs 25,000 under Section I-D, and up to Rs 2 lakh per claim under Section II. Scheme listings published since then show revised, higher limits, for example Rs 4,00,000 for death following sterilisation, Rs 60,000 for failure of sterilisation and Rs 50,000 towards the cost of treating complications. Because the revision order is not reproduced on the Ministry's schemes page, confirm the limit applicable to your claim with the State Nodal Officer for Family Planning in Goa or the designated district health officer before you file. The claim procedure below is unaffected by which set of figures applies.

Who is eligible and who is not eligible?

You are covered if:

• You have undergone, or are undergoing, a sterilisation operation in a public health facility in Goa.
• You have undergone sterilisation in a non-government or private facility empanelled or accredited with the District Health Authority.
• Your Consent Form was filled at the time of enrolling for the operation and countersigned at the medical facility, since that form is the proof of coverage.
• The event, death, failure or complication — occurred and you are filing within 90 days of it.

For the doctor or facility side, all doctors and health facilities of central, state and local self governments, other public sector bodies, and all non-government and private doctors and facilities empanelled or accredited with the District Health Authority and conducting such operations, are covered under Section II.

You are not eligible, or cannot claim, if:

• The sterilisation was performed at a private facility that is not empanelled or accredited with the District Health Authority.
• The claim is filed more than 90 days after the event of death, failure or complication. The manual is explicit that claims fall within the scheme only if filed with the DQAC within that window.
• The Consent Form and Sterilization Certificate cannot be produced, since these are the documents that establish coverage and the fact of the operation.
• The case relates to a sterilisation detected and reported before 1st April 2013, which is handled under the guidelines of the expired insurance policies that ran from 29 November 2005 to 31 March 2013, and not under state PIPs.
• A doctor or facility claims more than 4 cases in a year under Section II.

How to apply for Family Planning Indemnity Scheme compensation

1. Act within 90 days. The claim must be filed with the District Quality Assurance Committee (DQAC) within 90 days from the occurrence of the event of failure, death or complication. This is the single hardest condition in the scheme.
2. Obtain and complete the Claim Form cum Medical Certificate (Annexure-I) in original. It must be completed in all respects by the beneficiary and authenticated by the CMO, CDMO, CMHO, CDHMO, DMO, DHO or Joint Director designated for the purpose at district level.
3. Attach the Consent Form (Annexure-II) and the Sterilization Certificate (Annexure-IV), both duly attested by the convener of the Quality Assurance Committee or the designated district officer.
4. Add the evidence specific to your head of claim. For a death claim, the death certificate issued by the hospital, municipality or designated authority, and proof of pre and post operative procedure or the discharge certificate. For a failure claim after tubectomy, a urine test report supported by a physical examination report, AN card or USG report, or an MTP report, physical examination report, USG report, or in extreme cases a birth certificate in the case of a full term pregnancy; after vasectomy, a semen test report. Any one of these is sufficient to process a failure claim.
5. Submit through the designated hospital and doctors, so that the claim is authenticated at district level, and keep a copy of everything you file.
6. Track the processing timeline. Claims processing is decentralised at state and district level and is to be done preferably within 30 days from the date the covered cause is documented, with settlement within 15 working days in case of death and 21 days in other cases after all required documents are submitted.

Who gets paid, and how?

Under Sections I-A and I-B, the amount is paid equally in favour of the spouse and the unmarried dependent children whose names appear in the Consent Form or Claim Form. If there is no spouse, the payment is made to the unmarried dependent children. Where there is neither a surviving spouse nor unmarried dependent children, the claim is payable to the legal heir, on production of a legal heir certificate.

Where the dependent children are minors, the District Health Society issues the cheque in the name of the minor beneficiary with an endorsement that the amount is to be deposited as a fixed deposit in the minor's name until maturity, that no premature payment of the FDR is allowed, and that quarterly interest may be paid to the guardian.

Under Sections I-C and I-D, failure and complication claims are paid in the name of the beneficiary, the person who underwent the operation.

Where a Rogi Kalyan Samiti has already paid an ex-gratia amount in a death case, the State or District Health Society first reimburses that amount to the RKS of the district and pays the balance to the other eligible members of the deceased's family.

Who oversees the scheme in Goa?

Quality Assurance Committees are formed at state and district level to ensure that the Government of India's standards for female and male sterilisation are followed, pre-operative measures such as pathological tests, operational facilities such as sufficient equipment and aseptic conditions, and post-operative follow up.

The committee's duties include collecting and publishing six-monthly reports on the number of persons sterilised and the number of deaths or complications arising out of sterilisation, and it is required to meet at least once every three months. The District Quality Assurance Committee is where the beneficiary's claim is filed, and the designated district health officer is who authenticates it.

Why FPIS claims get rejected

• Filed after the 90-day window from the event.
• The facility was not empanelled or accredited with the District Health Authority.
• Consent Form missing, which is the proof of coverage under the scheme.
• Sterilization Certificate or discharge proof missing, or not attested by the designated district officer.
• No diagnostic report confirming failure, in a Section I-C claim.
• Vasectomy claim without a semen test report showing motility after three months.
• Claim Form not authenticated by the CMO, CDMO, CMHO, CDHMO, DMO, DHO or Joint Director designated at district level.
• A doctor or facility exceeding 4 cases in a year under Section II.

Where to get help

• District Quality Assurance Committee in your district, which receives and processes the claim.
• The CMO, CDMO, CMHO, CDHMO, DMO, DHO or Joint Director designated for the purpose at district level, who authenticates the Claim Form cum Medical Certificate.
• State Nodal Officer for Family Planning, Directorate of Health Services and National Health Mission, Government of Goa, the right person to confirm the current compensation limits before you file.
• nhm.goa.gov.in, the National Health Mission Goa website, which lists FPIS under its Reproductive Health components.

There is no fee to file a claim, and no agent has any role in the process. Every claim, writ and summons related to an event of failure, death or complication is to be forwarded to the district or state by the doctor or health facility under Section II, so the provider has a parallel duty to report the same event.

How to check your Family Planning Indemnity Scheme claim status

FPIS has no online tracking portal and no claim reference number system of its own, since the claim is processed entirely on paper through the District Quality Assurance Committee (DQAC). Checking status in Goa means following up directly with the office that holds your file, not logging into a website.

1. Note your filing details before you leave the district office. Keep a copy of the completed Claim Form cum Medical Certificate, the date it was submitted, and the name of the CMO, CDMO, CMHO, CDHMO, DMO, DHO or Joint Director who authenticated it. Without these, no one at the district office can locate your file quickly.
2. Track the timeline the scheme itself sets. Processing is meant to happen preferably within 30 days of the covered cause being documented, with settlement within 15 working days for a death claim and 21 days for other claims once every required document has been submitted. If these windows have passed without a response, that is the point to actively follow up rather than wait further.
3. Follow up with the District Quality Assurance Committee first, since this is the body that received and is processing the claim. Ask specifically whether the file is still awaiting a document, awaiting the committee's quarterly meeting, or has been forwarded for payment approval.
4. Escalate to the designated district health officer (the CMO, CDMO, CMHO, CDHMO, DMO, DHO or Joint Director who authenticated the form) if the DQAC does not give a clear update, since this officer is accountable for the authentication and forwarding of the claim.
5. Contact the State Nodal Officer for Family Planning at the Directorate of Health Services or National Health Mission, Government of Goa, if the district level does not resolve the query. This office also confirms which compensation amount applies to your claim, so it is worth raising both questions together.
6. Check the National Health Mission Goa website at nhm.goa.gov.in for current contact details of the Reproductive Health division and district health offices, since a dedicated FPIS helpline number is not published.
7. For a payment already sanctioned to a minor, remember the amount is deposited as a fixed deposit in the minor's name rather than paid out directly, so a status query in that case is really a query to the District Health Society about whether the FDR has been created, not about a bank transfer to the family.

There is no fee for a status check and no agent or intermediary is needed. If a private party asks for money to "expedite" a status update, that request has no basis in the scheme and should be reported to the DQAC or the State Nodal Officer.