Family Planning Indemnity Scheme (Haryana)

What is the Family Planning Indemnity Scheme in Haryana?

Family Planning Indemnity Scheme in Haryana is the compensation mechanism that pays a sterilisation acceptor, or the acceptor's nominee, when a sterilisation goes wrong; death, failure or a medical complication, and simultaneously indemnifies the doctor and the health facility that performed it. The Department of Health and Family Welfare, Haryana runs the scheme through the National Health Mission, and it is listed among the department's onboarded schemes on the Haryana State DBT portal.

The scheme exists because of a Supreme Court order. In Ramakant Rai v. Union of India, decided on 1 March 2005, the Court directed the Union and the states to maintain an approved panel of sterilisation doctors, use a uniform checklist and consent form, set up Quality Assurance Committees at state and district level, and lay down uniform compensation norms. The Government of India first met that direction through the National Family Planning Insurance Scheme from 29 November 2005. From 1 April 2013 the insurance policy was discontinued and replaced by the Family Planning Indemnity Scheme, under which the state itself processes and pays claims from NHM Programme Implementation Plan funds. The scheme has all-India coverage and applies uniformly to every state, Haryana included.

How much does the Family Planning Indemnity Scheme pay?

Section II cover also extends to the legal costs of defending a prosecuted doctor or facility in court.

Funding is allocated to states on the basis of either the average claims paid in the last three years, or an amount not exceeding Rs 50 per sterilisation acceptor, whichever is less. A state that wishes to pay more than its allocation may do so from its own budget.

Who is eligible to claim under the scheme?

A claim can be made if:

• The person underwent sterilisation at a government health facility in Haryana, or at a private or NGO facility empanelled or accredited with the District Health Authority.
• The application-cum-consent form was filled by the person before the procedure and countersigned at the medical facility. This form is the proof of coverage.
• The medical record and checklist for male or female sterilisation was duly filled by the operating doctor.
• The event, death, failure or complication; falls within the time limits set out in the table above.
• The claim is filed with the District Quality Assurance Committee within 90 days of the event.

A claim is not eligible if:

• The 90-day filing window has passed. This is the most common reason claims are refused, and it is not extendable under the scheme.
• The sterilisation was performed at a facility that is neither a government facility nor accredited by the District Health Authority.
• The consent form or checklist was never filled, so coverage cannot be established.
• A complication is claimed more than 60 days after discharge, or a death more than 30 days after discharge.
• The claim arises from a sterilisation detected and reported before 1 April 2013. Such cases fall under the expired insurance policies of 2005 to 2013 and are handled by the CMO of the district, not through the current scheme.
• The claimant is a doctor seeking a fifth Section II claim in the same year.

A person seeking only compensation for wages lost on the day of the procedure cannot apply here — that is the separate Family Planning Compensation Scheme.

What documents are needed for an indemnity claim?

How to apply for a Family Planning Indemnity claim

1. Report the event immediately to the facility where the sterilisation was done and to the Medical Officer of the nearest PHC or CHC. For a death, the facility must complete the death notification form and the death audit proforma.
2. Collect the papers. The consent form, the sterilisation certificate, the medical record and checklist, and the evidence specific to your claim type (death certificate and post-mortem report, or pregnancy report, or hospital bills).
3. Fill the claim form (Annexure-I) with the checklist at Annexure-V, and add the claimant's or nominee's Aadhaar card and bank passbook copy.
4. File the claim with the District Quality Assurance Committee through the Chief Medical Officer's office in the district where the sterilisation was performed. Do this within 90 days of the event and take a dated acknowledgement.
5. Attend the DQAC examination if called. The Committee, chaired by the District Collector with the CMO as convener and the District Family Welfare Officer as member secretary, examines the record and forwards it to the state.
6. Await disposal by the State Family Planning Indemnity Subcommittee, a five-member body within the State Quality Assurance Committee chaired by the NHM Mission Director, which disposes of and disburses claims to the district health society.

How to check the status of an indemnity claim

1. Quote the acknowledgement number from the CMO office and ask the District Family Welfare Officer, who is the member secretary of the DQAC, for the meeting in which the claim was placed.
2. The DQAC is required to meet at least once in three months, so a claim filed just after a meeting may take up to a quarter to be examined.
3. If the claim has been forwarded to the state, follow up with the State Family Planning Indemnity Subcommittee through the NHM Haryana office in Panchkula.
4. Once sanctioned, the amount reaches the district health society and is credited to the claimant's Aadhaar-seeded account.

Why indemnity claims get rejected

• Filed after 90 days. The single largest cause of rejection.
• Consent form missing, so coverage under Sections I-A to I-D cannot be established.
• Checklist not filled by the operating doctor, which is also a breach of the Supreme Court's directions.
• Complication claimed beyond 60 days from discharge, or a death claim beyond 30 days.
• Non-accredited private facility performed the procedure.
• Bank account not Aadhaar-seeded, causing a sanctioned payment to fail.

What the Quality Assurance Committees also do

The District and State Quality Assurance Committees are not only claim bodies. They inspect public and accredited private facilities providing family planning services, review and report every death and complication following sterilisation in the district, review conceptions arising from failed sterilisation, and publish six-monthly reports on the number of persons sterilised alongside the number of deaths and complications. Every case of a breach of the national guidelines by a doctor or organisation must be enquired into, and the doctor's name removed from the empanelled list pending the enquiry.

Help and grievance redressal

• Haryana health helpline: 104
• 104 Grievance Redressal and Health Helpline portal run by NHM Haryana
• Chief Medical Officer / Civil Surgeon's office in the district where the sterilisation was done. The entry point for every claim
• District Family Welfare Officer / RCHO, member secretary of the DQAC
• Directorate General Health Services, Swasthya Bhawan, Sector 6, Panchkula 134109

No fee is payable for filing an indemnity claim. Keep the consent form and the sterilisation certificate permanently, a failure claim can arise years after the procedure, and without those two papers the claim cannot be established.