Family Planning Indemnity Scheme (Sterilization), Mizoram

What is the Family Planning Indemnity Scheme in Mizoram?

Family Planning Indemnity Scheme is a compensation and indemnity cover attached to sterilisation operations, listed by the Health & Family Welfare Department, Government of Mizoram at position six on its schemes page as Family Planning Indemnity (Sterilization). The Department publishes three documents on its Family Planning page: the Manual for Family Planning Indemnity Scheme, the Informed Consent Form for Sterilization Operation, and the Family Planning (Sterilization) Scheme document.

The scheme is a Government of India programme of the Ministry of Health & Family Welfare, implemented through state Programme Implementation Plans under the National Health Mission and delivered in Mizoram by the Family Welfare wing of the Directorate of Health Services. It has all-India coverage, which means a Mizoram resident is covered on the same terms as anyone else in the country.

The scheme replaced an older insurance-company arrangement. Until 2013 the cover sat with an insurer; from 1 April 2013 it became part of state Programme Implementation Plans, was renamed the Family Planning Indemnity Scheme, and claim processing was decentralised to the state with cheques issued by the district health machinery. The Mizoram Health Department also carries the 2016 version of the manual.

What the scheme actually is

• It is not a scheme that pays you for having a sterilisation. That is a separate compensation for loss of wages.
• It is a safety net for the small number of cases where something goes wrong: death, failure of the procedure, or a medical complication.
• It also protects the doctor and the facility against litigation arising from those same events.
• There is no premium, no enrolment and no card. Signing the consent form is the entire act of joining.

Who is covered and who is not eligible?

You are covered if:

• You have undergone or are undergoing a sterilisation operation; tubectomy or vasectomy.
• The operation took place at a public health facility, or at a non-government or private facility that is empanelled or accredited with the District Health Authority.
• You signed the Informed Consent Form at the time of enrolling for the operation, and the facility countersigned it.

Doctors and health facilities are covered separately under Section II. This includes doctors and facilities of central, state and local self-governments and other public sector bodies, and all accredited non-government and private sector doctors and facilities rendering family planning services.

You are not eligible if:

• The sterilisation was done at a private facility that is not empanelled or accredited with the District Health Authority. Accreditation of private facilities and the eligibility and qualification of doctors performing sterilisation are decided by the state government against norms in the Government of India manual.
• No consent form was signed, since the consent form is the proof of cover.
• The event you are claiming for falls outside the defined windows. A death more than 30 days after discharge, or a complication arising more than 60 days after discharge.
• The claim is for a recanalisation or a reversal procedure rather than the sterilisation itself.

How much compensation does the scheme pay?

Section I-A cover includes death during the process of the sterilisation operation itself, and Section I-D likewise covers complications arising during the procedure.

Who gets paid what. Death claims under Sections I-A and I-B are paid equally to the spouse and the unmarried dependent children named on the consent or claim form. If there is no spouse, the unmarried dependent children take the whole amount. Where the children are minors, the District Health Society issues the cheque in the minor's name endorsed for deposit as a fixed deposit until majority, with no premature payment allowed and quarterly interest payable to the guardian. If there is no surviving spouse and no unmarried dependent children, the claim is payable to the legal heir on production of a legal heir certificate.

Claims under Section I-C for failure and Section I-D for complications are paid in the name of the beneficiary directly.

Where the district Rogi Kalyan Samiti has already paid Rs 50,000 as ex-gratia in a Section I-A case, the State or District Health Society first reimburses that amount to the RKS and pays the balance to the eligible family members.

How to apply for a Family Planning Indemnity Scheme claim

1. Report the event to the facility where the sterilisation was done. If the covered cause is detected during examination of the acceptor at a health facility, that facility is required to get the claim form filled from the beneficiary on the spot, without loss of time.
2. Fill the Claim Form cum Medical Certificate in original, completed in all respects by the beneficiary, submitted through the designated hospital and doctor. The form is at Annexure-II of the scheme manual.
3. Attach the supporting documents for your section. A death claim needs the death certificate issued by the hospital, municipality or other designated authority, plus proof of pre and post-operative procedure or the discharge certificate. A complication claim needs the original bills, cash memos, prescriptions and diagnostic reports that establish the cost.
4. Let the facility forward the papers to the designated district officer. The health facility sends the claim papers with the necessary documents to the designated officer of the district.
5. The designated district health officer authenticates and approves the claim. In Mizoram this is the officer designated at district level — the CMO, CDMO, DMO, DHO or Joint Director as the case may be.
6. Collect the cheque from the district machinery. Claim settlement and issue of cheques is done from the office of the district level machinery, preferably within 30 days of the covered cause being documented.

For complication claims the designated district officer must certify the cost of treating the complication, which is why the original bills matter so much, a photocopy or an estimate is not enough.

What a doctor or hospital does when a case goes to court

1. Inform the State or District Health Society in writing immediately on receiving any legal notice or court summons.
2. Hand over the defence. The Society thereafter takes over the entire defence process, including engaging an advocate and paying legal expenses.
3. Keep within the ceiling. The Society is not liable to pay more than the Section II amount under all heads combined, and its liability is limited to four cases of litigation per doctor or facility in a year.

In an emergent situation where the doctor or facility incurs defence costs directly, those costs are reimbursable if incurred in consultation with the State or District Health Society, limited to Rs 5,000 per incidence.

Who verifies a claim in Mizoram?

Verification and medical evaluation of a claim is done by the Quality Assurance Committee, which the state government forms for this purpose. For all practical purposes the authority sits with the designated district-level health officer. Quality Assurance Committees also carry the wider job of overseeing standards in sterilisation services, which is why the scheme manual carries a full annexure on their constitution and a set of quality assurance reporting formats.

Common reasons a claim fails, and how to avoid them

• No signed consent form on record. Without it there is no proof of coverage. Ask for and keep your own copy at the time of the operation.
• The 7-day, 30-day and 60-day windows. These are counted from the date of discharge from hospital, not from the date of the operation. Note the discharge date carefully.
• Bills submitted as photocopies. Section I-D requires original bills, cash memos, prescriptions and diagnostic reports.
• Claim form not authenticated. A form completed by the beneficiary but not authenticated by the designated district officer cannot be paid.
• Facility not accredited. A sterilisation at an unaccredited private facility falls outside the scheme entirely.
• Names missing from the consent form. Death compensation is split among the spouse and unmarried dependent children whose names appear on the consent or claim form, so those names should be entered correctly at the time of the operation.

Where to get help in Mizoram

• Directorate of Health Services, Mineco, Khatla, Aizawl to 0389-2336452. The Family Welfare wing sits here, and the Additional Director (FW) is on 0389-2335045 as listed in the Department's 2026 telephone directory.
• Health & Family Welfare Department, office of the Commissioner & Secretary to 0389-2336641.
• District health office of your district, which holds the designated officer who authenticates and settles claims.
• Scheme page and forms: health.mizoram.gov.in on the Family Planning (Sterilization) page, which carries the indemnity scheme manual and the informed consent form as downloads.

There is no fee to make a claim, and no agent is needed. The claim moves from the health facility to the district office on its own paperwork.