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Odisha –Aam Admi Bima Yojana (O-AABY)

Scheme and Operational Manual on

Odisha –Aam Admi Bima Yojana (O-AABY) for WSHG Members

(A joint initiative of GoI, GoO & LIC)

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Odisha Livelihoods MissionPanchayati Raj Department

Government of Odisha

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Odisha- Aam Admi Bima Yojana (O-AABY)

Aam Admi Bima Yojana’ is a social security scheme of the Central & State Governments launched on 2nd October 2007, administered by LIC of India for the benefit of poor’ households . It is a group Insurance Scheme for the age group of 18 -59 years. The members should be head of the family (bread earner) or one earning member in the family of rural poor household. The Premium to be charged under the Scheme is Rs.200/- per annum per member, of which 50% will be contributed by the Central Government and the remaining by State Government. It is ‘Zero’ cost scheme for the beneficiaries.

Odisha Aam Admi Bima Yojana (O-AABY) has been launched in Odisha by signing an MoU between National Rural Livelihoods Mission-Odisha (now Odisha Livelihoods Mission), Panchayati Raj Department, Government of Odisha and LIC of India on 19 th

December 2011. In the first phase 4,97,333 beneficiaries have been covered those who have worked 100 days under MGNREGA during the year 2010-11, 2011-12 &2012-13. In addition to that , during this financial year 2013-14, It has been decided that all household head of WSHG members under TRIPTI project will be covered under the scheme.

1. Benefits

Under the Scheme, all insured beneficiaries would be provided life and disability cover. On death and permanent disability due to accident, the family would get Rs.75,000/- In case of partial disability due to accident, the insurance cover would be Rs.37,500/-. On natural death, the family would get Rs.30,000/-. A free add-on scholarship benefit for the children of the members of O-AABY is provided under this scheme. A scholarship at the rate of Rs.100/- per month will be given to maximum two children studying between 9th to 12th Standard and ITI students. This scholarship, however, is payable half yearly.

NOTE: “Death/Total Permanent Disability due to Accident” shall mean Death/Disability occurring within 180 days of the happening of bodily injury, resulting solely and directly from accident caused by violent, external and visible means, independently of any other cause which have occurred after commencement of the Policy.

However, Death/Total permanent disability due to accident shall not include death/disability:

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Caused by intentional self-injury, suicide, or attempted suicide, insanity or immorality or whilst the member is under influence of intoxicating liquor, drug or narcotic; or

Caused by injuries resulting from riots, civil commotion, rebellion, war (whether war be declared or not), invasion, hunting, mountaineering, steeple chasing or racing of any kind; or

Resulting from member committing any breach of law.In respect of Physically Handicapped Persons the Accidental Cover would be restricted to death and disablement, excluding the existing disablement.

Permanent Total disability Benefit:

Documentary evidence of the accident as also the Medical certificate from the Assistant Civil Surgeon of Govt. Hospital certifying permanent total/partial disability due to accident, stating loss of limbs of the member covered under the scheme is to be submitted.

2. Nodal Agency

The Panchayati Raj Department will implement this scheme and Odisha Livelihoods Mission-(OLM) will function as the Nodal Agency for such scheme. Nodal Agency will Act for and on behalf of Government of Odisha and the insured member in all matters relating to the scheme. 3. Coverage/ Eligibility Criteria of beneficiaries:

The following categories of rural poor households are covered under the scheme.

Families who have membership in Women Self Help Group/Producer groups (TRIPTI/ORMAS) under TRIPTI (OLM). Non-SHG Poor and EPVG members are also eligible to cover under the scheme.

Head of the Family or an Earning Member of the eligible households aged between 18 and 59 years.

4. Role of Nodal Agencyi. The Nodal Agency shall furnish to the Corporation all the relevant

particulars of the members as are required for the administration of the scheme such as particulars of new members, death of the insured members and other particulars for verification of eligibility conditions, while settling the claims.

ii. The Nodal Agency shall furnish to the Corporation all the relevant particulars in Soft and/or hard copy as may be called for by the Corporation.

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iii. Enroll the members as per the guidelines of the scheme. iv. Make all the arrangements for the purpose of admission into the

scheme that each member shall make an application in the form prescribed in the Scheme by the Corporation and to adhere to all the specific conditions laid down in the scheme AAM ADMI BIMA YOJANA at the commencement of the scheme and at Annual Renewal Date for new entrants.

v. Arrange payment of State Government share of premium to the Corporation in respect of AAM ADMI BIMA YOJANA.

vi. Make all the arrangements to computerize the data in the software specially developed for this purpose by the Nodal Agency.

vii. Nodal agency shall also submit a summary of the claims with due authentication in the format. The Authentication to be done by an authorized official of Nodal Agency.

viii. The payment in respect of claims admitted by the Corporation will be made in favor of beneficiary/ nominee through NEFT/ECS.

ix. The claims in respect of scholarships along with required forms to be collected by Nodal Agency.

x. Nodal Agency shall submit a summary of the scholarship claims with due authentication in the format. The Authentication to be done by an authorized official of Nodal Agency.

xi. Corporation shall process the scholarship claims.xii. The Scholarship payment shall be made available to the Nodal agency

as per rules. xiii. The data on the Nodal Agency site will be accessible to both the Nodal

agency and the Corporation. Physical papers will be with the BPFTL in case of TRIPTI block .

5. Master PolicyThe Corporation shall issue a single master policy to the Nodal Agency (OLM). The individual member ID shall be issued by LIC India and that will uploaded in www.tripti.org website. All members will be provided with a certificate of insurance to be issued by LIC of India. The policy is valid for one year effective from 1st June 2014 to 31st May 2015.

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http://www.tripti.org/


6. Modalities for Implementation

The OLM has set up a different procedures at different levels for smooth implementation of the programme.

i. State Level: a. At state level the Mission Director, NRLM will the sole authority for

implementation of the scheme in the state.b. Members data to be furnished to LIC in soft copy in the prescribed format.c. State will receive information on death of the insured through block nodal

agency to facilitate required action.d. Will submit the claims within one month of death / accident/ disability with

due authentication in the format by the BPFTL of TRIPTI block /or any authorized person.

e. The summary of scholarships along with required document to be submitted to LIC once in six months i.e. in the month of June and December.

f. Shall furnish to the Corporation all the relevant particulars in Soft and/or hard copy as may be called for by the Corporation.

ii. District Level a. District Collector shall be sole authority for implementation of the scheme in

their respective district.b. The District Project Managers (DPM) in TRIPTI district shall act as

nodal/anchor persons for O-AABY in the districtc. Organizing district level sensitization cum training program for field

functionaries d. Ensuring and Monitoring of data collection in hard copy OLMe. They will also ensure data collection of scholarship forms and monitor

receipts of scholarship.f. Monitoring of the claims and redressed of grievance if any and required

follow up will be done by officers iii. Block Level

a. The Block Project Facilitation Team Leader (BPFTL) of TRIPTI project will be the nodal/anchor person for AABY scheme at Block level.

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b. Nodal person shall be responsible for facilitating collection of relevant data/ information including enrolment of new beneficiaries, scholarship applications/Death claim applications along with the claim forms from the beneficiaries and data entry into excel form prescribed by SMMU or AABY software (if provided) and submit the soft copy to SMMU through district nodal agency.

c. MIS&FMC and IBF of TRIPTI project shall be responsible for consolidation of data and capacity building of community professional for administering the scheme respectively.

d. Distribution of certificate of insurance to the families insured.e. In TRIPTI blocks the BPFTL or any authorized person is authorized to

authenticate in the claim forms of beneficiaries.f. Ensuring opening bank accounts those who have no accounts yet in

Nationalized bank or RRBs for remitting of scholarship and claims if any in futures.

g. Also monitor the receipt of scholarship amounts by the beneficiaries. iv. At Village/GPLF Level

a. CCs/CRP/MBK in TRIPTI blocks shall be engaged for collection of beneficiary related data, application form, students scholarship forms, claim forms etc.

b. Enrollment of beneficiaries /renewal of beneficiaries. c. Collection of School/College certificates in respect of the 9th to 12th

class/vocational ITI children belonging to the families insured.d. Documentation for filing claim within 15 days of the incident of death /

accident.7. Claim Settlement

A. Death/ Accidents/ Disabilities BPFTL and MIS&FMCs will facilitate for collection of claim forms along with

required documents by CC / CRP/MBK within one month of death/ accident/ disability.

Entry of these data at block level and forwarding the claim forms to the District (OLM) office within seven days of receiving claims from field.

DPM(TRIPTI) /APD Credit will verify whether the documents are proper and forward to LIC, Bhubaneswar within seven days of receiving the claims from block.

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LIC will process the claims and inform the requirement if any within seven days and balance cases will be settled within 15 days.

Claim will be credited directly to the bank account of beneficiary/ nominee through NEFT/ECS.

Claim settlement will be made at LIC of India (Pension and Group Insurance Scheme Unit),756,1st Floor, Saheed Nagar, Bhubaneswar-751007, Ph: 0674-2544040/2544240, Email ID: [email protected].

B. Scholarship Claim The CC/MBK/CRP will help the member of AAM ADMI BIMA YOJANA whose

child is eligible for scholarship and shall fill up an application form as per PROFORMA (A-I) and submit it to the Nodal Agency.

A list of beneficiary students has to be submitted to the P&GS unit for disbursement of scholarship by the Nodal Agency with full details such as, Name of the Student, School’s Name, class, Member’s Name, members’ LIC id, Master Policy no., Membership no. bank account number, Bank and branch name, IFSC code as per PROFORMA (A-II).

The scholarship will be paid once in six months i.e. in the month of January and July through the Bank account of either the students or to the member.The scholarship will be remitted directly from LIC to the accounts by electronic mode (NEFT/ ECS). Therefore all beneficiaries who is eligible to get scholarship they (either in member’s bank account or students accounts) must have a CBS account preferable in any nationalized bank or RRBs.

8. Procedures for data collection and settlement of claims

(i). Enrolment of beneficiaries

The enrollment of beneficiaries will be filled up as per prescribed formats (annexure -1)and the soft copy of the collected data will be prepared in Excel form or O-AABY software (If provided in future) by block nodal team and to be submitted to SMMU in

E-mail ID: [email protected] . The hard copy will be retained at Block office.

(ii) Collection of data for Scholarship a. The prescribed format on student scholarship in PROFORMA A-1 is to be

collected from the member with all particulars signed by insured member, duly countersigned by authorized signatory of the School/institution and nodal

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agency. The original hard copy is to be sent to SMMU/LIC of india and a photocopy will be retained at Block nodal office.

b. The PROFORMA A-II , the consolidated statement of scholarship application is to be submitted in soft copy in Excel form to SMMU/LIC of india for disbursement of schalrship

(iii)Claim settlement process (death)

Settlement of Claims

In the event of death of the Insured Member whilst being covered under the scheme, the benefits under the Assurance on his life will be paid to the Nominee (through NEFT/ECS) on receipt of claim papers along with the requirements to the satisfaction of LIC. The Corporation reserves the right to cause an investigation be made into the genuineness of any claim preferred or disbursement effected.

The settlement of Death Claims would be subject to the Nodal Agency submitting to the Corporation claim-cum-discharge form (Performa A-III ) with LIC id and copy of the Death Registration Certificate and age proof.

In accidental death benefit claim cases the following additional requirements to the satisfaction of the Corporation will have to be submitted in addition to Death Registration Certificate.

a. Copy of FIR

b. Post Mortem Report

c. Police Inquest Report (panchanama)

In case of claims due to snake bite and wild animals, following additional requirements are called for:

Medical Certificate given by Assistant Civil Surgeon Police Inquest Report (panchanama)

CLAIM SETTLEMENT PROCESS CHART

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LIC of India ,BBSR

SMMU,OLM

DMU,OLM

BMMU,OLM

Transferred of claim amount to nominees A/C through NEFT/CBS

Forwarding for claim settlement

Forwarding for claim settlement forms


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LIFE INSURANCE CORPORATION OF INDIA

CENTRAL OFFICE,MUMBAI PROFORMA A-I

Odisha -AAM ADMI BIMA YOJANA (O-AABY) POLICY NO. AABY

APPLICATION FOR SCHOLARSHIP UNDER O-AABY (SHIKSHA SAHAYOG YOJANA )

1. TO BE FILLED IN BY THE MEMBERA) NAME OF THE MEMBER UNDER ODISHA AAM ADMI BIMA YOJANA (O-AABY)-

B) SHG MEMBERSHIP NO.-C) LIC membership ID-D) ADDRESS-E) NAME OF THE STUDENT- F) WHETHER SON OR DAUGHTER-G) NAME AND PLACE OF THE SCHOOL/INSTITUTION-H) DATE OF BIRTH OF STUDENT-I) STD/CLASS: ACADEMIC YEAR: 2013-14J) MEMBER/STUDENT’S BANK ACCOUNT NO:

(CBS account is preferable for online transfer. Please attach a Xerox copy of bank passbook where bank account number must be visible clearly)

K) Bank and Branch Name :L) Bank branch code……………………………………….Bank IFSC Name………………………………………………..M) I HEREBY DECLARE THAT I AM FULLY MADE TO UNDERSTAND THAT THE SCHOLARSHIP BENEFIT UNDER SHIKSHA

SAHAYOG YOJANA IS RESTRICTED TO MAXIMUM OF TWO CHILDREN OFA FAMILY AND IS PAYABLE TO STUDENTS STUDYING IN IXTH TO XIITH (INCLUDING ITI COURSES). I HEREBY DECLARE THAT MY CHILD HAS NOT FAILED IN LAST ACADEMIC YEAR.

_________________________________

(SIGNATURE OF THE MEMBER)

2. TO BE FILLED IN BY THE SCHOOL/INSTITUTIONCERTIFIED THAT THE ABOVE PARTICULARS OF THE CHILD ARE TRUE AND CORRECT AS PER SCHOOL/INSTITUTION’S RECORDS.

______________________________________

(COUNTER SIGNED BY THE

AUTHORISED SIGNATORY OF THE

SCHOOL/INSTITUTION UNDER SEAL)

3. TO BE FILLED BY THE NODAL AGENCY

a. NAME OF THE NODAL AGENCY: NRLM-Odisha

b. DATE OF COMMENCEMENT OF THE SCHEME: 1 st June 2014

WE HEREBY UNDERTAKE TO PASS ON THE BENEFIT OF SCHOLARSHIP AVAILABEL UNDER THE SHIKSHA SAHAYOG YOJANA TO THE ABOVE NAMED BENEFICIARY

__________________________SEAL and SIGNATURE OF THE AUTHORISED NODAL OFFICER OF THE BLOCK)

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P&GS DEPARTMENT, CENTRAL OFFICE, MUMBAI PROFORMA A-II

(To be submitted in Soft copy in Excel form)

MASTER POLICY NO.-(AABY)

LIST OF STUDENTS ELIGIBLE FOR SCHOLARSHIP UNDER O-AABY SHIKSHA SAHAYOG YOJAN (TO BE SUBMITTED BY NODAL AGENCY TO P&GS UNIT)

SR NO.

NAME OF THE STUDENTS INSTITUTION’S/

SCHOOL’S NAME

CLASS IN WHICH STUDYING

DoB of student

MEMBER’S

NAME

LIC-AABY MEMBERSHIP

ID NUMBER

BANK A/C NO

BANK NAME BANK BRANCH NAME

Bank IFSC NO

For the year 2012-13

1

2

3

4

5

6

7

8

9

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DATE SEAL AND SIGNATURE OF AUTHORISED OFFICIAL OF NODAL AGENCY

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Format –1 Enrollment Data Sheet FOR SOCIAL SECURITY SCHEMES(O-AABY)

LIFE INSURANCE CORPORATION OF INDIA, P & GS UNIT, PLOT NO-756, (NEAR INDOOR HALL), SAHID NAGAR, BHUBANESWAR-751007PHONE NO-0674 2544240/2544040, FAX NO-0674 2544316.E- MAIL:[email protected]

; NAME OF THE NODAL AGENCY:

Odisha Livelihoods Mission, PR Deptt, GoO MAASTER POLICY NO-

Sl. No

Member. Id

Membe

r Nam

e

Father/

Husband Nam

e

F or H

SexM/F

Date of Birth/ Age

Date of

Joining

Caste/Language

Name of the SHG

House Street/Name

of SHG mrmbe

r

Village and GP name

Taluka/Block

District

State

Pin

Code

Identification mark. ( if any)

State Of Health

Member

Occupation

No of

Children studing in 9th-12th/ITI

Nominee's Name

Nominee relation

Nominee- DOB/age

Nominee

Occupation

BPL CARD/

RATION CAR

D NO

LIC_ID

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

1/6/2014

Good

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ANNEXURE-A-III


CENTRAL OFFICE, MUMBAI

GROUP INSURANCE SCHEME UNDER AABY

Master .Policy .NO.36000

CLAIM FORM

PART A: (To be completed by the beneficiary)

1) Name and Address of the deceased Member

2) Name and Address of Nodal Agency :

3) Membership No. :

4) Date of Entry into the Scheme :

5) Name of Father/Husband :

6) a) Date of death (b) Age at death

7) b) Place of death (b) Cause of death

8) Name of Nominee :

9) Full address of nominee :

10) Relationship with member :

11) Name and Address of Bank and Savings Bank .A/c No.:

I hereby declare that the answers to all the above questions are true in every respect.

(Signature of beneficiary)

Witness : (Signature)

Name : _____________________________ Place :

Address : _____________________________ Date :

PART B : (To be completed by the Nodal Agency)

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Certified that the replies to the above questions are correct in every respect. Nominee named above is registered in the Register of Nominations at serial no.__________________

Signature of Authorised Signatory of

SEAL the Nodal Agency/Master Policy hold

PART C

DISCHARGE RECEIPT

We_________________________________________________________hereby acknowledge receipt from Life Insurance Corporation of India a sum of Rs._______________(Rupees ___________________) in full and final satisfaction and discharge of all our claims under the above master policy on the life of member____________________________.

Dated at ________________this __________________day of _____________________20

Revenue Stamp

SEAL Signature of Authorised Official of the

Nodal Agency/Master Policy holder

PART-D

Please send the claim amount by cheque to the credit of Savings Bank A/c No.____________held by the beneficiary with ________________________________________

(Name and address of the Bank)

SEAL and Signature of Authorized Official of the

Nodal Agency/Master Policy holder

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For any further clarification the contact persons are 1. Sri Subrata Kumar Biswal, MFS, TRIPTI/NRLM cell no-94392268392. Sri Subrata Kumar Pradhan, PE-FM OLM Cell No: 94382904003. Sri Ashis Vikram , YP-MF: 90407104114. Sri AK Sahoo, Sr Div Manager , Cell No: 94374630405. Sri Sushil Ku Mohanty, Nodal office LIC (O-AABY) cell no: 9437287547Contact address : TRIPTI/ Odisha Livelihoods Mission, SIRD Campus, Unit-VIIIBhubaneswar-751012. Odisha, Tel:91-674-2560166/126,

Email ID: [email protected] Email: Website : www.tripti.org

***All the Best ***

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tel:91-674-2560166/126


Odisha Livelihoods Mission-OdishaSIRD Campus,Unit-VIII,Bhubaneswar,Odisha

Ph.:0674-2560166/126, Fax: 0674 -2563966Email ID: [email protected]/[email protected]

e-mail: www.tripti.org

LIC of India

(Pension and Group Insurance Scheme Unit),756,1st Floor, Saheed Nagar, Bhubaneswar-751007,

Ph: 0674-2544040/2544240, Email ID: [email protected].

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· web viewaam admi bima yojana’ is a social security scheme of the central & state...

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