Karunya Arogya Suraksha Padhathi (KASP) is the health care scheme in Kerala similar to Ayushman Bharat Yojana at central level. The Karunya Health Scheme aims at providing a health cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization. KASP health insurance scheme will cover more than 42 Lakhs poor and vulnerable families (approximately 64 lakhs beneficiaries) that form the bottom 40% of the Kerala population. In this article, we will tell you about the complete details of the Karunya Health Scheme.
Karunya Arogya Suraksha Padhathi (KASP) in Kerala
The state govt. of Kerala has decided to converge all the government sponsored health care schemes namely:-
- RSBY (Central and State Government combined scheme, where the premium is shared in the ratio 60:40)
- Comprehensive Health Insurance Scheme-CHIS (Kerala government fully sponsored scheme i.e. full premium paid by the State)
- Senior Citizen Health Insurance Scheme-SCHIS (all the senior beneficiaries aged 60 years and above in the RSBY/CHIS families were provided additional coverage of Rs 30,000 per beneficiary)
- Karunya Benevolent Fund-KBF (Trust model implemented through Lottery department)
- Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY)
With the convergence of all these scheme, Kerala govt. has now formulated Karunya Arogya Suraksha Padhathi (KASP).
Ayushman Bharat – PM Jan Arogya Yojana in Kerala
Ayushman Bharat PM-JAY is the largest health care scheme in the world which aims at providing a health cover of Rs. 5 lakhs per family per year. This insurance coverage is for secondary and tertiary care hospitalization to over 10.74 crores poor and vulnerable families (approximately 50 crore beneficiaries) that form the bottom 40% of the Indian population. The households included are based on the deprivation and occupational criteria of Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas respectively.
Karunya Arogya Suraksha Padhathi Launch
PM-JAY was earlier known as the National Health Protection Scheme (NHPS) before being rechristened. It subsumed the then existing Rashtriya Swasthya Bima Yojana (RSBY) which had been launched in 2008. The coverage mentioned under PM-JAY, therefore, also includes families that were covered in RSBY but are not present in the SECC 2011 database. PM-JAY is fully funded by the Government and cost of implementation is shared between the Central and State Governments. State of Kerala signed an agreement with NHA on 31st October 2018 and constituted State Health Agency (SHA) for implementing the scheme in the State as Karunya Arogya Suraksha Padhathi (KASP).
From 1st July 2020, the scheme is implemented directly by Government of Kerala under trust mode (through the newly constituted State Health Agency (SHA)). The claims of Private Empanelled Health care Providers will be serviced by a TPA/ISA. The TPA selected through tender process is HealthIndia TPA Services Pvt. Ltd.
Key Features of KASP – PMJAY
- Karunya Health Scheme is fully financed by the government.
- It provides a cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization across public and private empanelled hospitals.
- KASP – PMJAY provides cashless access to health care services for the beneficiary at the point of service, that is, the hospital.
- KASP – PMJAY envisions to help mitigate catastrophic expenditure on medical treatment.
- It covers up to 3 days of pre-hospitalization and 15 days post-hospitalization expenses such as diagnostics and medicines.
- There is no restriction on the family size, age or gender.
- All pre-existing conditions are covered from day one.
- Benefits of the scheme are portable across the country i.e. a beneficiary can visit any empanelled public or private hospital in India to avail cashless treatment.
- Services include approximately 1,573 procedures covering all the costs related to treatment, including but not limited to drugs, supplies, diagnostic services, physician’s fees, room charges, surgeon charges, OT and ICU charges etc.
- Public hospitals are reimbursed for the healthcare services at par with the private hospitals.
Benefit Cover under KASP – PMJAY
Benefit cover under various Government-funded health insurance schemes in India have always been structured on an upper ceiling limit ranging from an annual cover of Rs. 30,000 to Rs. 3,00,000 per family across various states which created a fragmented system. KASP – PMJAY provides cashless cover of up to Rs. 5,00,000 to each eligible family per annul for listed secondary and tertiary care conditions. The cover under the scheme includes all expenses incurred on the following components of the treatment.
- Medical examination, treatment and consultation
- Medicine and medical consumables
- Non-intensive and intensive care services
- Diagnostic and laboratory investigations
- Medical implantation services (where necessary)
- Accommodation benefits
- Complications arising during treatment
- Post-hospitalization follow-up care up to 15 days
Family Floater Benefits under Karunya Health Scheme
The benefits of Rs. 5,00,000 are on a family floater basis which means that it can be used by one or all members of the family. The RSBY had a family cap of five members. However, based on learning’s from those schemes, KASP PMJAY has been designed in such a way that there is no cap on family size or age of members. In addition, pre-existing diseases are covered from the very first day. This means that any eligible person suffering from any medical condition before being covered by KASP – PMJAY will now be able to get treatment for all those medical conditions as well under this scheme right from the day they are enrolled.
Karunya Benevolent Fund (KBF)
Karunya Benevolent Fund is an assurance scheme of the State Government which provides financial aid for poor people suffering from serious ailments, by raising funds through Kerala lottery. The scheme is managed by the State Lotteries Department (Taxes). Karunya Benevolent Fund is providing financial assistance to under-privileged people suffering from acute ailments like Cancer, Haemophilia, Kidney and Heart diseases and for Palliative Care. KBF Details can be checked at http://www.karunya.kerala.gov.in/
The amount for the health scheme is raised through lottery. This welfare measure is helpful to those who suffer from ailments, the cost of treatment of which are proved to be unbearable to lower and even middle strata of society with an annual family income of less than Rs. 3 lakhs.
- Eligible beneficiary can approach any KASP empaneled hospitals for availing cashless treatment
- Significant increase in number of health care providers under KBF scheme.
- Number of treatment packages also increase
- IT integration enhances patient friendly approaches in KBF scheme
KASP health insurance hospital list, eligibility, registration, status complete details here can be checked at https://sha.kerala.gov.in/karunya-arogya-suraksha-padhathi/
State Health Agency Kerala (SHA),
5th and 8th Floor, Artech Meenakshi Plaza,
Opposite Government Women And Children’s Hospital, Thycaud,
Thiruvananthapuram, 695 014
Ph. No. 0471 4063121,
Helpline Number – 0471 4063121, 1056
E-mail Id – [email protected]