Ayushman Bharat- Arogya Karnataka Scheme

The objective of Arogya Karnataka scheme is to extend ‘Universal Health Coverage’ to all residents in Karnataka State. Under Arogya Karnataka scheme, primary health care, specified secondary and tertiary health care benefits will be provided.

Similarly, in order to provide financial protection to poor and vulnerable families against catastrophic health expenditure and to reduce out of pocket expenditure for accessing health services due to hospitalization, Government of India has rolled out the Ayushman Bharat scheme to provide holistic care to all citizens including preventive health promotion as well as primary, secondary and tertiary care.

Since both the schemes have similar coverage, both the schemes were integrated to achieve operational efficiency. The integrated scheme is called Ayushman Bharat- Arogya Karnataka scheme.

The following existing schemes shall be converged in the Ayushman Bharat- Arogya Karnataka scheme.

• Yeshaswini Scheme;

• Vajpayee Arogyashree Scheme;

• Rajiv Arogya Bhagya Scheme;

• Rashtriya Swasthaya Bima Yojana (RSBY) including RSBY for senior citizens;

• Rashtriya Bala Swasthaya Karyakram (RBSK);

• Mukhyamantri Santwana Harish Scheme.

• Indira Suraksha Yojane

Benefits of Ayushman Bharat- Arogya Karnataka Scheme

• Financial assistance up to INR 5 lakh per annum will be provided for specified simple secondary care, complex secondary healthcare treatment, tertiary healthcare and emergency healthcare to a family that comes under the definition of "Eligible Patients". This will be on a family floater basis meaning one or more persons of the family can use the full cover of INR 5 lakh. One person can use the entire INR 5 lakh as well.

• The benefit limit for General Patient shall be 30% of Government package rates, with overall annual limit of INR 1.50 lakh per family per year on a co-payment basis.

Eligibility Criteria of Ayushman Bharat- Arogya Karnataka Scheme

Eligible Patient: A patient who is a resident of Karnataka State and belongs to “Eligible Household” as defined under the National Food Security Act, 2013; This category shall also include the beneficiaries listed in the SECC data and the enrolled members of the earlier Rashtriya Swasthya Bhima Yojana

General Patient: A patient who is a resident of Karnataka State but does not come under the definition of “Eligible Household” as defined under the National Food Security Act, 2013, or does not produce the eligible household card. The treatment cost will be on co-payment basis.

Exclusions

Universal health coverage as assured in this new scheme shall exclude the following categories of residents as they can avail healthcare through other schemes.

1. Residents covered under Employees’ State Insurance Scheme;

2. Residents covered under health assurance or health insurance schemes of their employers;

3. Residents who have taken private health insurance policies on their own;

4. Residents covered under Central Government Health Scheme of the Government of India;

5. Employees of Government of Karnataka till the amendment of the Karnataka Government Servants’ (Medical Attendance) Rules;

6. Members of Karnataka Legislature till the amendment of the Karnataka Legislature (Members Medical Attendance) Rules 1968.

Documents Required for Ayushman Bharat- Arogya Karnataka Scheme

In order to get enrolled into Ayushman Bharat - Arogya Karnataka Scheme, beneficiaries should carry Aadhar card and ration card. In case, Aadhar card is not available, ration card is mandatory to avail the scheme benefits.

Even if you have an Aadhar Card but no Ration card, You will certainly be enrolled in the scheme but you will be considered as “General Patient” and will get benefits as entitled for a General Patient under the scheme.

If you have a  Ration card but do not have an Aadhar card, You will be enrolled as a beneficiary and will get a card and will be entitled to the benefit package for an “Eligible Patient” but when you visit the empanelled private hospital after being referred from a Public Health Institute, you will mandatorily have to produce an Aadhar card, or at least an acknowledgement that you have applied for an Aadhaar card

If you do not have either of the Aadhaar or Ration cards you will not be able to enroll, but you will get treatment in the Public Health Institutions as per the norms and general practices of that public health institute.

Children below three years can get enrolled under the scheme with their parent’s/ guardian’s Aadhar card

Enrollment for Ayushman Bharat - Arogya Karnataka scheme

The following one-time enrollment process should be followed for enrolling beneficiaries in the Ayushman Bharat - Arogya Karnataka scheme at the Public Health Institute/Private Empanelled Hospital/Enrollment Centers.

• When a patient approaches a Public Health Institute for the treatment, the enrollment staff of the public health institute will be enrolling the patient on the enrollment portal developed for the Arogya Karnataka scheme.

• In order for a patient to enroll, he or she shall present an Aadhar card and a PDS card. An Aadhar card is mandatory for enrollment for all beneficiaries. A PDS card is mandatory for a patient to be enrolled as an “Eligible Patient”. If a patient does not have a PDS card, he or she will be categorized as a “General Patient” regardless of financial status.

• As a first step, the beneficiary will be asked to provide his or her Aadhar Card number and his biometric impression on a biometric device. The captured biometric data will then be used for verification. In case there is a failure in reading the bio metric impression of the beneficiary wishing to enrol, other options such as “OTP”, capturing data from the QR code and getting data from the Food Department’s database are provided.

• At the same time, the beneficiary should also produce his Ration card to the enrollment staff. The Ration card details will then be verified, via a web service, with the stored Ration card details in the Food and Civil Service Database to determine whether the beneficiary belongs to “Eligible Category” or not, as per the norms defined under the National Food Security Act 2013. Accordingly, he will be categorized as ‘Eligible Patient”. If a beneficiary is not from the “Eligible category”  or if the beneficiary does not have a Ration card, he or she will be automatically enrolled as a “General Patient”.

Ayushman Bharat - Arogya Karnataka Card (AB-ArK ID)

Under the Ayushman Bharat - Arogya Karnataka scheme the enrolment card shall be called AB-Ark Card and the unique ID generated while enrollment shall be called AB-ArK ID.

On successful enrollment in Ayushman Bharat - Arogya Karnataka Scheme, a unique identity number, AB-ArK ID, shall be generated and a health card called “Ayushman Bharat - Arogya Karnataka Card” shall be provided to the patient at the enrollment counter.

The unique AB-ArK ID will be the PDS card Number with a separator (-) and a sequential number for each member of the family that approaches a PHI for service and seeks to get enrolled

The UHC Card provided will contain Photo, Name, Unique Scheme ID and Basic Details of the Beneficiary. An SMS alert will also be sent to the Enrolled Patient to his mobile number wherever the mobile number has been shared with the registration personnel

Once the Scheme card is generated the patient can access the treatment under the “Ayushman Bharat - Arogya Karnataka” scheme.

The beneficiary will not be required to carry his Adhaar card or Ration card the next time he visits the hospital for treatment. He will be serviced based on the Ayushman Bharat - Arogya Karnataka card. In the absence of the Ayushman Bharat - Arogya Karnataka card not being produced during a subsequent visit, the OPD registration can be done by fetching the ARKID from the IT system based on Aadhaar card or Ration Card, and Aadhaar authentication.

The beneficiary has to pay an onetime fee of Rs. 10/- only for the Ayushman Bharat - Arogya Karnataka Card.

In case of loss of the health card, a duplicate card can be obtained at any public health institute or at the enrollment center on payment Rs. 20 (twenty) only on production of Aadhaar or Ration Card and on Aadhaar authentication.

Ayushman Bharat- Arogya Karnataka Scheme Hospital List

List of Hospitals that provides services under Ayushman Bharat - Arogya Karnataka scheme is provided below.

Arogya Karnataka Hospital List - Government and Private

Important Information

Annexure 2A-Simple Secondary Healthcare

Annexure 2B - Complex Secondary Healthcare Treatments

Annexure 3: Tertiary Healthcare Treatments

Annexure 4: Emergency Healthcare Treatments

Annexure 7A-Package Rates for Simple Secondary Healthcare

Annexure 7B-Package Rates for Complex Secondary Healthcare

Annexure 8: Package Rate List for Tertiary Healthcare Treatments

Annexure 9-Package Rates for Emergency Healthcare