Organisations

KARUNYA AROGYA SURAKSHA PADHATHI (KASP) is the health care scheme which aims at providing a health cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization to over 42 Lakhs poor and vulnerable families (approximately 64 lakhs beneficiaries) that form the bottom 40% of the Kerala population”. State of Kerala 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) and Karunya Benevolent Fund-KBF (Trust model implemented through Lottery department) along with Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY) and formulated Karunya Arogya Suraksha Padhathi (KASP).

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 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. 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 will be implemented directly by Government of Kerala under trust mode (through the newly constituted State Health Agency (SHA)). The claims of Empanelled Health care Providers will be serviced by a TPA/ISA. Current TPA selected through the tender process is Heritage Health Insurance Pvt Ltd.

Key Features of KASP – PMJAY

• Health care scheme 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.

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 INR30,000 to INR3,00,000 per family across various States which created a fragmented system. KASP – PMJAY provides cashless cover of up to INR5,00,000 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
• Pre-hospitalization
• 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

The benefits of INR 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) 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. 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 empanelled 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
• Comparison between Old KBF (Taxes) and revamped KASP-KBF (H&FWD)

AROGYAKIRANAM Scheme, a state-run health benefit program, caters to the healthcare needs of children aged 1 to 18 years across government hospitals in Kerala. All disease conditions, except the 30 diseases covered under the Rashtriya Bal Swasthya Karyakram (RBSK), are included under the Arogyakiranam Scheme. Beneficiaries are entitled to both OPD and IPD treatments from government healthcare institutions, ranging from primary to tertiary care facilities.

Children below the age of one year will continue to receive healthcare benefits under the Janani Sishu Suraksha Karyakram (JSSK), which is implemented in the State under the National Health Mission (NHM).

The scheme was initially implemented by the National Health Mission and, in 2022, its implementation was transferred to the State Health Agency (SHA) vide G.O.(Rt)No.2619/2022/H&FWD dated 01.11.2022, which has been administering the scheme since 1st November 2022.

Through this scheme, medicines, diagnostic tests, and treatments are provided free of charge to all beneficiaries at government hospitals, irrespective of APL/BPL status. Services not available within government hospitals may also be availed free of cost from institutions empanelled with these hospitals.

Children from the specified age group, excluding those from families of Central/State Government employees and income tax payees, are eligible to receive benefits under the scheme. However, if a family is eligible under the AB PM-JAY/KASP scheme, priority will be given to availing benefits under the KASP scheme.

Treatment costs exceeding ₹2 lakh are classified as high-cost treatments. Such cases require prior approval from a government-constituted Technical Committee before being undertaken by hospitals. Vide G.O.(Rt)No.3356/2023/H&FWD dated 20-12-2023, Technical Committees are established in every district, in addition to the State-Level Technical Committee (SLTC), to conduct the initial review of these applications. The committees are responsible for the scrutiny of the applications received under the scheme and provide necessary guidance for the scheme implementation. The technical committees at two tiers are composed of the following members. 

• District Level Technical Committee (DLTC)

• State Level Technical Committee (SLTC) 

Beneficiaries may submit applications to any of the following district officials: District Medical Officer (Health), District Programme Manager (NHM), or District Project Coordinator (SHA). Feedback will be issued to applicants once verification is completed.

For availing routine benefits under the scheme, beneficiaries may approach the KASP KIOSKs/Hospital Authorities at empanelled hospitals, with necessary documents such as the Ration Card, Aadhaar Card, etc., at the time of treatment. 

(For more details, contact DISHA toll-free numbers – 1056/104) 

SRUTHITHARANGAM is a state government scheme that provides free cochlear implantation surgery and follow-up assistance, including ‘Surgical assistance for Cochlear Implantation’, ‘Auditory Verbal Habilitation Therapies (AVHT)’, ‘Maintenance of Spares and Accessories’, and ‘speech processor upgrades.’ The scheme began in 2012 under the Social Justice Department and was initially implemented by the Kerala Social Security Mission (KSSM). Later, as part of converging various publicly funded health financing programmes, the Government of Kerala has decided to implement the scheme by the State Health Agency, Kerala, from the year 2023-24.

The benefits of the scheme are applicable to resident beneficiaries of the State, excluding those belonging to families of Central/State Government employees and income tax payees. The age-specific eligibility criteria for different categories of assistance under the scheme are as follows:

Cochlear Implantation Surgery: Preferably within 3 years of the beneficiary. However, special approval from the Technical Committee may extend eligibility up to 5 years.

Cases of profound hearing loss due to post-meningitis injury will be considered without age restrictions, and post-lingual profound hearing loss cases above 5 years up to a specific age will also be considered, subject to the technical committee decision. 

Speech Processor Upgrade: Eligible up to 25 years of age.

Maintenance of Spares & Accessories of the Processor: Eligible up to 25 years of age. 

Maintenance and processor upgrade benefits under the scheme are extended to implantees who have undergone surgery through schemes other than Sruthitharangam, or through self-funding, crowd-funding, etc., subject to the eligibility criteria mentioned above.

The maintenance assistance under the scheme is provided every year with the financial support of concerned LSGIs (₹50,000/beneficiary/FY). For this, vide Government Circular നം. ഡിഎ1/284/284/2023-തസ്വഭവ dated. 09-11-2023, the concerned LSGI is required to provide the said amount to the concerned bank account of the State Health Agency. 

A State Level Technical Committee (SLTC) constituted vide GO (Rt). No.1530/2023/H&FWD Dated 27.06.2023 for the implementation of Sruthitharangam Scheme is responsible for the scrutiny of the applications received under the scheme and provides necessary guidance for the scheme implementation. The committee convenes its meetings regularly, depending on the receipt of applications. The technical committee comprises the following members. 

Beneficiaries can submit their applications for assistance under all three categories in the prescribed format through empanelled hospitals. These applications are then reviewed by the Technical Committee. Once approved, the applications are further processed by the empaneled hospitals in a cashless mode, and the matter of the technical committee decision will be informed to the beneficiary/applicant via a letter through the post. The claim process is managed through the online portal designed for the Arogyakiranam Scheme.

A state empanelment committee constituted vide G.O. (Rt)No.1580/2024/H&FWD dated 01.07.2024, which is responsible for the technical verifications and evaluations related to the empanelment of new hospitals under the scheme. The list of empanelled hospitals under the scheme is provided below. 

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