Karunya Health Insurance Scheme 2024: Check Eligibility, Benefits, Application Process

With advancements in medical technology, healthcare costs in India are on the rise, including expenses related to infrastructure, facilities, hospitalization, and pharmaceuticals. Unfortunately, many citizens are still unable to access basic healthcare services. To address this issue, the Indian government has launched various health insurance schemes aimed at supporting the economically disadvantaged. State governments are also stepping in to implement healthcare initiatives for the poor. 

One such initiative is Kerala’s Karunya Arogya Suraksha Padhathi. This essay will explore the details of the government-backed Karunya Health Insurance Scheme, highlighting its benefits. Furthermore, we will delve into the eligibility criteria, required documentation, and the application process for enrolling in the program.

Karunya Health Insurance Scheme 2024

The Karunya Health Insurance Scheme, initiated by the Kerala State Government, aims to provide affordable healthcare to economically disadvantaged individuals, ensuring access to quality medical treatment through a nominal monthly subscription. This critical illness policy is designed to assist financially vulnerable sections of society, helping them cover medical expenses. The scheme is primarily funded by the Kerala Lottery, with timely payments made to reimburse the network hospitals.

Comparable to the Ayushman Bharat Yojana, the Karunya Health Insurance Scheme covers more than 42 lakh underprivileged households in Kerala, offering up to Rs. 5 lakhs in medical coverage per family each year. This health insurance plan is available at both government and private hospitals across the state.

Under the Karunya Swasthya Yojana, the Kerala government offers health insurance coverage worth Rs. 5 lakh to eligible individuals. Beneficiaries can access treatment for a range of major illnesses, including cancer, hemophilia, kidney diseases, and heart conditions, at hospitals listed under the scheme. Each beneficiary family receives a unique identification card, and up to five family members can be included in the coverage. The head of the household is issued a single card for the family.

Detailed information regarding the Karunya Swasthya Yojana, including the application process, claim forms, and a list of participating hospitals, is available on the official Kerala government website, www.karunya.kerala.gov.in.

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Karunya Arogya Suraksha Padhathi Details in Highlights 

Karunya Health Scheme 2025 Objectives

The primary objective of the Karunya Health Scheme is to offer medical insurance coverage to the low-income citizens of Kerala, particularly those already facing life-threatening health conditions. The scheme aims to provide financial assistance for healthcare needs, ensuring that individuals from economically disadvantaged backgrounds can access quality medical treatment. Under this program, each registered household is eligible for a medical coverage of up to Rs. 5 lakh annually. This amount is intended to cover hospitalization expenses in secondary and tertiary care facilities, offering a significant financial safety net for those in need.

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Karunya Arogya Suraksha Padhathi (KASP)

Karunya Arogya Suraksha Padhathi (KASP) is a healthcare initiative designed to provide a health coverage of Rs. 5 lakh per family per year for secondary and tertiary care hospitalization. The scheme targets over 42 lakh vulnerable families (approximately 64 lakh beneficiaries) from the bottom 40% of Kerala's population. It consolidates several existing government-sponsored health programs such as the Rashtriya Swasthya Bima Yojana (RSBY), Comprehensive Health Insurance Scheme (CHIS), Senior Citizen Health Insurance Scheme (SCHIS), and Karunya Benevolent Fund (KBF), along with the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY). The aim is to create a unified healthcare program under KASP to ensure broader coverage for the population.

PMJAY, the largest healthcare scheme in the world, provides Rs. 5 lakh per family per year for secondary and tertiary hospitalization to over 10.74 crore vulnerable families (approximately 50 crore beneficiaries) across India. The beneficiaries are selected based on the deprivation and occupational criteria from the Socio-Economic Caste Census (SECC) 2011 for both rural and urban areas. Initially launched as the National Health Protection Scheme (NHPS) in 2018, PMJAY replaced the previous RSBY and now covers families from the SECC 2011 database, including those previously covered by RSBY.

In Kerala, the implementation of PMJAY was formalized in October 2018, with an agreement between the state government and the National Health Authority (NHA). The healthcare scheme is now managed under the newly established State Health Agency (SHA) as Karunya Arogya Suraksha Padhathi. As of 1st July 2020, the scheme is directly administered by the Kerala government under a trust model. A Third-Party Administrator (TPA), Heritage Health Insurance Pvt. Ltd., was selected to process the claims from empaneled healthcare providers.

Karunya Health Insurance Scheme Benefits 

The Karunya Health Insurance Scheme in Kerala provides critical illness coverage, particularly aimed at individuals with chronic conditions. It covers various serious ailments such as cancer, hemophilia, palliative care, cardiovascular diseases, and kidney-related issues.

The scheme offers up to Rs. 2 lakh for treatment of these conditions. For more severe cases, the maximum benefit is extended to Rs. 3 lakh. In instances where medical expenses exceed the estimated amount, the scheme ensures reimbursement.

The Kerala government has allocated a budget of Rs. 250 crore for this health insurance initiative. Initially, the scheme covered treatment only at government hospitals, but over time, it has expanded to include private hospitals as well.

The comprehensive coverage includes expenses for exams, consultations, and treatments, as well as pre-hospitalization, medications, intensive and non-intensive care, diagnostics, and accommodation. It also covers any complications arising during treatment, and offers up to 15 days of follow-up care after hospitalization.

One key feature of the scheme is its family coverage, with benefits up to Rs. 5 lakh, which can be used by any family member under the policy.

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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 empaneled 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)

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 empaneled hospitals for availing cashless treatment
• Significant increase in number of health care providers under KBF scheme.
• Number of treatment packages also increase

Karunya Arogya Suraksha Padhathi Eligibility 

The eligibility criteria for the Karunya Arogya Suraksha Padhathi are as follows:

• Citizenship: The applicant must be a resident of Kerala.
• Income Criteria: Only those from Below Poverty Line (BPL) and Above Poverty Line (APL) households with an annual income of less than Rs. 3 lakhs are eligible for this scheme.
• Required Documents: Applicants must have an Aadhaar card, income certificate, and any other relevant documents to apply for the program.

These criteria ensure that the scheme benefits those who need financial assistance for healthcare, particularly low-income families.

Karunya Health Insurance Scheme Documents

To apply for the Karunya Health Insurance Scheme, applicants need to provide the following documents:

• Identity Proof: A valid Aadhaar Card, Voter ID, or other government-issued identity documents to verify residency in Kerala.
• Residential Proof: Original documents verifying the applicant’s residence in Kerala.
• BPL Card: Proof of being Below Poverty Line (BPL), as the scheme is designed for low-income individuals.
• Income Certificate: A document indicating the annual income, which determines eligibility for the scheme.
• Additional Documents: A copy of the ration card, a recent passport-size photograph, and an estimate of medical expenses.
• Contact Details: Mobile number and other relevant contact information for communication.

These documents help ensure that the applicant meets the eligibility criteria and can avail of the benefits offered by the scheme.

Karunya Health Insurance Scheme Application Procedure

The application procedure for the Karunya Health Insurance Scheme is as follows:

• Visit the Official Website: Go to the Government of Kerala’s official website at http://karunya.kerala.gov.in.
• Navigate to "How to Apply" Section: On the website, locate the section labeled "How to Apply."
• Download the Application Form: Click on the link provided, which will allow you to download the application form in PDF format.
• Complete the Application: Fill out the application form with accurate and complete details.
• Submit the Form: After completing the form, submit it along with the required documents to the designated government agency or office.

By following these steps, you can successfully apply for the Karunya Health Insurance Scheme.

Karunya Health Insurance Hospital List Check @ https://sha.kerala.gov.in/list-of-empanelled-hospitals/

To check the list of empaneled hospitals under the Karunya Health Insurance scheme, you can visit the official website of the State Health Agency (SHA) Kerala. The direct link to access the list is:

Karunya Health Insurance Hospital List - https://sha.kerala.gov.in/list-of-empanelled-hospitals/

Once you open the link, you will find a list of all the hospitals that are empaneled under the Karunya Arogya Suraksha Padhathi (KASP) and eligible to provide healthcare services under the scheme. You can also search for hospitals by district or specialty depending on the available options on the website.

Karunya Health Scheme Login At https://sha.kerala.gov.in/

To log in to the Karunya Health Scheme portal, follow these steps:

• Visit the Official Website: Open your web browser and go to the official website of the State Health Agency (SHA) Kerala: https://sha.kerala.gov.in/
• Locate the Login Section: On the homepage, look for the "Login" option. This is typically found at the top right corner or under the "Services" section.
• Enter Your Credentials: Click on the "Login" button, which will prompt you to enter your login credentials. You will typically need a username and password to access your account.
• Select the Role: Depending on your role (e.g., hospital administrator, beneficiary, or other stakeholders), select the appropriate login option.
• Click on Login: After entering the required details, click on the "Login" button to access your dashboard or relevant information.
• Troubleshooting: If you don't have login credentials or face any issues, look for the "Forgot Password" or "Help" options on the login page, or contact the SHA Kerala support for assistance.

This should allow you to successfully log in to the Karunya Health Scheme portal.

Karunya Health Scheme Contact Number

Karunya Health Scheme in Kerala Contact Information Helpline Number: (0471) 3230-448 / 449 Email ID: [email protected]

For Beneficiaries

State Health Agency                       

5th and 8th Floor, Artech Meenakshi Plaza,

Opp. Government Women and Child Hospital, Thycaud,

Thiruvananthapuram, 695 014.

Phone No : 0471 2960221, 4063121

Disha  : 1056(toll free)

[email protected]

For Hospitals 

If hospitals have any queries and issues Please contact your respective District Project Coordinators. - Click Hare

Summary of Karunya Health Insurance Scheme 2024

The Karunya Health Insurance Scheme 2024 is a government initiative in Kerala that provides health coverage of up to Rs. 5 lakh per family per year for secondary and tertiary care hospitalization. It targets vulnerable families from the bottom 40% of Kerala’s population. The scheme integrates several existing health insurance programs, including PMJAY, RSBY, and CHIS, offering comprehensive healthcare support. It is managed by the State Health Agency (SHA) Kerala, with Heritage Health Insurance Pvt. Ltd. as the Third-Party Administrator.