“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 Private Empanelled Health care Providers will be serviced by a TPA/ISA. The TPA selected through tender process is Vidal Health TPA Services 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 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
• 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 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
- IT integration enhances patient friendly approaches in KBF scheme
Arogyakiranam Scheme, a state-run health entitlement scheme, caters to health care needs of 0 to 18-year-old children, in government hospitals of Kerala. Apart from the 30 diseases covered under the Rashtriya Bal Swasthya Karyakram (RBSK) scheme, all diseases (OP/IP) will be covered under the Arogyakiranam Scheme. The children below the age of one can be included under JSSK Scheme. Through this scheme, medicines, tests and treatments are available free of charge from the government hospitals to all the beneficiaries irrespective of APL / BPL and the services not available in the hospital can be availed completely free of charge from institutions empanelled with the hospital.
The Arogyakiranam scheme is being implemented by the State Health Agency from 1st November 2022 onwards.
Whenever the beneficiary approaches the hospital for treatment, the hospital can verify whether the family is covered under the ABPMJAY/KASP scheme and if the family is not covered under KASP beneficiary, they can be included under Arogyakiranam Scheme provided that the parent of the beneficiary is not a government employee or income tax payer.
A separate OP portal is used for claiming OP services covered under the scheme and the IP services are processed through ABPMJAY TMS portal.
Sruthitharangam (Cochlear Implantation Scheme) provides free cochlear implantation surgery as well as auditory verbal habilitation (AVH) for children in the age group of 0-5 years, who are hearing impaired. As part of converging various publicly funded health financing programmes, Government of Kerala has decided to implement Cochlear Implantation for Children (Sruthi Tharangam) by State Health Agency, Kerala from the year 2023-24.
The expenditure for Srutitharangam will have a cap of Rs.5,20,000/- per patient. The package rate recommended by the State Level Technical Committee (SLTC) is furnished below.
|Sl No.||Item||Unit Rate||No of Units||Total|
|3||Mapping & Programming||Rs.18,000/-||1||Rs.18,000/-|
A 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 scrutiny of the applications received under Sruthitharangam scheme and provide necessary guidance for the scheme implementation.
|1||Convenor||Joint Director (Ops), State Health Agency, Kerala|
|2||Member||State Nodal Officer, Child Health, National Health Mission, Kerala|
|3||Expert Member||HoD, Dept. of ENT, Govt. Medical College, Trivandrum|
|4||Expert Member||HoD, Dept. of ENT, Govt. Medical College, Kottayam|
|5||Expert Member||HoD, Dept. of ENT, Govt. Medical College, Kozhikkode|
|6||Expert Member||Dr. C John Panicker, Good Health ENT Centre, Thiruvananthapuram.|
|7||Expert Member||Dr. Manoj, Managing Director, Dr. Manoj’s ENT Super Specialty Institute & Research Center, Kozhikkode|
|8||Expert Member||HoD ENT, GMCH Kottayam may be renamed as Professor, Dept. of ENT, GMCH Kottayam.|
|9||Expert Member||Asst. Professor – Audiology, Govt. Medical College, Kozhikkode|
|10||Expert Member||Audiologist, National Institute of Speech and Hearing (NISH), Trivandrum|
The committee should convene its meeting once in three months or within 10 working days of receiving an application under Sruthitharangam.
The committee will be responsible for the following.
- Monitoring of the scheme implementation
- Evaluation of the application received for scheme benefits
- Take decision on the application received and inform the providers on the decision with specific remarks
- Fixing the cost of treatment packages covered under the scheme.
- Evaluate and take decisions on the applications received from hospitals for getting empaneled under the scheme and providing treatment benefits.
- Provide guidance on audit of the past claims and prevent leakages.
- Periodic monitoring of the scheme implementation
- Outcome of the treatment
- Morbidity, Mortality and One year follow-up of the treatment to be evaluated by the State Level Technical Committee of Sruthitharangam.
- The institutions who have performed the procedure should inform the details regarding the follow up of the patients up to one year to the State Level Technical Committee.
- The State Level Technical Committee will evaluate these outcome indicators up to one year and further decisions will be taken based on the report.
Treatment The treatment services to eligible beneficiaries will be provided on cashless basis through empanelled hospitals. Hospitals can raise the claim through the OPD online module of the Arogyakiranam Scheme being implemented by SHA. The claim submitted by the hospital through the online platform will be processed within 30 working days.