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Karunya Health Insurance Scheme: Explanation, how to apply, and benefits

Team AckoFeb 15, 2024

As per the National Multidimensional Poverty Index published by Niti Aayog, 0.71% of the population in Kerala falls below the poverty line. These families are usually unable to access quality healthcare due to the expensive treatment costs. The government has taken steps to solve this issue to an extent by providing free health insurance under the Karunya Health Insurance Scheme. This article discusses the meaning, benefits, coverages, application process, and more related to the scheme, including how it improves access to Health Insurance in Kerala.

Contents

What is Karunya Health Insurance Scheme?
Benefits of the Karunya Health Insurance Scheme
Coverages of Karunya Health Insurance
Key features of Karunya Health Insurance
How does Karunya Health Insurance work?
Eligibility criteria for Karunya Health Insurance
- Required documents
How to apply for Karunya Health Insurance Scheme online
- Contact address
The Bottom Line
Frequently asked questions

What is Karunya Health Insurance Scheme?

Karunya Health Insurance Scheme or the ‘Karunya Arogya Suraksha Padhathi’ is a Critical Illness Health Plan for underprivileged people in Kerala.

The State Lotteries Department (Taxes) oversees the functioning of this scheme, and the Karunya Benevolent Fund finances it.

This social welfare programme benefits those with illnesses whose costs are too high to manage for lower and even middle-class families (earning less than Rs. 3 lakhs per year). The premium of this scheme is very low.

Benefits of the Karunya Health Insurance Scheme

This insurance scheme enables beneficiaries with chronic illnesses to receive treatment benefits. Here are the benefits of this health insurance scheme.

1. Critical illness coverage

The Karunya Health Scheme in Kerala is a type of critical illness health insurance policy. People with chronic conditions can make use of this scheme to lower their out-of-pocket expenses. Conditions like Haemophilia, Cancer, Cardiovascular issues, palliative care, nephrology, etc., are covered.

In addition, the scheme provides coverage for procedures and treatments related to these critical illnesses, such as chemotherapy, radiotherapy, dialysis, bypass surgery, pacemaker implantation, and more. Pre and post-hospitalisation expenses are also covered for up to 30 and 60 days, respectively. This extensive coverage for critical care makes the Karunya scheme beneficial for chronically ill patients in Kerala.

2. Sum insured

The Karunya Health Insurance Scheme is a version of the Ayushman Bharat Yojana in Kerala. Each household has access to Rs. 5 lakhs annually for availing health care facilities. More than 42 lakh low-income and needy households are covered by this health insurance scheme.

This substantial sum insured provides adequate financial protection for beneficiaries against catastrophic health expenditures. The central and state government pays the entire premium for the policy to ensure that lack of funds does not prevent people with low incomes from accessing quality medical care. This coverage makes treatment possible even for complex illnesses and procedures which may cost more.

3. Wider coverage

The plan covers all of the expenditures associated with the following aspects of treatment: investigation, treatment, consultations, pre-hospitalisation services, medications, non-intensive and intensive care, diagnostic tests, hospital stay, post-hospital care, etc.

Additionally, the scheme has expanded coverage to include more medical procedures and treatments over time. The network of empanelled hospitals, too, has been widened under the Karunya scheme, with more government and private hospitals enrolled. This means beneficiaries have increased choice and access to quality care for cashless treatment across Kerala.

4. Getting your money back

If the actual treatment cost for a serious illness becomes higher than the initial approved amount, the insured person can ask to be paid back for the extra money they had to spend. This helps provide extra financial assistance when unexpected medical expenses come up. This is a crucial benefit as critical treatments often involve lengthy procedures or complications leading to inflated costs. The reimbursed amount takes care of expenses like:

Unexpected diagnostic tests
Prolonged ICU stays
Rare post-treatment medications
Any other last-minute costs

Coverages of Karunya Health Insurance

India's healthcare system is progressively getting better with the introduction of several government-backed initiatives and state-of-the-art facilities. Plans like Karunya Insurance ensure that people who have trouble finding the funds for costly healthcare procedures can receive the help they need to get the necessary treatment. Following are the coverages of the Karunya Health Insurance scheme.

Coverage for medical consultation, examination, and treatment
Coverage for pre-hospitalisation for 3 days before the first day of admission
Post-hospitalisation charges for up to 15 days after the date of discharge
Diagnostics and laboratory charges are covered
Coverage for the cost of implants
Coverage for complications that may arise at the time of hospitalisation
Coverage for non-intensive and intensive care services

Key features of Karunya Health Insurance

Here is a list of key features of the Karunya Health Insurance Scheme.

This health insurance scheme is funded by the government.
It offers Rs. 5 lakhs annual coverage per family for secondary and tertiary hospitalisation in both public and private empanelled hospitals.
The beneficiary has cashless access to medical services at the hospital.
The scheme aims to reduce potentially high medical treatment costs.
There are no limitations on the number of children in the family and age or gender of the insured members.
Insured members can claim for pre-existing diseases from day 01 of when the policy begins.
The scheme is valid throughout the nation. An insured person may visit any public or private hospital in India that has been accredited to provide cashless care.
Approximately 1,573 medical procedures are covered under the scheme. All treatment-related expenses such as medications, equipment, diagnostic services, physician fees, accommodation and board, surgical fees, OT and ICU fees, etc., are included.

How does Karunya Health Insurance work?

When this health insurance programme was first created, the policyholders could only receive their medical care from government institutions. Later, after receiving accreditation, a number of private hospitals were able to provide superior patient care because of their upgraded infrastructure and resources. This is how the health insurance programme functions. For the Karunya Health Insurance Scheme, the Kerala government has set aside Rs. 250 crores. As a result, beneficiaries can simply file claims for the price of medications, doctor visits, hospital stays, significant testing, ICU stays, surgeries, etc., without spending money out-of-pocket.

All updated information is available on the official internet portal, which may also be used to register for Karunya Health Insurance. Additionally, applicants can find network hospitals, the claiming process, and other important information here.

Eligibility criteria for Karunya Health Insurance

The following list comprises different types of eligibility criteria for enrolling under the Karunya Health Insurance scheme.

The receiver needs to live in Kerala.
Only those who fall below the poverty line can apply for this programme.
Every household Below Poverty line and Above Poverty line with an annual income under Rs. 3 lakhs are eligible for this insurance programme.
The Aadhaar card, an income certificate, and any other required documentation is needed.

Required documents

An applicant must submit these documents during the registration process for Karunya Health Insurance.

Voter ID card or Aadhaar card
Income Certificate: The Kerala Government will determine your eligibility for the program based on your yearly income. Therefore, while you are enrolling for the healthcare plan, be sure to have all the documents revealing your income information.
Address proof: You must send the original copy of your residential proof.
BPL Card: Candidates must present evidence to support their claim that they belong to the underprivileged segment of society since this programme is primarily for them. Below Poverty Line (BPL) cardholders must also submit this document when signing up for the Karunya Health Insurance Scheme's benefits online.
Ration card
A passport-sized picture

Note: This is an indicative list and the exact set of documents required to register under the Karunya Health Insurance Scheme may differ.

How to apply for Karunya Health Insurance Scheme online

Applying for any health insurance program has become more accessible with access to the internet. You can apply directly through the Kerala Government's official website.

Here are the steps to apply for the Karunya Health Insurance Scheme.

Step 1: To start your application procedure, go to http://karunya.kerala.gov.in.
Step 2: Click "How to Apply" and download the application form.
Step 3: Be sure to provide all of your information accurately and submit it with the required paperwork.

To monitor the status of your application, you may also use the "Application Tracking" option. Alternatively, you can look up your name on the home page's "List of Beneficiaries" option.

Contact address

Here is the contact address of the Karunya Health Insurance Scheme.

State Health Agency Kerala (SHA),

5th and 8th Floor, Artech Meenakshi Plaza,

Opposite Government Women And Children's Hospital

Thycaud,

Thiruvananthapuram, 695 014

Contact number: 0471 4063121

The Bottom Line

The Karunya Health Insurance Scheme represents a significant step forward in Kerala's efforts to provide accessible and affordable healthcare to its most vulnerable populations. By focusing on critical illnesses, which often come with high treatment costs, the scheme aims to lessen the financial burden on low and middle-income families, ensuring that no one is denied essential healthcare services due to lack of funds.

Frequently asked questions

Following are some common questions and answers about the Karunya Health Insurance Scheme.

How do I know if I am eligible for the Karunya Health Insurance Scheme?

Eligibility is primarily based on residency in Kerala, falling below the poverty line, or having an annual household income of less than Rs. 3 lakhs. The specific documentation required includes an Aadhaar card, income certificate, and proof of residence.

What procedures are covered under the Karunya Health Insurance Scheme?

The scheme covers approximately 1,573 medical procedures, including but not limited to surgeries, ICU stays, diagnostics, medications, and both non-intensive and intensive care services.

Can I use the Karunya Health Insurance Scheme at any hospital?

Yes, you can use the insurance at any public or private hospital in India that is empanelled with the scheme to provide cashless treatment.

How can I find empanelled hospitals under the Karunya Health Insurance Scheme?

Empanelled hospitals can be found on the official Karunya Health Insurance Scheme portal or by contacting the State Health Agency Kerala for the latest list of empanelled hospitals.

What is the process to file a complaint or grievance regarding the Karunya Health Insurance Scheme?

Grievances can be reported directly through the official portal or by contacting the State Health Agency Kerala at their provided contact numbers or address.

When will I get the Karunya Health Insurance Scheme card?

You will get the Karunya Health Insurance Scheme card after enrolment. The authorities will verify your details and issue the health card. You must carry this card while getting admission to the hospital.

Can I claim for a disease I already suffer from, under the Karunya Health Insurance Scheme?

Yes, you can claim for a disease you already suffer from (as per applicable terms) under the Karunya Health Insurance Scheme.

Is there a way to obtain the application for the Karunya Insurance Scheme offline?

No, obtaining the application for the Karunya Insurance Scheme offline is not possible. However, you can get the PDF application format from the Kerala Government webpage at http://karunya.kerala.gov.in.

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet, and is subject to changes.