Arogya Karnataka Scheme

Why was Arogya Karnataka needed?

For a family belonging to the Below Poverty Line category, poverty is not all they have to deal with; it is the overwhelming cost of hospitalisation. Research revealed that out-of-pocket expenditure (OOE) is one of the major contributors to poverty in Karnataka. A World Bank study found that before AB-ArK, mortality among BPL families needing hospitalisation was significantly higher, simply because families delayed or avoided treatment due to the high cost.

Karnataka had recognised this early. The problem was fragmentation, such as the multiple schemes, multiple cards, and multiple processes. Arogya Karnataka was designed to fix that. One scheme. One card. Universal coverage. Every resident of Karnataka, regardless of income, has some level of financial protection when illness strikes.

Eligibility

Arogya Karnataka divides beneficiaries into two clear categories:

Category A- Eligible Patients (BPL Households):

• Must be a permanent resident of Karnataka.
• Must belong to an "Eligible Household" as defined under the National Food Security Act (NFSA) 2013, which covers BPL families, Priority Household (PHH) ration card holders, and Antyodaya Anna Yojana (AAY) families.
• Specifically includes farmers, unorganised sector labourers, deprived households, SC/ST families, Pourakarmika (sanitation workers), and members of cooperative societies.
• Free cashless treatment up to ₹5 lakh per family per year, zero cost to the beneficiary.

Category B- General Patients (APL Households):

• Must be a permanent resident of Karnataka.
• Does not hold an NFSA eligible household card, or is not an RSBY enrolled beneficiary.
• Receives 30% subsidy on the government package rate, meaning the state pays 30% and the family pays 70%.
• Coverage capped at ₹1.5 lakh per family per year on a co-payment basis.
• Around 19 lakh APL families are covered under this category.

There is no age restriction under the scheme. Newborns, elderly citizens, and everyone in between are covered under the same family floater limit.

Registration Process

Enrollment under Arogya Karnataka is done at the point of care, which simply means that the patient registers when they first go for treatment. There is no need to pre-register or stand in a queue at a government office.

How enrollment works:

• Visit the nearest Public Health Institution (PHI).
• Carry your Aadhaar card and PDS (ration) card.
• The enrollment staff at the PHI registers you on the Arogya Karnataka Enrollment Portal.
• Your biometric impression (fingerprint) is captured and authenticated with the CIDR Aadhaar Server.
• E-KYC details are auto-populated. There is no manual filling of lengthy forms.
• If biometric authentication fails, alternatives are available, such as the OTP verification, QR code scan, or data from the Food Department database.
• A unique patient ID called the Arogya Karnataka ID (ArKID) is generated and linked to your PDS card number.
• A self-declaration consent form is signed, confirming that you are not enrolled under any other insurance scheme.
• A UHC (Universal Health Card) with your photo, name, and ArKID is issued for ₹10 (A4 format) or ₹35 (plastic card).

Once enrolled, a patient needs to register only once. The ArKID remains valid for all future visits at any empanelled hospital across Karnataka.

Enrollment can also be done at:

• KarnatakaOne centres across districts.
• Common Service Centres (CSCs).
• Empanelled private hospitals with dedicated enrollment staff.

Benefits and Coverage

This is where AB-ArK stands apart. The scheme covers primary, secondary, tertiary, and emergency care, all under one framework.

For BPL (Category A) families:

• ₹5 lakh per family per year- fully cashless, zero cost.
• Over 1,650 medical procedures across specialities, including cardiology, oncology, neurosurgery, orthopaedics, paediatrics, burns, and general surgery.
• Pre-existing diseases are covered from day one without any waiting period.
• Follow-up care, 60 procedures available for annual follow-up treatment at empanelled hospitals.
• Emergency treatment, which means patients can walk in directly to any empanelled hospital without a referral.
• Free treatment at all government PHIs for primary and secondary care.

For APL (Category B) families:

• Financial assistance of up to ₹30,000 per annum for complex secondary care (family of 5).
• This limit increases to ₹1.5 lakh per annum for tertiary care.
• An additional ₹50,000 is available for emergency tertiary care even after the annual limit is exhausted.
• APL families pay 70% of the treatment cost; the state covers 30%.

What the scheme covers across all categories:

• Cardiac surgery- bypass, valve replacement, angioplasty.
• Cancer- chemotherapy, radiation, surgery.
• Neurosurgery- stroke, brain tumour, epilepsy.
• Nephrology- dialysis, kidney transplant.
• Orthopaedics- joint replacement, spine surgery.
• Burns and trauma care.
• Paediatric procedures.
• Emergency procedures- available without referral at any empanelled hospital.

Pregnant women covered under AB-ArK for maternity hospitalisation can simultaneously access Janani Suraksha Yojana (JSY) for institutional delivery incentives and Pradhan Mantri Matru Vandana Yojana (PMMVY) for direct maternity cash support. Antenatal care also aligns with Surakshit Matritva Aashwasan Yojana (SUMAN), ensuring specialist check-ups and respectful delivery care at public health facilities.

TB patients whose hospitalisation is covered under AB-ArK can simultaneously claim nutritional support of ₹1,000 per month through Nikshay Poshan Yojana. BPL families whose treatment costs exceed the ₹5 lakh AB-ArK limit can apply for additional one-time financial assistance through Rashtriya Arogya Nidhi (RAN) up to ₹15 lakh at government super-speciality hospitals.

What is NOT covered:

• Cosmetic and elective procedures are not on the approved list.
• Treatment at non-empanelled private hospitals.
• OPD consultations that do not lead to hospitalisation.
• Conditions and procedures not listed in the approved package list.

Documents required

Documents needed at the time of enrollment:

• Aadhaar card, which is mandatory for biometric authentication.
• PDS ration card determines Category A or B entitlement.
• Self-declaration consent form, which is provided and signed at the PHI.

Card Download Process

Once enrolled and your ArKID is generated:

• Visit arogya.karnataka.gov.in and log in with your registered credentials or ArKID.
• Navigate to the card download section.
• Enter your Aadhaar number or ArKID.
• Download the AB-ArK health card in PDF format.

The card can also be physically collected at the PHI where you enrolled for ₹10 (A4) or ₹35 (plastic card). The card displays your photograph, name, ArKID, and family details and is accepted at all empanelled hospitals across Karnataka.

Claim Process

AB-ArK works on a fully cashless model for Category A (BPL) beneficiaries. There is no reimbursement route for treatment taken outside empanelled hospitals.

• Visit any empanelled hospital with your AB-ArK card and Aadhaar card.
• The hospital's Aarogya Mitra (dedicated scheme facilitator) verifies your identity and card at the help desk.
• For non-emergency conditions, the treating doctor confirms the diagnosis, and the hospital submits a pre-authorisation request online to SAST.
• Once pre-authorised, treatment begins, which is fully cashless for Category A; a co-payment applies for Category B.
• In emergency cases, patients can walk in directly to any empanelled hospital without a referral, and treatment begins immediately.
• Post-discharge, the e-health record is updated on the portal.

Families with members having Autism, Cerebral Palsy, or Multiple Disabilities can additionally explore the Niramaya Health Insurance Scheme for specialised disability coverage beyond what AB-ArK provides. Children in institutional care under Mission Vatsalya who are Karnataka residents can access AB-ArK hospitalisation benefits at empanelled hospitals. Adolescent girls supported under the Scheme for Adolescent Girls (SAG) at Anganwadi Centres can transition into AB-ArK coverage as they grow older and their families qualify.

Residents of Tamil Nadu seeking similar state-level coverage can explore CMCHIS, which provides ₹5 lakh annual cashless coverage for low-income families. Andhra Pradesh residents can look at Dr YSR Aarogyasri, and Telangana residents at Rajiv Aarogyasri, both operating on parallel models.

Helpline Details

For any issue at the hospital, during enrollment, or with the card, you can contact:

• Toll-Free Helpline: 1800-425-8330- available for scheme queries across Karnataka.
• PAN India Health Helpline: 104- for queries in the local language.
• Official Portal: arogya.karnataka.gov.in.
• Department Address: Department of Health and Family Welfare Services, Arogya Soudha, Madagi Road, Bengaluru- 560023.
• Aarogya Mitra Help Desks: Available at all empanelled hospitals and government PHIs across Karnataka.

Any hospital that denies cashless treatment or demands out-of-pocket payment from a Category A AB-ArK beneficiary must be reported on the helpline immediately.

Why Arogya Karnataka Matters

Karnataka became the first state in India to declare universal health coverage, not just for the poor, but for every resident. That is not a small thing. A scheme that reduced out-of-pocket expenditure by 64%, reduced mortality among BPL families by 64%, and increased the likelihood of hospitalisation access by 12.3%, as documented in a World Bank study, is making a measurable difference.

For a daily wage worker in Mysuru who needs bypass surgery, or a farming family in Dharwad whose child needs cancer treatment, AB-ArK means getting care without selling assets or borrowing money. The scheme is not without gaps. APL families still pay 70% of treatment costs, and awareness in some remote talukas remains limited. But as a commitment by a state government to bring every citizen under a healthcare umbrella, Arogya Karnataka is one of the most ambitious and well-documented state health programmes in India.

If you are a resident of Karnataka, visit your nearest government PHI with your Aadhaar and ration card. Enrollment happens on the spot. The card costs ₹10. And the coverage it unlocks could be worth far more than you expect.