Ayushman Bharat PM-JAY Karnataka

How PM-JAY works in Karnataka

The AB-Arogya Karnataka plan is managed through the Suvarna Arogya Suraksha Trust (SAST). This is an autonomous organisation that works under the health and family welfare department of Karnataka. During the implementation stage, the SAST manages the claim, authorisation, and empanelment of the hospitals.

The Arogya Karnataka scheme was officially launched on March 2, 2018.

On the other hand, although the core PM-JAY scheme has relied solely on the SECC 2011 data, the state of Karnataka has customised the scheme such that it can cater to all residents of the state into two main groups, namely, category A for eligible/BPL families and category B for general/APL families.

Key Highlights: Ayushman Bharat Arogya Karnataka (AB-ArK)

Who Is Eligible for Ayushman Bharat Arogya Karnataka (AB-ArK)

• Category A (Eligible/BPL Household): People with a BPL card, Priority Household card, Antyodaya Anna Yojan (AAY) ration card under NFSA 2013 or registered in SECC 2011 are eligible.
• Category B (General/APL Household): People with an APL ration card or a non-NFSA card.
• Permanent Residents: Residents of Karnataka State with a valid Aadhaar card. Includes all family members irrespective of age and gender.

Benefits and Coverage under Ayushman Bharat Arogya Karnataka (AB-ArK)

• Financial Cover (Category A- BPL/Eligible Families): ₹5 lakhs per family annually on a family floater plan. Provides 100% cashless and free treatment for defined secondary and tertiary procedures.
• Financial Cover (Category B- APL/General Families): Co-pay arrangement where the government contributes 30% of the package charges, capped at ₹1.5 lakhs per family annually, with the patient contributing 70%.
• Scope of Care: Includes primary care (government healthcare institutions), simple secondary care, complicated secondary care, tertiary care, and emergency care with 1,600+ surgical and medical procedures.
• Pre and Post-Hospitalisation Expenses: Includes diagnostic tests, medicines, and consultation charges for 3 days before hospitalisation and 15 days after discharge.
• Pre-Existing Diseases: All pre-existing conditions are covered on Day 1 without any waiting period. Family Flexibility: There is no restriction on the number of family members, gender, or age.

Documents that are Required to Apply for PM-JAY Karnataka

• Adhaar Card: Required for establishing basic identification, residence proof, and biometric verification through e-KYC (fingerprint / iris scan).
• Ration Card (PDS Card): Used to define the beneficiary type
• Eligible (BPL / AAY): To avail the complete cashless benefit entitlement till ₹5 lakhs per annum.
• General (APL): To avail subsidised benefit entitlements (30% till ₹1.5 lakhs per annum).
• Proof of Residence: Domicile, Voter ID or utility bills (in case of further identification of residence in case of Aadhaar / Ration Card).
• Hospital Referral Form: Required for treatment in empanelled private facilities (issued by a public health facility, except in case of emergency situations).

Supporting Documents (As Required or Needed)

• PM-JAY Letter / PM-CM Letter: Issued by the government in case your family name appears in the SECC (Socio-Economic Caste Census) records.
• Income / Caste Certificate: Necessary only when PDS / Ration Card status needs confirmation or special category state-wise.
• Passport-size photo: In case of failure of biometric scanning or further verification

How to Find PM-JAY Hospitals in Karnataka

• Go to arogya.karnataka.gov.in to find empanelled hospitals or use the national website hospitals.pmjay.gov.in.
• Select your district - the empanelled hospitals in Karnataka cover Bengaluru, Mysuru, Mangalore, Hubli, and other districts.
• Verify whether the particular hospital is empanelled for your category (A/B) and particular procedure, because not all hospitals are empanelled for all procedures.

How to Apply Step by Step to PM-JAY Karnataka

Step 1: Visit an Enrollment Centre

Visit the nearest Public Health Institution (PHI) (Primary Health Centre, Taluk Hospital, or District Hospital). Or visit any Common Service Centre (CSC) in Karnataka.

Step 2: Provide Your Verification Documents

• Provide your Aadhar Card (Compulsory for biometric authentication).
• Provide your Ration Card (PDS Card) to be classified either as an Eligible (BPL) or General (APL) beneficiary.

Step 3: Perform Biometric Authentication & e-KYC

• The fingerprint or iris of your hand is scanned for the e-KYC process with the help of the Aadhar server.
• Alternative: In case of failure in biometric authentication, your identity will be authenticated using OTP to your registered mobile number.

Step 4: Verify Your Category & Self-Declaration Consent

• Your Ration card will be verified against the database of the state to identify your category.
• Sign the self-declaration consent form offered by the enrollment agency.

Step 5: Issuance of Ayushman Bharat - Arogya Karnataka (AB-ArK) Cards

• Arogya Karnataka ID will be generated for each individual family member.
• Pay the Rs. 10 fee and get your printed AB-ArK Health card.

Helpline and Support

Other Government Schemes

• Yeshasvini Health Insurance Scheme: a state health insurance scheme designed for rural and urban cooperative societies. It offers medical coverage of up to ₹5 lakh per family per year for network hospitals in Karnataka.
• Thayi Bhagya Scheme: a maternal health initiative which provides post and prenatal services to expectant mothers from below poverty line (BPL) and SC/ST families.
• Ayushman Bharat Scheme: centrally sponsored health insurance which provides coverage of up to ₹5 lakh per family per year.
• Central Government Health Scheme: a central government accident security scheme that offers coverage to government employees and pensioners.
• Pradhanmantri Suraksha Bima Yojana: An accidental social security scheme that offers coverage of up to ₹2 lakh for death and permanent disability and up to ₹1 lakh for partial disability.