Karunya Arogya Suraksha Padhathi (KASP) - Kerala Health Insurance Scheme

Why Was KASP Introduced

The state of Kerala had several government health schemes, such as RSBY, CHIS, SCHIS and KBF, all of which had varying eligibility and coverage levels, which made for a disjointed approach. In the state, with the inception of Ayushman Bharat Yojana (PMJAY) in the country, all the existing health schemes were clubbed under the umbrella of Kerala Ayushman Bharat Scheme (KASP) to make the scheme more inclusive and experience-free for the beneficiaries.

Nikshay Poshan Yojana support for TB patients can be claimed at the same time as the monthly amount of ₹1,000. Janani Suraksha Yojana (JSY) and SUMAN benefits are available for pregnant women. If the costs are more than ₹5 lakh, Rashtriya Arogya Nidhi (RAN) will cover up to ₹15 lakh at the government super-speciality hospitals.

KASP- Key Highlights

KASP Eligibility - Who Can Apply

• Families with a child who was identified as being in deprivation and/or in an occupation as per SECC-2011 criteria
• Those who were beneficiaries of RSBY, CHIS and SCHIS when the programme was in operation in Kerala.
• The annual income of a family, for Karunya Benevolent Fund (KBF) is less than ₹3 lakh.
• There is no restriction on family size, age or gender.

Who is NOT eligible: Families with income above the bottom 40% of the funding limit under any of the converged schemes and other states' residents.

What Does KASP Cover

How to Apply for KASP

1. Online Registration:

   • Go to the official Kerala State Health Agency website.
   • Verify eligibility with Aadhar Number/ Ration Card Information.
   • Complete personal/ family information correctly.
   • Upload required documents.
   • Submit and await verification, KASP card issued after approval.

2. When you visit an Empanelled Hospital:

   • Go to any KASP empanelled Hospital with Aadhaar and Ration Card.
   • Candidates are checked for eligibility at the hospital help desk and help with enrollment at the time.

Documents Required

• Aadhaar Card - Primary Identity Proof and ABHA linkage
• Ration card (for proof of family eligibility)
• Income certificate (for KBF component - income of less than ₹3 lakh)
• Recent photos of Family Members.
• Mobile number - for OTP, updates and more

How to Check KASP Card Status

• Go to the official Kerala State Health Agency website.
• Please go to the Beneficiary Search/Cards Status section.
• You can enter your registered mobile number or Aadhaar number.
• Get real-time enrollment status and card information.

The status can also be verified using the Ayushman App on the Google Play Store, as KASP is linked to the AB PM-JAY system.

How the Claim Process Works

• KASP is a purely cashless operation:
• Go to any KASP or AB PM-JAY empanelled hospital in Kerala or any hospital in India and use your KASP card with Aadhaar to avail the benefits.
• Heroes' help desk is connected to the Heritage Health Insurance Pvt Ltd TPA system and verifies eligibility.
• Pre-authorisation for planned treatments prior to admission.
• All bills are treated cashless - that is, bills are paid between the hospital and the State Health Agency.
• Treatment is started immediately in emergencies, and authorisation is completed later.
• Post-discharge records are digitally updated and linked to your ABHA ID card.

Grievance and Rejection Process

In case of a denial of a claim or if a hospital requires payment immediately:

• Step 1: Call the hospital help desk/TPA (Heritage Health Insurance Pvt Ltd) for the rejection reason.
• Step 2: Contact the National Health Helpline 104 or the Ayushman Bharat helpline 14555
• Step 3: You can reach the Kerala State Health Agency via the official website.

Typical causes of rejection:

• Treatment at a hospital that is not on the list of 'Asst. Hospitals'
• There was a procedure not in the package list (1,573)
• Mismatch of Aadhaar and/or document at verification
• Household income is earned above the income eligibility limit for the KBF program.

KASP and Other Schemes

• Central scheme integrated with KASP for pan-India portability - Ayushman Bharat PM-JAY
• Nikshay Poshan Yojana - A dose of ₹1,000 per month to TB patients, in addition to KASP.
• Janani Suraksha Yojana (JSY) is a cash incentive scheme for institutional delivery introduced by the government.
• Rashtriya Arogya Nidhi (RAN) - up to ₹15 lakh for expenses of more than ₹5 lakh.
• The Niramaya Health Insurance Scheme covers family members who have a disability of Autism, Cerebral Palsy or Multiple Disabilities.
• CMCHIS (Tamil Nadu) - parallel scheme for the people of Tamil Nadu
• Children in institutional care in Kerala can avail themselves of benefits for hospitalisation under Mission Vatsalya.

Helpline and Support for KASP

KASP brings all the disjointed health insurance initiatives in Kerala together in a single programme linked with Ayushman Bharat Yojana - RSBY, CHIS, SCHIS and Karunya Benevolent Fund. It offers coverage of more than 42 lakh Kerala families (State Health Agency, Kerala) and provides ₹5 lakh annual cashless coverage, 1,573 procedures, pan-India portability and no age and family size cap. Register your ABHA card at abdm.gov.in and visit your nearest empanelled hospital or the official Kerala SHA portal to check eligibility and apply.