Karunya Arogya Suraksha Padhathi: Eligibility, Coverage & Application

Kerala’s healthcare system, once a model for India, now faces significant challenges, including shortages of doctors and staff, inadequate infrastructure, delays in essential medicines, and rising out-of-pocket expenses. Public hospitals are often overwhelmed, pushing many to costly private care, which disproportionately affects marginalized and low-income populations. With only 0.74% of GDP allocated to health, systemic inefficiencies persist.

The Karunya Arogya Suraksha Padhathi (KASP) scheme plays a crucial role in bridging this gap. Launched in 2019, KASP provides comprehensive, government-backed health insurance that helps economically disadvantaged individuals access hospitalization and essential medical treatments without financial strain. By offering this safety net, the scheme ensures that vulnerable communities can receive timely care and protection against unexpected health costs.

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This blog will take you through what Karunya Arogya Suraksha Padhathi is, its eligibility criteria, documents required, enrolment procedures, and claim process, everything you need to know in one place.

• Reduce the financial burden of costly medical treatments on poor families by providing cashless treatment access in government and empanelled private hospitals.
• Cover a wide range of critical illnesses including cancer, cardiac issues, kidney failure, and others requiring expensive hospitalization and treatment.
• Ensure no restrictions on age, gender, or family size for beneficiaries.
• Support coverage for all pre-existing medical conditions and hospitalization components such as pre- and post-hospitalization care, medicines, consultations, and diagnostics.

In short, KASP is a government-funded initiative that aims to promote equitable healthcare access by protecting financially vulnerable families from catastrophic health expenses with extensive coverage and cashless treatment facilities.

Eligibility Criteria for Karunya Arogya Suraksha Padhathi

The beneficiaries of KASP are pre-identified households based on the deprivation and occupational criteria outlined in the Socio-Economic Caste Census (SECC) 2011 data. The scheme covers families already included under previous government health insurance programs such as RSBY and CHIS. KASP does not accept open applications or use an income threshold as a criterion for eligibility. 

For more detailed insights on health insurance options and coverage challenges in Kerala, you can read this comprehensive guide on Health Insurance in Kerala.

What Does Karunya Arogya Suraksha Padhathi Cover?

Here is a breakdown of what the Karunya Arogya Suraksha Padhathi (KASP) covers and excludes:

1. Coverage (What the Scheme Includes)

The KASP provides cashless coverage for most expenses related to hospitalization for eligible procedures, including approximately 1,573 procedures across various specialties.

2. Exclusions (What the Scheme Does Not Cover)

Like most health insurance schemes, KASP generally excludes treatments that are not related to active medical conditions or hospitalization. Common exclusions include:

• Cosmetic and elective procedures: Surgeries or treatments done for aesthetic purposes are not covered.
• Outpatient treatments: Regular doctor visits, routine check-ups, and minor procedures outside hospitalization are excluded.
• Non-empanelled hospitals: Treatments received in hospitals not empanelled under KASP are not covered.
• Non-medical expenses: Costs like personal comfort items, hospital phone charges, or other non-treatment-related fees are excluded.
• Experimental treatments: Procedures or medications not approved under standard medical guidelines are not eligible.
• Specific exclusions: Any treatments explicitly listed as excluded in the scheme guidelines.

Note: The exact and complete list of exclusions is detailed in the official scheme documents/Schedule of the Service Contract for KASP-PMJAY, which may be updated by the State Health Agency (SHA).

Documents Required for Karunya Arogya Suraksha Padhathi Application

To apply for this scheme, the following documents are generally required:

• Voter ID or Aadhaar Card
• Passport-size photograph
• Ration Card
• Income Certificate: Required to verify eligibility based on annual income. Applicants should also keep all related income documents ready.
• BPL Card: To confirm eligibility for underprivileged families; BPL cardholders need to upload this while applying online.

How to Register for Karunya Arogya Suraksha Padhathi?

To get your KASP e-card and avail benefits:

• Visit any KASP-empanelled hospital or a designated kiosk/CSC (Arogya Mitra counter).
• Complete the electronic KYC by providing Aadhaar card and ration card (or an alternative family ID).
• The hospital/kiosk verifies your eligibility from the government database.
• If your family is on the eligible list, the AB PM-JAY–KASP e-card is generated on the spot.
• Cashless treatment benefits are immediately available at empanelled hospitals upon card issuance.

You can check your name in the List of Beneficiaries on the State Health Agency Kerala website or inquire at empanelled hospitals.

For assistance or inquiries:

• Toll-Free Helpline: 1056
• Alternate Phone: 0471-2552056
• Email: 
• statehealthagencykerala@gmail.com
• Office: State Health Agency, Kerala Government, 5th and 8th Floor, Artech Meenakshi Plaza, Opposite Government Women and Child Hospital, Thycaud, Thiruvananthapuram - 695014

For more information on hospitals under KASP, visit the official list of Empanelled Hospitals under KASP–AB PMJAY.

What Is The Process To File A Hospitalization Claim Under KASP?

To avail hospitalization under KASP, follow these steps:

1. Check the Hospital: Make sure the hospital is empanelled under the Karunya Health Insurance Scheme.
2. Present Insurance Details: Show your KASP insurance card or provide the relevant details at the hospital admissions desk.
3. Verification & Claim: The hospital will verify your coverage and start the claim process.
4. Treatment Coverage: Medical treatments will be provided according to the scheme’s guidelines during your hospital stay.
5. Coordinate with the Hospital: Work with the hospital’s insurance or billing department to complete any necessary approvals or documentation smoothly.

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Conclusion

The Karunya Arogya Suraksha Padhathi (KASP) is one of Kerala’s most important health initiatives. It provides financial protection and accessible healthcare to over 42 lakh vulnerable families. Since 2019, it has combined several government schemes into a single plan to provide financial and medical support for critical and tertiary care. The scheme covers pre-existing conditions, offers cashless treatment in empanelled hospitals, and has minimal eligibility barriers. This makes it easier for economically weaker families to get the care they need without worrying about costs.

If your budget permits, Ditto suggests choosing a comprehensive personal health insurance plan that offers access to premium treatments, a wider selection of hospitals and doctors, and the convenience of private rooms without waiting times.

If you need help in deciding which policy is right for you, feel free to connect with a Ditto advisor. Book a free call with our expert to get unbiased, personalized guidance and make an informed choice.

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