Medical Assistance (Karmika Arogya Bhagya)

What is Medical Assistance (Karmika Arogya Bhagya)?

The "Karmika Arogya Bhagya" scheme is a healthcare initiative in the state of Karnataka, India, designed to extend medical benefits to registered construction workers and their families. This program provides financial support to cover various medical expenses, including hospitalization and treatment costs. 

The financial assistance is applicable to registered construction workers and their family members who are hospitalized in a government hospital, a private hospital listed in Schedule I of the Karnataka Government Servant’s (Medical Attendance) Rules, 1963, or a hospital recognized under any state government insurance scheme. 

This assistance is available for a minimum continuous hospitalization period of 48 hours, and it amounts to Rs 300 per day of hospitalization, with a maximum cap of Rs 20,000, subject to actual expenses incurred. 

What is the eligibility criteria for accessing benefits from the scheme? 

Registered construction worker and their dependents hospitalized in a Government hospital or a private hospital (this is as per RSBY list)

Arogya Karnataka Hospital List- Government & Private Hospital

List of Government and Private Hospitals Approved under AYUSHMAN BHARAT - AROGYA KARNATAKA

Where to Apply Karmika Arogya Bhagya?

List of Enrolment centers-Arogya Karnataka Scheme

What type of documents required for application?

1. Proof of Identity/Smart card issued by the Board (Attested)
2. Employment Certificate
3. Proof of Bank Account
4. Bills of hospital showing admission and discharge dates and all treatment given
5. Any medical documents on hospitalization of beneficiary/dependent in government/private hospital included in schedule1 of the Karnataka government servants (medical attendance) Rules 1963
6. Form XXII-A (hospital has to fill and given to worker)
7. Application can be submitted within 6 months of hospitalization commencement datedate.

What is the procedure to apply?

1. Applicant needs to submit the application.
2. Application processing and Verification by Senior/ Labour Inspector.
3. Review and Approval by Labour Officer

Why do construction workers often fail to receive the benefits they are entitled under Karmika Arogya Bhagya?

1. Eligibility conditions- 
   Labour has to be registered as construction workerworker.
2. Documents-
   Attested proof of Identity/Smart card issued by the Board- self attested or from gazette officer?
3. Reimbursement criteria-
   1. Scheme confusion: Initial criteria indicate 48-hour hospitalization, but rejection occurs if discharge made under 7 days.
   2. Discharge before 7 days renders the scheme ineligible.
   3. Reimbursed done only if treatment is in hospitals empanelled with the board.
   4. Form 22 signing: Doctor's signature required, often replaced by backup.
   5. Apply for reimbursement within 6 months from hospitalization start.
   6. Initial payment must be made by worker, then he must apply for reimbursement.
   7. Reimbursement varies: 75%-90%.
   8. No subsidized rates like CGHS for diagnosis, doctor fees, and medicines.