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Step 2.1: Medical assistance | ಕಾರ್ಮಿಕ ಆರೋಗ್ಯ ಭಾಗ್ಯ

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Karmika Arogya Bhagya"Bhagya scheme is a healthcare initiative in the state of Karnataka, India, designed to extend medical benefits toprovides registered construction workers and their families

What are workers entitled to under 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. 

What are the workers entitled to?

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. 

ThisWorkers have to first pay and then seek reimbursement.

On paper, 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. See a later section on this page for challenges in reimbursement especially with respect to minimum period of hospitalisation.

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

Registered

  • The construction worker has to be registered and their dependents hospitalized in apossession Government hospital orof a privatevalid labour card.
  • The treatment can only be done in an approved hospital (thisgovernment isor private hospital, as per RSBY list)

    .
  • Claim has to be made within 6 months of hospitalisation.
What typedocuments of documentsare required for application?
  1. Attested Proof of Identity/Smart card from the Board
  2. Employment Certificate
  3. Proof of Bank Account
  4. Hospital invoices detailing admission and discharge dates, inclusive of the provided treatment
  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. Completed Form XXII-A from the hospital

SubmitReimbursement applicationclaim should be submitted within 6 months of hospitalization start date.

CentersClick where one can enrollhere for thea Arogyalist Karnatakaof Schemecenters for enrollment

What is the procedure to apply?
    • Applicant needs to submit the application.application via the Seva Sindhu portal.

     At this step, applicants depend on CSOs for guidance and assistance on the paperwork/ online process.  

    • Application processingis andfirst Verificationverified by a Senior/ Labour Inspector.
    • ReviewIn the final stage, the application is reviewed and Approvalapproved by a Labour OfficerOfficer.

Common reasons why construction workers fail to receive the benefits under Karmika Arogya Bhagya

Exclusion owing to policy design
  • Upon discharge from the hospital, construction workers often face difficulties in obtaining essential documents such as the pharmacy bill and final bill which are necessary to apply for assistance.
Exclusion owing to lack of supporting documentation
  • Obtaining attestation of the Identity/Smart card issued by the Board from a gazetted officer poses a challenge for laborers. It consumes their time, and there is a risk of not being entertained by the gazetted officer.

The absence of Aadhar seeding poses a significant challenge, as without it, workers may not receive assistance, which is typically transferred directly to their accounts through Direct Bank Transfer (DBT).

Exclusion owing to reimbursement process related reasons
  • Initial criteria indicate 48-hour hospitalization, but rejection occurs if discharge made under 7 days.
  • The doctor providing the treatment must sign Form 22A for the construction worker, but obtaining the doctor's signature is often challenging. As an alternative, a backup signature is commonly used.
  • Initial payment must be made by worker, then he must apply for reimbursement.
  • Reimbursement varies: 75%-90%.

Apply for reimbursement within 6 months from hospitalization start.

Reimbursement is done only if treatment is in hospitals empaneled with the board.

No subsidized rates like CGHS for diagnosis, doctor fees, and medicines.

List of approved Government and Private Hospitals under Arogya Karnataka


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