Step 2.2 Assistance For Major ailments ಪ್ರಮುಖ ಕಾಯಿಲೆಗಳಿಗೆ ಸಹಾಯ

Assistance for Major Ailments provides support for medical expenses, with a maximum amount of Rs. 2,00,000/- (Rupees Two Lakh only), related to the treatment of significant illnesses for registered construction workers and their dependents.

What are the workers entitled to?

Financial assistance is provided to registered construction workers and their dependents during hospitalization in either a Government hospital or a private hospital listed in Schedule I of the Karnataka Government Servant’s Rules,1963, or a hospital recognized under any insurance scheme of the State Government.hospitalization.

The assistance is applicable for a minimum continuous hospitalization period of 48 hours.

The financial aid amounts to Rs 300/- per day of hospitalization, with a maximum limit of Rs 20,000/-.

The application must be submitted within six months from the commencement date of hospitalization.

Hospitalization is limited to either a Government hospital or a private hospital listed in Schedule I of the Karnataka Government Servant’s Rules, 1963, or a hospital recognized under any insurance scheme of the State Government.

Click here for list of approved Government and Private Hospitals

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 are the eligibility criteria?

• The construction worker has to be registered and in possession of a valid labour card.
• Every registered construction worker's dependent (in the case of the worker's death during treatment) eligible for medical expense assistance must submit an application in Form XXII to the Board.
• The treatment can only be done in an approved hospital (government or private hospital, as per RSBY list).

What type of documents required?

• Proof of Identity/Smart card issued by the Board
  
• Employment Certificate
  
• Proof of Bank Account
  
• Bills of hospital showing Admission and Discharge Dates and all treatment given
  
• Any medical documents on hospitalization of beneficiary/dependent in government/private
  
• Hospital included in schedule1 of the Karnataka government servants (medical attendance)
  
• RulesFilled 1963 or a hospital recognized under any insurance scheme of the state government.
  
• Formform XXII-A

Application can be submitted within 6 months of the hospitalization commencement date."

WhyCommon doreasons why construction workers often fail to receive the benefits theyunder areBoCW entitledschemes

Exclusion owing to for major ailments (Karmika Chikitsa Bhagya)?

On-on-ground implementation-

implementation

• The scheme appears to havehas a somewhatdiscrepancy confusingin criterion.its Onhospitalization onecriteria. hand,While it stipulates that the worker (patient) must undergo hospitalization formentions a minimum of 48 hours. However, duringhours, the actual application process,process it becomes evident that the scheme rejects applications unless the worker is admitted forrequires a periodhospital extendingstay of at least 7 daysdays. orApplications more.are Consequently, the scheme deems an application ineligiblerejected if the patient is discharged before completing 7this days7-day of hospitalization.period.
• The programscheme stipulates that its validity is contingent upon themandates treatment being received in a hospital board-affiliated withhospital, the board. However, there have beenbut instances whereof workers soughtseeking treatment in non-affiliated hospitals,hospitals whichhave couldbeen posereported, apotentially challengeaffecting or limitation to their eligibility under the scheme.eligibility.
• Form 22 requiresnecessitates the signature of the attending doctor.doctor, However,but in numerousmany cases, another doctor, typically a backup or substitute,substitute endsdoctor upsigns signingit, theleading form,to resultingclaim in the rejection of the claim.rejection.

Exclusion owing to Lack of awareness and trust among workers-

workers

• The lack of knowledge or awareness among laborers regarding the renewal process may lead to a failure to renew on time. This failure could subsequently result in the loss of benefits if an unforeseen event occurs.

Annexure:

What is considered as a major ailment?

Major ailments refer to any heart operation, covid-19, eye operation, treatment of paralysis, orthopedics operation, uterus operation, treatment of asthma disease, maternity miscarriage cases, treatment of gall bladder related ailments, removal of kidney stone, treatment of brain hemorrhage, treatment of ulcer, cancer, dialysis, kidney related surgery, ENT treatment and surgery, neurosurgery, vascular surgery, esophagus treatment and surgery, gastrointestinal surgery, breast-related treatment surgery, hernia surgery, appendicitis, surgery, treatment of fracture/dislocation, general surgery or such other ailments as in the opinion of the Board be considered as major ailments and occupational diseases. 

List of approved Government and Private Hospitals under Karmika Chiktsa Bhagya

What

 is the procedure to apply for the scheme?

The application process for medical expense assistance under the Karmika Chikitsa Bhagya involves the following steps:

1. Application Submission: Registered construction workers or their dependents must submit an application in Form XXII to the Board.
2. Certificate Requirement: The application should be accompanied by a certificate in Form XXII-A. This certificate can be issued by:
   1. An Assistant Surgeon of a Government Hospital,
   2. The treating Surgeon or Doctor, or
   3. The Head of a Private Hospital specified in Schedule I of the Karnataka Government Servants’ (Medical Attendance) Rules, 1963, or a hospital recognized under the RSBY.
3. Evaluation by the Secretary or Authorized Officer: The Secretary or an authorized officer of the Board will assess the claim for medical expenses. This evaluation is based on the provisions outlined in the relevant rule.
4. Decision by the Board: The Board, through the Secretary or the authorized officer, has the authority to either accept or reject the claim. The decision reached by the Board is considered final.
5. Opportunity for Representation: Before rejecting a claim, the Secretary or the authorized officer is obligated to provide the applicant with a reasonable opportunity to make a representation. This ensures that the applicant has a chance to present additional information or arguments in support of their claim.