How To Avail The Scheme Benefit:
"Under the scheme, the patients need to get admitted in a government hospital first. After a screening by the government hospital doctors, a letter will be generated by the authorities indicating required procedure/ operation facility is not available in the hospital and the patient can be shifted to any private notified hospital. Based on this letter, free treatment will be provided at the private hospitals.A total number of 1,650 treatments/ procedures are available under the scheme in the government/ private hospitals".
The United Nations, people oriented ‘Millennium Development Goals’ concluded in the year 2015, which triggered new initiatives in the form of ‘Sustainable Development Goals (SDG)’ with a continuing mandate to “Ensure healthy lives and promoting well-being for all, at all ages”. The focus towards achieving Universal Health Coverage for ensuring the wellbeing of all was expressly underpinned in this goal.
Karnataka has been in the forefront of successfully implementing various health care schemes through Suvarna Arogya Suraksha Trust on an Assurance Mode, for the benefit of a large section of BPL and APL populace in the State including Road Accident Victims within the borders of Karnataka. The success of implementation through Assurance Mode was reinforced by the fact that there was 64 % reduction in Out of Pocket Expenditure (OOE), mortality was reduced by 64 % among BPL families and 12.3 % households are more likely to access hospital care –as per a World Bank Study.Thus continuing the mandate of SDGs, the government decided to extend Universal Health Care in all the three sectors of primary, secondary and tertiary care to all residents of Karnataka by pooling resources from various on-going schemes.
Hence the launch of the pioneering “Ayushman Bharat Arogya Karnataka” dedicated to the people of Karnataka. With this Karnataka is proud to be the FIRST STATE in the Country to declare and implement Universal Health Coverage to insulate Karnataka people from impoverishment as well as to ensure the overall health and well-being of the people of Karnataka.
The objective of the scheme is to extend ‘Universal Health Coverage’ to all residents in Karnataka State. Under this new scheme, primary health care, specified secondary and tertiary health care benefits will be provided.
The current ongoing health schemes like Vajpayee Arogyashree, Yeshaswini Scheme, Rajiv Arogya Bhagya Scheme, RashtriyaSwasthayaBimaYojana (RSBY) including RSBY for senior citizens, RashtriyaBalaSwasthayaKaryakram (RBSK), MukhyamantriSantwana Harish Scheme, Indira Suraksha Yojane, Cochlear Implant Scheme etc. will all be converged under this new Ayushman Bharat Arogya Karnataka Scheme.
The scheme will be rolled out in Karnataka in phases. In the first phase 10 major hospitals have been chosen, They are KC General Hospital, Jaya Sri Jayadeva Institute of cardiology and research PMSSY, Victoria Campus, Mandya Institute of Medical sciences, Mcgann Institute of Medical Sciences,Shimogga,Wenlock District Hospital, Mangluru, Karnataka institute of Medical sciences, Hubli, Gulbarga Institute of Medical Sciences, GulbargaVijayanagara Institute of Medical sciences, Bellari. In the next phase it shall be rolled out in other 33 major and district level hospitals within 30.6.2018.Thereafter, the roll out of the scheme to taluka level hospitals, CHC and PHCs shall be completed by 30.9.2018, 31.10.2018 and 31.12.2018 respectively.
For accessing the scheme benefits, the beneficiaries have to be enrolled in the “Ayushman Bharat Arogya Karnataka” system. A patient needs to be enrolled at a PHI only once. When a patient approaches a PHI for the treatment, the enrollment staff of the PHI will be enrolling the patient on the enrollment portal developed for “Ayushman Bharat Arogya Karnataka” and generate a unique ID called “ArKID”. The enrollment is based on a person’s Aadhar Card number. The patient’s biometric impression is captured on a biometric device and authenticated with CIDR Aadhar Server. The E-KYC details will be auto populated.
In case there is a failure in reading the bio metric impression of the beneficiary wishing to enroll, other options such as “OTP”, capturing data from the QR code and getting data from the Food Department’s database are provided.
While benefits of the scheme can be availed in PHIs by the alternate methods provided for enrolment, producing Adhaar card/ number and authentication with the Adhaar database is mandatory for referral to private hospitals.
A mandatory consent will be obtained using a pre-printed self-declaration form from the enrolling beneficiary to use his details only for the purpose of enrollment. The self–declaration form will also containa section where in the beneficiary desiring to be enrolled under “Ayushman Bharat Arogya Karnataka” scheme gives a declaration that he/she does not have aninsurance in any other scheme.
Patient Entitlement under the Scheme:
The PDS card decides the entitlement of the patient and is authenticated via a web service, with the stored PDS details in the Food and Civil Service Database to determine whether the beneficiary belongs to “Eligible Category” or not, as per the norms defined under the National Food Security Act 2013. Accordingly He will be categorized as ‘Eligible Patient”. If a beneficiary is not from the “Eligible category” as per the FSA or if the beneficiary does not have a PDS card, he or she will be automatically enrolled as a “General Patient”.
Once the E-KYC form is filled and the beneficiary categorization is completed, the beneficiary will become registered under the Scheme and will be given a unique scheme ID “Ab-ArK ID”number. The generated unique ID number printed on a card will be provided on a payment of Rs.10/- only for the first time to the successfully enrolled beneficiary. For reprinting the card on request of the enrolled beneficiary in case he has lost the card he will be given another card at a cost of Rs.20/- only.
The unique Ab-ArK ID will be the PDS card Number with a separator (-) and a sequential number for each member of the family that approaches a PHI for service and seeks to get enrolled.
The UHC Card provided will contain Photo, Name, Unique Scheme ID and Basic Details of the Beneficiary. An SMS alert will also be sent to the Enrolled Patient to his mobile number wherever the mobile number has been shared with the registration personnel.
Once the Scheme card is generated the patient can access the treatment under the “Ayushman Bharat Arogya Karnataka” scheme.
The beneficiary will not be required to carry his Adhaar card or Food card the next time he visits the hospital for treatment. He will be serviced based on the Ayushman Bharat Arogya Karnataka card.