Introduction to Karnataka Arogya Sanjeevini Scheme (KASS)

The **Karnataka Arogya Sanjeevini Scheme (KASS)** is a comprehensive health assurance scheme launched by the Government of Karnataka to provide cashless medical treatment to all its State Government employees and their eligible dependent family members. The scheme aims to alleviate the financial burden of healthcare expenses on government employees by providing access to quality medical services in empanelled hospitals.

Implemented in collaboration with the **Suvarna Arogya Suraksha Trust (SAST)**, KASS ensures that beneficiaries receive timely and comprehensive medical care for critical illnesses and surgical interventions without upfront payment at network hospitals.

Scheme Objectives:

• To provide comprehensive cashless medical treatment to State Government employees and their dependents.
• To cover a wide range of critical illnesses and surgical procedures.
• To ensure access to quality healthcare services through a network of empanelled super-specialty hospitals.
• To simplify the process of availing medical benefits for government employees.

Key Features and Benefits of KASS

• Cashless Treatment: Beneficiaries can avail cashless treatment at empanelled network hospitals.
• Comprehensive Coverage: The scheme covers a wide array of medical conditions and procedures, including specific critical illnesses and surgeries that require tertiary care. This may include specialities like Cardiology, Oncology, Neurology, Renal disorders, Poly-trauma, Burns, and Paediatric surgeries.
• No Financial Cap: The scheme operates on an assurance mode, and generally, there is no fixed financial cap on the expenditure for covered treatments, ensuring comprehensive support for beneficiaries.
• Pre and Post-Hospitalization: Expenses incurred before and after hospitalization (e.g., diagnostics, follow-up consultations) related to the covered treatment are typically included.
• AYUSH Coverage: The scheme may also cover treatments under AYUSH systems of medicine (Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy) in recognized facilities.
• Simplified Process: The scheme aims for a streamlined process, often linking benefits directly through the employee's KGID (Karnataka Government Insurance Department) number and Aadhaar.

Eligibility Criteria for KASS

The scheme is specifically designed for:

• Karnataka State Government Employees: All regular state government employees are eligible.
• Eligible Dependent Family Members: The definition of eligible dependents generally includes:
  • Spouse (Husband/Wife) of the government employee.
  • Dependent Parents (Father and Mother) of the employee, subject to specific income criteria (e.g., monthly income below a certain limit, living with the employee).
  • Dependent Children, including legally adopted children and step-children, up to a certain age limit (e.g., 25 years) or until they become employed/married, as per government rules.
• Exclusion: Government employees already covered under other government-sponsored healthcare schemes (e.g., CGHS for Central Government employees) might not be eligible for KASS.

The eligibility of dependents is often aligned with the Karnataka Government Servants (Medical Attendance) Rules, 1963, with updates as per recent government orders.

Application and Availing Benefits Process

The process for enrolling and availing benefits under KASS is primarily integrated with the Human Resource Management System (HRMS) for government employees:

1. Employee Data Entry in HRMS: Drawing and Disbursing Officers (DDOs) are responsible for accurately entering and updating the details of employees and their eligible dependent family members into the HRMS portal.
2. Self-Declaration: Employees typically need to submit a self-declaration form, certifying the accuracy of dependent information and their eligibility under the scheme.
3. No Separate Card Issued: Unlike some other health schemes, KASS usually does not issue a separate health card. The KGID number of the employee and Aadhaar card are used for identification at empanelled hospitals.
4. Availing Cashless Treatment:
   • Visit Empanelled Hospital: Beneficiaries must visit a super-specialty hospital empanelled under KASS.
   • Identification: Present the government employee's KGID number and Aadhaar card (of the patient) at the hospital's Arogyamitra desk.
   • Pre-Authorization: The hospital will initiate a pre-authorization request with the Suvarna Arogya Suraksha Trust (SAST) for the required treatment/surgery.
   • Cashless Treatment: Upon approval of the pre-authorization, the beneficiary can avail cashless treatment. The hospital directly settles the bills with SAST as per the scheme guidelines.
   • Discharge: Post-treatment, the hospital submits the necessary documents for final claim settlement.

The scheme emphasizes digital integration for streamlined procedures and transparent benefit management.

Implementing Agency and Covered Procedures

• Implementing Agency: The **Suvarna Arogya Suraksha Trust (SAST)** is the nodal agency responsible for the implementation of the Karnataka Arogya Sanjeevini Scheme. SAST manages the network of empanelled hospitals, processes pre-authorizations, and facilitates claim settlements.
• Covered Specialities: While the exact list of covered procedures and specialities is subject to official notifications, KASS typically focuses on critical and tertiary care. Common categories include:
  • Cardiology (Heart-related treatments)
  • Oncology (Cancer treatments)
  • Neurology (Brain and Nervous System disorders)
  • Renal Disorders (Kidney-related treatments, including dialysis and transplants)
  • Burns
  • Poly-trauma cases (excluding medico-legal cases)
  • Neonatal and Paediatric surgeries
  • Genito-urinary surgeries
  • Other complex surgical procedures and medical management.

A detailed list of covered procedures and empanelled hospitals is usually available on the SAST website or through official government gazette notifications.

Important Notes & Official Links

• Official Notifications: Always refer to the latest Gazette notifications and circulars issued by the Government of Karnataka and SAST for the most accurate and updated information regarding scheme rules, covered procedures, and eligibility.
• HRMS Update: Employees must ensure their and their dependents' details are correctly updated in the HRMS portal to facilitate seamless access to KASS benefits.
• Hospital Network: Verify the list of empanelled hospitals on the SAST website before seeking treatment.

Key Official Portals:

• Suvarna Arogya Suraksha Trust (SAST): Check the Karnataka Health & Family Welfare Department website, often SAST has a dedicated section/portal. Look for SAST's official page on the Karnataka govt website. (As per search, a direct SAST portal is often linked through the Health Dept.)
• Karnataka Health & Family Welfare Department: https://hfw.karnataka.gov.in/
• Official Karnataka Government Portal: https://www.karnataka.gov.in/
• Human Resource Management System (HRMS) Karnataka: (Internal portal for government employees, often accessed via finance/treasury department websites of Karnataka govt)
• eSarkari Land Services (Relevant): For land records, e-Nibandhan for property registration, and Jharkhand Municipal for property tax payment, please refer to their respective guides on eSarkari.

For the most accurate and current information on the Karnataka Arogya Sanjeevini Scheme, including specific guidelines, covered procedures, and the list of empanelled hospitals, always consult the official portals of the Suvarna Arogya Suraksha Trust and the Government of Karnataka's Health and Family Welfare Department.