Ayushman Bharat Arogya Karnataka (AB-ArK) Scheme: A Guide

The Ayushman Bharat Arogya Karnataka (AB-ArK) scheme is the flagship health insurance program of the Government of Karnataka, designed to provide healthcare access to all residents of the state. The scheme was originally launched in March 2018 as "Arogya Karnataka" and was later integrated with the central government's Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) on October 30, 2018, to form the current co-branded scheme.

Previously known by names like Arogya Bhagya, the scheme subsumed several earlier health programs, including the Vajpayee Arogyashree, Yeshaswini, and Rashtriya Swasthya Bima Yojana (RSBY), into a single comprehensive plan. It is managed by the Suvarna Arogya Suraksha Trust (SAST), which serves as the State Health Agency (SHA). The program aims to provide cashless medical treatment for a wide range of procedures at a network of government and empanelled private hospitals.

Arogya Karnataka Scheme at a Glance

The operational status of the 104 Arogyavani helpline has been reported as uncertain.

• Scheme Name — Ayushman Bharat Arogya Karnataka (AB-ArK)
• Launch Date (as Arogya Karnataka) — March 2018
• Integration with PM-JAY — October 30, 2018
• Cover for BPL Families — Up to ₹5 lakh per family per year
• Cover for APL Families — Up to ₹1.5 lakh per family per year (30% government contribution)
• Implementing Agency — Suvarna Arogya Suraksha Trust (SAST)
• Toll-Free Helplines — 1800 425 8330, 14555
• State Health Helpline — 104 (Arogyavani)

Rates shown are as per the Suvarna Arogya Suraksha Trust (SAST), Government of Karnataka (2024) and are subject to periodic revision. Always verify the latest approved rates on the official source.

What Does the Arogya Karnataka Scheme Cover?

The Ayushman Bharat Arogya Karnataka scheme provides a family floater health cover with benefits divided into two tiers based on the beneficiary's economic status. It is designed to cover significant medical expenses for secondary, tertiary, and emergency care.

The key features of the coverage include:

The scheme covers over 1,650 medical procedures across various specialties, including cardiology, oncology, neurosurgery, and pediatrics. A significant benefit of the scheme is that pre-existing diseases are covered from the very first day of enrollment, with no waiting period.

• Eligible (BPL) Households: Beneficiaries from Below Poverty Line (BPL) families receive free, cashless coverage of up to ₹5 lakh per family per year. This is a family floater policy, meaning the entire sum can be used by one or more members of the family, with no cap on the number of family members.
• General (APL) Households: Beneficiaries from Above Poverty Line (APL) families receive subsidised coverage. Under this tier, the beneficiary is required to pay 70% of the treatment cost as per the approved package rate, while the government contributes the remaining 30%. The government's contribution is capped at a total of ₹1.5 lakh per family per year.

Who is Eligible for an AB-ArK Card?

All permanent residents of Karnataka are eligible to enroll in the AB-ArK scheme. Beneficiaries are categorized into two groups, which determines the extent of their coverage.

1. Eligible Patients (BPL Category): This group includes households that are defined under the National Food Security Act (NFSA), 2013. These are families holding a Below Poverty Line (BPL) or Antyodaya Anna Yojana (AAY) ration card. Households that were previously enrolled under the Rashtriya Swasthya Bima Yojana (RSBY) also fall into this category. These beneficiaries are entitled to the full ₹5 lakh annual coverage.

2. General Patients (APL Category): This category includes all other residents of Karnataka who do not fall into the 'Eligible Patient' group. These are primarily Above Poverty Line (APL) households. They receive subsidised coverage with a government contribution cap of ₹1.5 lakh per year.

It is important to note that residents who are already covered by other government health schemes, such as the Central Government Health Scheme (CGHS), or have private health insurance policies are not eligible to enroll in the AB-ArK scheme.

How to Enrol and Get an Arogya Karnataka Card

The enrollment process for the Ayushman Bharat Arogya Karnataka scheme must be completed in person, as there is no online portal for individual registration. Interested individuals need to visit a designated enrollment center.

Enrollment can be done at various locations across the state, including Primary Health Institutes (PHIs), Bangalore One (B1) centers, and Karnataka One (K1) centers. To enroll, you will need to provide the following documents:

At the center, an operator will perform an e-KYC (Know Your Customer) verification using your Aadhaar number and biometric data (fingerprint scan). Your ration card will be used to confirm your eligibility category as either BPL or APL. Once the verification is complete, a co-branded Ayushman Bharat Arogya Karnataka (AB-ArK) card containing a unique ID will be issued on the spot. A nominal fee of ₹10 is charged for the issuance of the card.

• Aadhaar Card: This is a mandatory document for identity and e-KYC verification.
• Ration Card: This is required to determine whether the applicant falls under the BPL or APL category, which decides the level of benefits.

Understanding the Integration with Ayushman Bharat PM-JAY

Ayushman Bharat Arogya Karnataka (AB-ArK) is a co-branded scheme that combines the state's universal health coverage goals with the framework of the national Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY). This integration allows for shared funding and a wider beneficiary base.

For beneficiaries who are eligible under the national PM-JAY criteria (identified through the Socio-Economic and Caste Census data), the funding for their treatment is shared between the central and state governments. In these cases, the central government bears 60% of the expenditure, while the Government of Karnataka covers the remaining 40%.

For the additional beneficiaries covered exclusively under the state's scheme—the 'General Patient' category, which includes APL families—the state government bears 100% of its contribution. This structure enables Karnataka to extend health coverage to its entire population, going beyond the scope of the centrally sponsored PM-JAY beneficiaries.

Using the AB-ArK Card at Hospitals in Karnataka

The AB-ArK scheme operates on a cashless basis, meaning beneficiaries do not have to pay out-of-pocket for approved treatments at empanelled hospitals. The network includes a wide range of public government hospitals and numerous empanelled private hospitals across the state.

For many planned tertiary care treatments at a private hospital, the scheme has traditionally operated on a referral system. This means a patient would first need to visit a government hospital for diagnosis and then get a referral to an empanelled private facility if the required treatment is not available at the public hospital.

However, for medical emergencies, this referral is not required. Patients can directly approach any empanelled public or private hospital for cashless treatment. Recently, the government has also initiated changes to relax these referral rules. As part of a year-long pilot program in Bengaluru, patients are allowed to directly access treatment at four specific empanelled private medical colleges—St. John's Hospital, Ramaiah Memorial Hospital, KIMS, and Dr. BR Ambedkar Medical College—without a referral from a government facility.

Frequently Asked Questions

What is the difference between the BPL and APL coverage under Arogya Karnataka?

Beneficiaries from BPL (Eligible) families receive free, cashless coverage of up to ₹5 lakh per family per year. Beneficiaries from APL (General) families receive subsidised coverage where the government contributes 30% of the approved treatment cost, up to a maximum of ₹1.5 lakh per year, with the patient paying the remaining 70%.

Can I apply for the Ayushman Bharat Arogya Karnataka card online?

No, online enrollment for individuals is not available. You must visit a designated enrollment center in person, such as a Primary Health Institute, Bangalore One, or Karnataka One center, to complete the registration process.

Are pre-existing diseases covered under the AB-ArK scheme?

Yes, the Ayushman Bharat Arogya Karnataka scheme covers pre-existing diseases from day one of enrollment for all beneficiaries.

Do I need a referral from a government hospital to get treatment at a private hospital?

For many tertiary treatments, a referral from a government hospital is often required to avail treatment at a private hospital. However, in case of a medical emergency, you can go directly to any empanelled hospital without a referral. There are also pilot programs that have relaxed this rule for certain hospitals.

I have a BPL ration card. Am I automatically enrolled in the scheme?

No. While holding a BPL card makes you eligible for the higher coverage tier of ₹5 lakh, enrollment is not automatic. You must visit an enrollment center with your Aadhaar card and ration card to complete the e-KYC process and have your AB-ArK card issued.

What documents do I need to get the AB-ArK card?

You need to present your Aadhaar card, which is mandatory for biometric e-KYC verification, and your ration card (BPL or APL) to determine your eligibility category.

How can I check my eligibility for the scheme?

You can check your eligibility by visiting the national beneficiary portal at beneficiary.nha.gov.in or by visiting an enrollment center where an operator can verify your status.

Related

• Government hospital OPD guides in Karnataka
• How to find an Ayushman Bharat (PM-JAY) hospital near you
• Ayushman Bharat PM-JAY eligibility check
• Government health schemes in India: a guide

Medical Disclaimer

The information provided in this article is for general informational and educational purposes only. It is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.

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