Ayushman Bharat–Arogya Karnataka (Arogya Karnataka Scheme)

What is the Arogya Karnataka scheme?

Arogya Karnataka is the Government of Karnataka's universal health coverage scheme, launched on 2 March 2018 by the Department of Health and Family Welfare and implemented by the Suvarna Arogya Suraksha Trust (SAST). Arogya Karnataka replaced a patchwork of earlier state health schemes, Vajpayee Arogyashree, Rajiv Arogya Bhagya, Rashtriya Swasthya Bima Yojana and others, with a single scheme covering the whole state population.

Later in 2018 Karnataka merged Arogya Karnataka with the central Ayushman Bharat Pradhan Mantri Jan Arogya Yojana. The combined scheme is officially called Ayushman Bharat–Arogya Karnataka, abbreviated AB-ArK, and that is the name printed on the health card issued to beneficiaries today. If you hear "Arogya Karnataka", "Ayushman card" and "AB-ArK" used interchangeably in Karnataka, they refer to the same entitlement.

AB-ArK divides the state's households into two classes:

• Eligible patients; families holding a BPL, Antyodaya or NFSA-linked ration card. These households receive cashless treatment of up to Rs 5 lakh per family per year at empanelled hospitals for approved secondary and tertiary packages.
• General patients — APL households. These families are not excluded from the scheme, but the government meets only a share of the package cost on a co-payment basis, subject to a lower annual ceiling, with the patient paying the balance.

Because the co-payment percentage and the general-patient ceiling have been revised by government order since 2018, an APL family should confirm the figure in force at the Arogya Mitra desk of the hospital before admission rather than relying on an older published number.

Who is eligible for Arogya Karnataka and who is not?

You can use the scheme if:

• You are a resident of Karnataka. Unlike most health schemes, AB-ArK has no income bar for entry; every resident household falls into one of the two classes.
• You hold a ration card, which determines your class. A BPL, Antyodaya or NFSA-linked card makes you an eligible patient; an APL card makes you a general patient.
• You have an ABArK health card, or can get one at the hospital.
• Your treatment is on the approved package list and is provided at an empanelled hospital.
• For planned treatment, you carry a referral from a government facility.

You cannot use the scheme, or are not eligible, if:

• You are not a resident of Karnataka. Out-of-state patients are covered by their own state's PM-JAY implementation, subject to portability rules.
• You go to a hospital that is not empanelled. No reimbursement is available for treatment taken outside the network.
• You seek planned treatment at a private hospital without a referral from a government facility. This is the rule most often broken and most often the reason a bill is refused.
• Your treatment is not on the approved package list.
• Your family's annual limit is already exhausted.
• You are seeking routine outpatient care at a private hospital, which the financial cover is not designed for.

How does the referral system work?

Arogya Karnataka is deliberately built as a referral-based system, not a free choice of hospital. The intended path is:

1. Attend a government primary health centre, community health centre, taluk hospital or district hospital first.
2. If that facility can treat you, it does so under the scheme.
3. If it cannot, it issues a referral to an empanelled hospital, which may be private, for the specific secondary or tertiary treatment needed.

The purpose is to keep routine care inside the public system and reserve private capacity for treatment government hospitals cannot deliver.

Emergencies are the exception. A genuine emergency admission at an empanelled hospital does not require a prior referral, and the hospital is expected to treat first and complete formalities afterwards.

What documents are required for Arogya Karnataka?

How to apply for the Arogya Karnataka card

1. Take your Aadhaar card and ration card to any of these: the Arogya Mitra desk at a government hospital, a Bapuji Seva Kendra, a Gram One, Karnataka One or Bangalore One service centre.
2. Ask the operator to register you for the ABArK health card. Give your Aadhaar number and complete the biometric or OTP verification.
3. Confirm that every family member on the ration card is added to the registration. A member left out will not be covered.
4. Collect the ABArK card, check the names and the eligible or general classification printed on it, and keep it with your ration card.
5. Carry the card and Aadhaar to any empanelled hospital when treatment is needed.

Registration is open all year and costs nothing beyond a small notified card fee where one is charged. You can also get the card made at the hospital on the day of admission, but doing it in advance avoids delay during an emergency.

How do I use the scheme at a hospital?

1. Confirm the hospital is empanelled under AB-ArK, using the list on arogya.karnataka.gov.in or by asking at the hospital.
2. Report to the Arogya Mitra desk, which is the scheme help desk staffed at every empanelled hospital.
3. Present your ABArK card, Aadhaar, ration card and referral letter.
4. The hospital raises a pre-authorisation request to the Suvarna Arogya Suraksha Trust with the package code for your treatment.
5. On approval, treatment proceeds cashless for eligible patients, and on the applicable co-payment basis for general patients.
6. Ask the Arogya Mitra to explain, in writing, exactly which costs you are being asked to pay and why, before you pay anything.

Why Arogya Karnataka claims run into trouble

• No referral for planned treatment at a private hospital.
• Hospital not empanelled, in which case nothing is payable and there is no reimbursement route.
• Ration card status not updated, so a genuinely BPL family is classified as general and asked to co-pay. Update the ration card with the Food and Civil Supplies Department first.
• A family member missing from the ABArK registration.
• Treatment not on the approved package list.
• Annual family limit exhausted.
• Aadhaar and ration card name mismatch, which stalls verification at the desk.

Who do I contact about Arogya Karnataka?

• Arogya Sahayavani health helpline: 104. This is the number to call about card problems, hospital refusals and demands for payment.
• Arogya Mitra desk at the empanelled hospital, for pre-authorisation and billing at the point of treatment.
• Suvarna Arogya Suraksha Trust, Department of Health and Family Welfare, Government of Karnataka, for scheme-level grievances.
• District Health Officer, for complaints against an empanelled hospital in your district.
• Official portal: arogya.karnataka.gov.in

An empanelled hospital may not charge an eligible patient for an approved package. If you are asked for money, call 104 before paying, and keep every receipt if you have already paid.

How to check your Arogya Karnataka (AB-ArK) status

Arogya Karnataka does not work like a one-time application that gets approved or rejected on a portal. There are three separate things a beneficiary typically needs to check, and each has its own channel.

1. Checking whether your ABArK card and family registration exist

• Visit the Arogya Mitra desk at any empanelled government or private hospital and ask the operator to look up your record using your Aadhaar number or ration card number. This is the fastest way to confirm whether a family member is already registered, or missing from the registration.
• You can also check beneficiary status on arogya.karnataka.gov.in, since AB-ArK data is linked to the central Ayushman Bharat PM-JAY beneficiary database. Look for the beneficiary search or "Am I Eligible" type link on the portal and search using your ration card or Aadhaar details.
• Call the Arogya Sahayavani helpline on 104 and ask the operator to confirm whether your family is registered and what classification (eligible or general patient) is recorded against your ration card.

2. Checking the status of a pre-authorisation request during treatment

Once a hospital has raised a pre-authorisation request with the Suvarna Arogya Suraksha Trust for a specific treatment package, the approval or query status is tracked by the hospital's own Arogya Mitra desk, not by the patient directly. If admission is being delayed:

1. Ask the Arogya Mitra at the hospital for the pre-authorisation reference number and its current status (pending, approved, or queried).
2. If the hospital cannot give a clear answer or the delay is unreasonable, call 104 and quote the reference number, the hospital name and the patient's name.
3. For a delay or refusal that the hospital and the helpline do not resolve, escalate in writing to the District Health Officer of your district.

3. Checking whether a ration card update has been reflected

If your family's classification changed because of a ration card correction (for example, moving from APL to BPL), that change has to first be updated with the Food, Civil Supplies and Consumer Affairs Department, and it can take time to reflect in the AB-ArK database afterwards. Confirm the updated classification at the Arogya Mitra desk before your next hospital visit rather than assuming the correction has already synced.

Keep your ABArK card number, Aadhaar number and ration card number handy for any of these checks, since the operator or helpline will ask for at least one of them to pull up your record.