KASP Health Insurance: Eligibility & ₹5 Lakh Family Cover

KASP Health Insurance: Eligibility & ₹5 Lakh Family Cover

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KASP health insurance in Kerala provides eligible families with cashless treatment coverage of up to ₹5 lakh per year for specified hospital care. Karunya Arogya Suraksha Padhathi (KASP) operates in convergence with Ayushman Bharat PM-JAY. This guide explains eligibility, the shared family coverage limit, card verification and how to find participating hospitals. Source: State Health Agency Kerala

The important word is eligible. This is not a ₹5 lakh cash payment, and having an Aadhaar or ration card does not automatically qualify every household.

This guide explains how to check your family’s position, what to ask before treatment, and where to get official help.

How Does the ₹5 Lakh Family Limit Work?

The standard benefit is a shared annual family limit, not ₹5 lakh separately for every member. One eligible member may use it, or several members may share it through covered treatment.

For example, if ₹2 lakh is charged to a family’s ₹5 lakh scheme balance for approved treatment, ₹3 lakh would remain in that same coverage year, assuming no other usage or adjustments. This is an illustration, not a treatment quotation.

The benefit is cashless hospital care under the scheme—not money transferred into your bank account. Source: SHA’s Ayushman Bharat overview

Who Is Eligible for KASP Health Insurance in Kerala?

Kerala’s Health Department identifies eligibility groups that include:

  • Families holding a valid RSBY/CHIS card for 2018–19.
  • Eligible vulnerable households identified through the 2011 Socio-Economic Caste Census framework.
  • Families that received the relevant Central Government beneficiary letter.

Have the hospital help desk check the applicable beneficiary records. A low income, Kerala address or particular ration-card colour alone should not be treated as confirmation of KASP entitlement.

Do not confuse KASP with the Karunya Benevolent Fund (KBF). The Health Department separately describes KBF assistance for qualifying families with annual income below ₹3 lakh that are not eligible for KASP. That income condition is not a universal open-registration rule for KASP. Source: Kerala Health Department eligibility guidance

What Treatment Expenses Can Be Covered?

KASP covers listed secondary and tertiary treatment packages at empanelled hospitals. Depending on the approved package, covered expenses include:

  • Consultations and examinations related to the treatment.
  • Medicines, consumables and diagnostic tests.
  • Hospital accommodation, operation theatre and intensive care charges.
  • Necessary implants and treatment-related complications.

SHA also describes coverage for relevant expenses up to three days before hospitalisation and 15 days afterwards. Pre-existing conditions are covered from the start of enrolment, subject to the scheme’s covered treatments and rules. There is no standard family-size, age or gender cap within an eligible family.

These provisions do not mean every medical bill is payable. Ask whether the exact procedure, tests and follow-up medicines fall within the approved package. Source: KASP benefits

How to Check Eligibility and Get Help With a Card

For Kerala-specific assistance, approach the KASP/AB PM-JAY counter at an empanelled hospital.

  1. Keep your Aadhaar, ration card and any existing scheme card or beneficiary letter ready.
  2. Ask staff to check the family record and the individual patient’s enrolment.
  3. Follow the identity-verification and card-issuance instructions applicable to your case.
  4. Check names and family details before leaving.

SHA’s FAQ explains that individual family members need their own enrolment/card record. For adding an eligible family member, it directs families to an empanelled hospital with the existing enrolled member and supporting documents.

Card creation is not the same as making an otherwise ineligible family eligible. If no record appears, request a further check for mismatched details or the correct beneficiary category. Do not assume that paying an agent will solve it.

SHA’s standard KASP FAQ does not describe unrestricted enrolment for all households; check newer announcements separately. Source: KASP FAQ

What About People Aged 70 and Above?

The national Ayushman Vay Vandana extension provides a separate eligibility route for citizens aged 70 and above, irrespective of income or socio-economic status.

For seniors in families already covered by AB PM-JAY, the extension provides an additional annual cover of up to ₹5 lakh reserved for eligible senior members, rather than younger family members. Do not interpret this as an automatic separate ₹5 lakh allowance for every person.

Official registration channels include the NHA beneficiary portal, the Ayushman App and empanelled hospitals. Kerala residents should confirm their enrolment and treatment arrangements with the local scheme desk before planned admission.

Seniors using CGHS, ECHS or Ayushman CAPF should seek official guidance about choosing between schemes before changing their existing benefits. Source: Ministry of Health’s Vay Vandana guidance

How to Find a Participating Hospital

Use the SHA Kerala empanelled-hospital directory, which lists government and private hospitals by district.

Before travelling for planned care, call the hospital’s scheme counter and ask:

  1. Are you currently accepting patients under my scheme?
  2. Is the required specialty and treatment package available here?
  3. Is approval needed before admission?
  4. What documents should the patient bring?

A hospital appearing in the directory should not be taken as a promise that every procedure is available there. Verify the specific treatment and current arrangements.

For treatment outside Kerala, confirm portability for your beneficiary category and the receiving hospital before making travel plans.

Five Questions to Ask Before Admission

Keep this checklist on your phone:

  • Is the patient’s scheme eligibility confirmed?
  • What is the remaining annual family balance?
  • Which package is being proposed for the treatment?
  • Which medicines, tests and follow-up services are included?
  • If any payment is requested, what exactly is it for, and why is it outside the package?

Keep copies of the admission papers, approval references, discharge summary and any receipts. Do not rely on a verbal promise of reimbursement after paying privately.

For a medical emergency, seek urgent care first. Do not postpone emergency assessment while searching for a card or completing online formalities.

Checking Details Through the KASP Health App

The State Health Agency’s KASP Health app is intended to help users check scheme eligibility, available balance and empanelled hospitals by location and specialty.

Use the official Google Play listing and check that the developer is STATE HEALTH AGENCY. Avoid APK files or registration links sent by unknown people.

If the app’s information is unclear, confirm it with the hospital scheme counter.

ABHA Card and Ayushman Card Are Different

An ABHA number is a digital health identifier used for health-record services. Creating one does not itself provide free treatment or establish KASP/PM-JAY eligibility.

If you only have an ABHA card, ask the scheme help desk to check your actual treatment entitlement separately. Source: ABDM FAQ

Where to Get Help or Report a Problem

If cashless treatment is refused or unexplained charges are requested, speak to the hospital’s scheme desk first.

Note the hospital name, date, proposed procedure and reason given, then contact the relevant helpline. Request a complaint reference for follow-up. This does not guarantee approval or reimbursement.

Never publish your Aadhaar, ration-card details, medical reports or verification codes in comments or social-media groups.

Frequently Asked Questions

Does every Kerala family receive ₹5 lakh?

No. Eligibility must be confirmed under the applicable KASP/PM-JAY category. The national 70-plus extension has a separate eligibility route.

Is the ₹5 lakh limit for each person?

Under standard family coverage, it is shared by eligible family members. The senior-citizen extension has additional provisions explained above.

Does a card guarantee every treatment is free?

No. The treatment must fall within the applicable scheme arrangements, approved package and available coverage.

What should I do if my family is not eligible?

Ask the hospital’s assistance desk whether KBF or another public assistance scheme applies to your circumstances. Do not pay for a promise of guaranteed KASP enrolment.

Last reviewed: September 1, 2026.

Disclaimer: DIGIT KERALA is an independent information website, not a government agency, insurer or hospital. This guide provides general scheme information, not medical advice or a guarantee of eligibility, treatment approval or payment. Rules, enrolment arrangements and hospital participation may change. Confirm your case with the State Health Agency or the hospital’s authorised scheme desk.