Yeshasvini Health Insurance Scheme

Yeshasvini Health Insurance Scheme

State governments across the country have been taking additional steps to improve the overall health of common people, especially the economically deprived section of society, like farmers, who are deprived of healthcare services owing to the affordability factor. Hence, to safeguard the health of farmers, the Karnataka Government has launched the Yeshasvini Health Insurance Scheme. The scheme provides health insurance coverage to farmers amidst the adverse financial crisis. The former Chief Minister of Karnataka, S.M. Krishna, launched this medical insurance scheme on 14th November 2002. However, its actual implementation started in 2013. Since then, farmers have been allowed to enroll under this scheme and avail of its benefits from network hospitals. The Department of Cooperatives implements this scheme in partnership with the Government of Karnataka. It uses the capital raised by cooperative societies via the Yeshasvini trust so that rural informal workers can enjoy required healthcare facilities at a reduced cost.

Eligibility Criteria for Yeshasvini Health Insurance Scheme

Here is a list of prerequisites that one must meet in order to sign up for this health insurance scheme.

  1. Co-operative Society members enrolled under the Karnataka Co-operative Societies Act, 1957, Karnataka Souhardha Sahakari Act, 1997, or Multi-State Co-operative Societies Act, 2002, can take advantage of the Yeshasvini Health Insurance Scheme.
  1. People enrolled under self-help groups set up by the District Central Co-operative Banks/Primary Agriculture Co-operative Societies are eligible.
  1. Co-operative Societies or rural self-help groups members can register under this health insurance scheme.
  1. Co-operative Society members who are beedi rollers, weavers, and fishermen by profession are eligible.
  1. One must not be a resident of Karnataka Cities and Corporations’ rural areas.
  1. There is no upper age limit to being a beneficiary.
  1. Family members of people registered under the above-mentioned Co-operative Societies are eligible.
  1. One member of the family must spend at least 3 months as a member of the mentioned Co-operative Societies so that the family becomes eligible for the Yeshasvini Health Insurance Scheme.

Benefits and Features of the Yeshasvini Health Insurance Scheme

Before purchasing the Yeshasvini Health Insurance Scheme, let’s first understand some of its salient features and various advantages that one can enjoy.

  • Availability: This scheme is available only in Karnataka and covers the entire state.
  • Contribution Charges or Premium: Every beneficiary of this scheme has to pay a fixed annual member contribution fee. The last updated contribution amount for Rural Yeshasvini is Rs. 300, and that for Urban Yeshasvini is Rs. 710.
  • Enrollment Period: Every year, enrollment under this scheme remains open from July to October.
  • Since 2008, applicants have been provided with Unique Health Identification enrollment forms comprising the details of the main beneficiary and his/her family members, which act as proof of enrolment.
  • Operational period: The individuals enrolling within the mentioned period can avail of its benefits any time between 1st June and 31st May of the following year.
  • This scheme offers cashless benefits against approximately 823 surgical procedures at network hospitals, including general surgery, ophthalmology surgery, cardiac and cardiothoracic surgery, pediatric surgeries, genitourinary surgeries, orthopedic surgeries, neurosurgery, vascular surgery, surgical gastroenterology, angioplasty, and surgical oncology.
  • The scheme sets a fixed tariff to be paid by the insured against specific procedures, which is 40%-50% lower than the hospitals’ regular tariff.
  • Beneficiaries can also get specific diagnostic tests done at rebated prices under this insurance plan.
  • One can also avail of hospital stays at discounted rates at certain network hospitals under this scheme.
  • Medical emergencies like accidents caused while operating agricultural equipment, electric shocks, snake bite, dog bite, and drowning will also be covered.
  • Other procedures requiring hospital stays like gynecology and obstetrics, normal delivery, and neonatal intensive care will be taken care of by the scheme.
  • Rural Yeshasvini members can avail of coverage up to Rs. 1.25 lakh- Rs. 2 lakhs, while urban member can claim for treatment cost up to Rs. 1.75 lacks in case of single hospitalization and Rs. 2.50 lakh in case of multiple hospitalizations.

What is Yeshasvini Cooperative Farmers Health Care Trust?

Yeshasvini Cooperative Farmers Health Care Trust is a financial trust that ensures seamless implementation of the health insurance scheme. The Chief Minister of the state of Karnataka is the chief patron of the trust, along with the Ministry of Cooperation as a contributor. The trust’s governing body also consists of renowned doctors, 5 senior officers, and a principal secretary. To deliver the mentioned benefits to individuals who are a part of the scheme, Karnataka Government also makes significant contributions to the funds

Guidelines are issued for enrollment and monitoring of the scheme by the Department of Cooperation under the Government of Karnataka. The Registrar of Cooperative Societies and Cooperative Development Officers take care of the enrollment process and contribution collection. The premium amount collected is sent to the District Central Cooperative Banks, which transfers the amount to the Apex Bank of Bangalore. The collected premium amount is then utilized to finance the medical coverage required by the policyholders.

Exclusions Under Yeshasvini Health Insurance Scheme

The Yeshasvini health care scheme does not cover any of the following medical requirements.

  • Cosmetic surgeries like implants, skin grafting, prosthesis, etc.
  • Other surgical procedures include heart transplant, kidney transplant, dental surgery, and joint replacement surgery.
  • Treatment for autoimmune diseases, chemotherapy, and inpatient medical treatment
  • Follow-up treatment post-surgery
  • Road accidents
  • Diagnostic investigations
  • Burns
  • Dialysis
  • Vaccination or inoculation
  • Cost of tonics, vitamins, or sanitary items

How To Register Online For Yeshasvini Health Insurance Scheme?

Individuals who are members of a cooperative society for a minimum duration of 3 months can register for the scheme. From May to June, registration of new members and renewal of existing ones is done at all cooperative societies. The local cooperative society signs up a member, issues a receipt, and deposits the premium amount before the commencement of the plan year. The main member receives a Unique Health Identification (UHID) form, which needs to be furnished while seeking healthcare services.

Documents Required:

The following documents are usually required to register for the Yeshasvini Health Insurance Scheme.

  • Age proof
  • Rural or urban co-operative societies certificate
  • Address Proof
  • Caste certificate

How To Get Yeshasvini Health Insurance Card?

Given below are the steps to get a Yeshasvini Health Card:

  • Visit https://sahakara.kar.gov.in/Societies&Associations.html.
  • Click on the ‘Register for the Cooperative Society’ option.
  • Next, click on the ‘Apply Online for Yeshasvini Health Card’ link.
  • Enter all the details on the online registration form and click on ‘Submit’.
  • Once the submission is made, you will get your User ID and Password.
  • Go to the ‘Home Page.’
  • Login to the portal using the necessary credentials.
  • After that, you will be redirected to the Yeshasvini Health Card form.
  • Fill out the form and click the ‘Submit’ button to get your card.

What is the Claim Procedure of the Yeshasvini Health Insurance Scheme?

To avail of the benefits of the Yeshasvini Health Insurance Scheme, an individual should approach its network hospital and follow the given procedures:

  • The beneficiary has to visit a network hospital.
  • The Coordination Officer of this hospital will check if the patient is a Yeshasvini beneficiary and if the required treatment/surgery is covered under the scheme.
  • Once confirmed, the patient must undergo a few medical tests for an initial diagnosis.
  • Based on the initial diagnosis, the network hospital will share a pre-authorization request online with supporting documents to the MSP (Management Services Provider).
  • The MSP will then verify the request shared by the hospital. Approval for the request shall be given within a day.
  • Once approved, the doctors at the network hospital can commence the treatment.
  • Post verification, the MSP shall send the payment to the hospital.

Frequently Asked Questions

Here is a list of people who are not eligible to register for the Yeshasvini Health Insurance Scheme.

  • Married daughters who are not members of the specified Co-operative Societies and live outside the jurisdiction of this health scheme are not eligible for this benefit.
  • Members of the Employees’ Co-operative Society are not eligible.
  • Members of liquidated or defunct Co-operative Society are not eligible.
  • Employees of the government sector or a private company that draws salary cannot apply.

Nearly 900 hospitals across several districts in Karnataka are part of the Yeshasvini Health Insurance Scheme network and offer benefits under the Yashasvini Card facility. Bangalore (urban) has the highest number of hospitals at 61, followed by Belgaum at 49, Bagalkot at 44, Tumkur at 27, Dakshina Kannada at 26, and Mandya at 25.

The Ayushman Bharat Yojana allows its beneficiaries to enroll in the Yeshasvini Health Insurance Scheme. However, only one of these schemes can be used for making claims, and multiple claims for one medical event are not permitted.

An individual should be below 75 years of age to avail of the Yeshasvini Health Insurance Scheme benefits.

For SC/ST families, the government will pay the premium amount. Members of Rural Co-operative Societies or SHGs must pay a premium of Rs. 500 for a family of four members and Rs. 100 each for the fifth member onwards. Members of Co-operative Societies in urban areas must pay a premium of Rs. 1,000 for a family of four members and Rs. 200 each for the fifth member onwards.

Enrollment in this scheme is open from 01, November 2022. Members can apply for the scheme benefits from this date. Individuals who enlist during the specified period can take advantage of its benefits starting from 01, January 2023.

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