Yeshasvini Health Insurance Scheme

What is Yeshasvini Health Insurance Scheme?

Yeshasvini is a self-funded scheme that offers coverage to informal workers in the lower-middle and middle-income groups of Karnataka. It was launched on November 14, 2002 by S.M. Krishna, the former CM of Karnataka to ensure health coverage is accessible to farmers and peasants as well. The scheme provides medical facilities at a reasonable cost to farmers across the state with the help of cooperative societies registered with the Karnataka Department of Cooperation.

In this article, we explore the Yeshasvini Health Insurance Scheme in detail.

Features and Benefits of Yeshasvini Health Insurance Scheme

Here are the key features and benefits of the Yeshasvini Health Insurance Scheme:

• Benefits of the scheme apply to the family of a rural co-operative society member.

• A fixed amount needs to be contributed by the beneficiaries annually. ₹300 was the yearly member contribution for the Rural Yeshasvini Scheme and ₹710 for Nagara Yeshasvini Scheme for 2017-18.

• Members of self-help groups, weavers, fishermen cooperative societies, ‘beedi’ workers, and Stree Shakti groups qualify for Yeshasvini card facility.

• The scheme offers coverage for 800+ procedures.

• Yeshasvini Health Insurance can be availed by a newborn baby as well as by anyone below the age of 75 years.

What is Yeshasvini Cooperative Farmers Health Care Trust?

The Yeshasvini Cooperative Farmers Health Care Trust aims to ensure efficient implementation of the Yeshasvini scheme. The governing body of the trust consists of senior doctors across the state and senior officers reporting to the Principal Secretary of the Department of Cooperation.

Eligibility Criteria for Yeshasvini Health Insurance Scheme

To be eligible for Yeshasvini Scheme coverage, the following criteria must be met:

• An individual can become a member of a cooperative society six months before the starting of the scheme. These include members of rural co-operative societies, weavers’ cooperative societies, self-help groups dealing with cooperative societies, beedi workers’ cooperative societies, and fishermen cooperative societies.

• Individuals should not belong to rural areas of cities and corporations in the state.

• Family members can also avail benefits of the Yeshasvini card even if they are not members of a rural co-operative society.

Enrolment and renewal guidelines are issued by the Department of Cooperation, Government of Karnataka. For premium collection, assistance is provided by the Deputy Registrar of Cooperative Societies and Cooperative Development Officers. The final amount collected is transferred to District Central Cooperative Banks, who, in turn, send it to the Apex Bank, Bangalore.

Coverage of Yeshasvini Health Insurance Scheme

Close to 30 lakh beneficiaries across 30 districts in Karnataka benefit from health insurance coverage through the Yeshasvini card. The scheme covers 823 procedures, some of which include:

• Cardiac, cardiothoracic, orthopaedic, paediatric, and general surgery

• Ophthalmology, genito-urinary and neurological surgery

• Neonatal intensive care, gynaecology, obstetrics

• Surgical oncology, gastroenterology, and vascular surgery

• Dog bites, snake bites, and drowning

• Accidents during operation of agricultural implements such as electrical shocks

Exclusions Under Yeshasvini Health Insurance Scheme

Some of the procedures excluded under the Yeshasvini card scheme include:

• Diagnostic investigations, follow-up treatments, and medico legal cases

• Burns, implants, prosthesis, skin grafting, and cosmetic surgery

• Chemotherapy, autoimmune diseases, and in-patient medical treatment

• Deviated nasal septum and dental surgery

• Joint replacement surgery, kidney and heart transplant

• Dialysis and road traffic accidents

How to Register for Yeshasvini Health Insurance Scheme Online?

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 for Yeshasvini Health Insurance Scheme

The following documents are required to enrol for the Yeshasvini Health Insurance Scheme:

• A certificate that proves the applicant is a member of Rural or Urban Cooperative Societies

• Age proof

• Address proof

How to Get the Yeshasvini Health Card

Initially, when the Yeshasvini Health Scheme was launched, beneficiaries were provided with a Yeshasvini Health Card, which signified the individual’s association with the scheme. However, from 2008-2009, the card was replaced with a Unique Health Identification form. The Yeshasvini Health Scheme UHID form contains details like name, age, relationship, etc. of the main member and his/her family.

How to Claim Yeshasvini Health Insurance Scheme

The implementation procedure of the Yeshasvini Health Insurance Scheme is as follows:

1. The beneficiary has to visit a network hospital.

2. 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.

3. Once confirmed, the patient must undergo a few medical tests for initial diagnosis.

4. Based on the initial diagnosis, the network hospital will share a pre-authorisation request online with supporting documents to the MSP (Management Services Provider).

5. The MSP will then verify the request shared by the hospital. Approval for the request shall be given within a day.

6. Once approved, the doctors at the network hospital can commence the treatment.

7. Post verification, the MSP shall send the payment to the hospital.

Number of Network Hospitals Under the Scheme

While there is no official figure, nearly 900 hospitals across several districts in Karnataka are a part of the network of Yeshasvini Health Insurance Scheme and offer benefits under the Yeshasvini Health 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 Yeshasvini Health Insurance Scheme covers various surgical procedures at pre-negotiated rates with network hospitals. As such, the beneficiary can avail cashless treatment using the Yeshasvini card per the prescribed limits. Normal delivery, neonatal care, dog and snake bites, electric shocks, accidents such as drowning are covered under the scheme.

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