Karnataka Yeshasvini Health Insurance Scheme 2024
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Karnataka Yeshasvini Health Insurance Scheme 2024
The Yashasvini Health Insurance Scheme is a community-based medical insurance program to assist employees in Karnataka’s informal economy who fall into the middle and lower-middle income brackets. S.M. Krishna, a former chief minister of Karnataka, introduced the Yeshasvini Health Insurance Scheme in 2003 to provide complete coverage to farmers who are members of the state cooperative organizations. This program is carried out in collaboration with the Government of Karnataka by the Department of Cooperatives. It makes use of the money earned by cooperative societies through the Yeshasvini trust to provide the rural unorganized workers with affordable access to the necessary healthcare facilities.
karnataka yeshasvini health insurance scheme 2024
The Yeshasvini Cooperative Health Care Trust, which is registered under the Indian Trust Act of 1882, oversees the program that provides coverage to people in more than 30 districts of Karnataka.
Benefits of the Yeshasvini Health Insurance Scheme
Here are the benefits offered by the Yeshasvini Health Insurance Scheme.
- Rs. 5 lakh sum insured: The Yeshjasvini Health Insurance Scheme offers an annual sum insured of Rs. 5 lakh. Insured members can also avail cashless facilities in any of the network hospitals.
- Wide number of diseases covered: The health insurance scheme provides cashless claim benefits for 1,650 diseases at select network hospitals.
- Discounts on treatment costs: One of the major advantages of this scheme is the fixed cost for certain medical treatments that are significantly lower than the standard costs.
- Discounts on diagnostic tests: The costs of diagnostic tests are usually excluded from health insurance claims. However, the beneficiaries of the Yeshasvini Health Insurance Scheme can undergo these tests at a discounted rate.
- Availability for cashless claims: The Yeshasvini scheme allows members to access treatment at network hospitals without paying upfront. You just show your card and the hospital bills the scheme directly. It’s super convenient not to handle payments during a health crisis.
Features and Benefits of the Yashasvini Health Insurance Scheme
Some of the main Features and Benefits of the Yashasvini Health Insurance Scheme are as follows:
- The entire state of Karnataka is covered by this program, which is only offered there.
- Under this insurance plan, beneficiaries can also receive discounted rates for several diagnostic tests.
- For at least three months, you must be a member of the Karnataka Rural Co-operative Society to be eligible for the benefits of this insurance plan. You will then become the key player.
- Enrollment is available under this program from July through October each year.
- Under this program, you can also take advantage of hospital stays at reduced costs at several network hospitals.
- A person’s maximum age to purchase the policy for a newborn child is 75 years old.
- Those who enlist during the specified time may use the benefits at any point between 1 June and 31 May of the succeeding year.
Network Hospitals Included in Yeshasvini Health Insurance Scheme
According to the Yeshasvini Co-operative Farmers Health Care Scheme, there are around 572 network hospitals. The number of network hospitals in Karnataka is displayed in the table below.
| District Name | Number of network hospitals |
| Hassan | 20 |
| Dakshina Kannada | 26 |
| Belgaum | 49 |
| Haveri | 16 |
| Raichur | 11 |
| Bangalore Rural | 7 |
| Davanagere | 21 |
| Chitradurga | 12 |
| Ramanagar | 11 |
| Bellary | 8 |
| Chikkaballapura | 8 |
| Dharwad | 19 |
| Bangalore Urban | 61 |
| Mysore | 22 |
| Gulbarga | 16 |
| Bidar | 11 |
| Gadag | 6 |
| Bijapur | 23 |
| Mandya | 25 |
| Kolar | 11 |
| Koppal | 8 |
| Udupi | 22 |
| Chamrajnagar | 4 |
| Bagalkote | 44 |
| Chikkamagalur | 7 |
| Kodagu | 5 |
| Shimoga | 22 |
| Uttara Kannada | 18 |
| Tumkur | 27 |
Coverages offered by Yeshasvini Health Insurance Scheme (YCFHS)
As mentioned earlier, the Yeshasvini Health Insurance Scheme offers coverage for more than 1,600 medical procedures. Following are the types of medical treatment that the insured members can avail of.
- Cardiac, orthopaedic, general, and paediatric surgery
- Ear, nose, throat diseases
- Surgical oncology, vascular surgery, and gastroenterology
- Ophthalmology, neurosurgery, and genito-urinary medicine
- Drowning, dog bites, snake bites, and so on
- Treatment for electrical shocks suffered when operating agricultural implements
- Obstetrics, gynaecology, and newborn intensive care
The Yeshasvini Health Insurance Scheme includes the cost of medicines, in-patient hospitalisation, surgery cost, operation theatre rent, anaesthetist fees, surgeon fees, consultant fees, bed charges, nurse fees, etc. Members are eligible for treatment in the General Ward of a hospital. For out-patient treatment (OPD), a limit of Rs. 200 (for a period of three months) can be claimed under the scheme. OPD treatment can be availed at any of the network hospitals.
Exclusions of the Yeshasvini Health Insurance Scheme
Yeshasvini Health Insurance Scheme does not cover you for the expenses incurred on the following.
- The cost of follow-up treatments
- Dental surgery
- Medico-legal cases
- Implants
- Deviated nasal septum surgery
- Skin grafting
- Burns
- Cosmetic surgery
- The cost of prosthesis
- Dialysis
- Road accidents
- Joint replacement surgery
- The expenses related to kidney and heart transplant surgeries
Who is not eligible for the Yeshasvini Health Insurance Scheme?
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 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.
Documents Required
The documents required for the Yashasvini Health Insurance Scheme are as follows:
- Age proof
- Address Proof
- A document attesting to a person’s membership in rural or urban cooperative societies
Coverage Provided by the Scheme
Farmers can receive coverage up to Rs. 2.5 lakh under the Yeshasvini Health Insurance Scheme for an annual premium payment of no less than Rs. 250. Farmers who participate in this program are covered for family members’ medical crises.
Implementing Steps for the Yashasvini Health Insurance Scheme
The Yeshasvini Health Insurance Scheme is being implemented by 730 network hospitals with ties to the trust. Both public and private hospitals are included. The trust authorizes the network hospitals to provide medical services under the empanelment standards. Through these 730 network hospitals, the Management Support Service Provider (MSP) makes arrangements for cashless hospitalization. The following steps are involved in implementing the Yeshasvini Health Insurance Scheme:
- A network hospital that the trust recognizes and authorizes is visited by the Yeshasvini beneficiary.
- A network hospital coordinating officer will check the beneficiary’s UHID card.
- The enrolling party is required to pay a charge.
- The patient must then go through an initial diagnosis and a few fundamental medical tests.
- The network hospital will submit an online pre-authorization request to the MSP with supporting documentation based on the initial diagnosis.
- The request will be examined by doctors chosen by the MSP, and approval will be issued the next day.
- The network hospital will offer the beneficiary cashless treatment while taking into account the restrictions outlined in the program.
- The network hospital will send the MSP the original invoices, discharge summary, and other medical records after the patient is discharged to settle the claim.
- Within 45 days of receiving the documentation, the trust will resolve the claim with the network hospital through the MSP.
How to get a Yeshasvini Health card
You can get the Yeshasvini Health Insurance Scheme card in the following manner.
- Any Co-operative Societies can register new members for the scheme and renew existing members. Here they issue a receipt and deposit the premium in a nearby Co-operative bank. The Co-operative Society also provides a UHID (Unique Health Identification) enrollment form.
- Each enrollment form provides information about the primary member and his or her family members, including the primary member’s name, age, relation, society membership number, enrollment date, and photo.
- Once all the information is processed, the society will issue the Yeshasvini Health Card.
How to claim Yeshasvini Health Scheme
Here is how to claim Yeshasvini Health Scheme.
- The patient must go to one of the network hospitals.
- If the patient is a Yeshasvini beneficiary, the Third Party Administrator (TPA) of this hospital will confirm that the necessary treatment/surgery is covered by the scheme. Once confirmed, the patient must go through medical testing.
- The network hospital will share a pre-authorisation request with supporting papers to the Management Services Provider (MSP) online based on the initial diagnosis. After that, the MSP will confirm the request that the hospital shared. The request should get approved within a day.
- The doctors at the network hospital can start the treatment after it has been approved. The MSP will then pay the hospital after verification.
List of Medical Services Covered by Yeshasvini Health Insurance Program
The Yeshasvini health program was put into place for the members of Urban & Rural Co-operative Societies, and it covers the following fees for surgery and treatment:
| General Surgery | Gynecology Surgery |
| Orthopedic, Pediatric, cardiothoracic Surgery | Cardiac Arrest |
| Vascular Surgery | Obstetrics |
| Neurological Surgery | Neonatal Intensive Care |
| Normal Delivery | Dog bite |
| Ophthalmology Surgery | Drowning |
| Genito-urinary Surgery | Snakebite |
| Surgical Oncology | Accidents during operation of agricultural implements |
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