Yeshasvini Health Insurance Scheme by Karnataka Government

As per the Population Census, approximately 61.33 per cent of the population in Karnataka resides in its rural villages. Rural workers in the informal sector, relatively farmers, are often deprived of adequate access to medical services as opposed to the employees working in the formal sectors.
 

The Yeshasvini Health Insurance Scheme aims to offer extended healthcare benefits to such farmers and cooperative members of the informal working sectors in Karnataka. 
 

Do you wish to know how the health scheme can benefit you? This guide outlines all information related to the Yashaswini health scheme, benefits, features coverage, exclusions, eligibility, registration and so on.

What is the Yeshasvini Health Scheme?

The Yeshasvini Health Scheme is the first cooperative medical insurance scheme introduced by the Government of Karnataka. It aims to provide quality healthcare and medical treatment to the cooperative members with low or middle-class incomes in Karnataka.
 

The scheme was first launched in the year 2003 to impact the resource-poor healthcare facilities and economic well-being across the state. 
 

The main purpose of this scheme lies in providing low-cost medical services and maximising healthcare utilisation in Karnataka. The Yeshasvini scheme also extends healthcare facilities to cooperative weavers, fishermen, Beedi workers and Stree Shakti groups.

Benefits of the Yeshasvini Health Scheme

Enlisted below are the main benefits offered under the Yeshasvini Health Insurance:
 

1. Wide range of medical procedures covered: More than 1650 medical procedures are included in the Yeshasvini scheme. It also covers around 823 surgical procedures mentioned in the benefit package.

2. Availability for cashless claims: The patient is not required to manage the payment or billing process. The insurer directly pays the healthcare provider, i.e. any Yeshasvini scheme hospital for pre-approved surgeries. 

3. Up to ₹5 lakhs sum insured: The annual medical coverage for a family of five members which lies Below the Poverty Line is fixed at ₹5 lakhs. 

4. Covers extensive treatment charges: The Yeshasvini scheme facilities in the network hospitals cover many types of charges, including medicine costs, hospital costs, surgery costs, operation theatre rent, bed charges, consultation fees, anaesthetic fees, nurse charges, etc.

5. Beneficiary discount on treatment and diagnostic tests: The Yeshasvini scheme provides medical procedures at discounted rates as compared to the general hospital charges. Apart from the treatment costs, the scheme also offers discounts on patient diagnosis and lab tests. 
    

Treatment Coverage Under the Scheme

Below is a list of specialities offered under the benefit package of the Yeshasvini Health Scheme:
 

• General surgery, Neurosurgery, and Polytrauma

• Cardiology, Cardiovascular surgery, and Cardiothoracic surgery

• Obstetrics and Gynaecology

• ENT (Ear, Nose, Throat) Infections/Diseases

• General Medicine

• Mental Disorder Packages

• Neonatal and Paediatrics

• Ophthalmology, Urology and 

• Medical, Surgical and Radiation Oncology

• Orthopaedics 

Exclusions Under the Yeshasvini Scheme

Some treatments that are excluded from any aid under the Yeshasvini Health scheme are as follows:
 

• Burns

• Transplants

• Vaccination

• Follow-up treatment

• Dental surgery

• Dialysis 

• Spectacles, hearing aids

• Skin grafting for wounds

• Biopsies

• Road Traffic Accidents

• Angioplasty

• Implants including valves, grafts, mesh, nails, screws

• Joint replacement surgeries 

• Any other expenditure not related to hospitalisation with surgery.

Features of the Yeshasvini Health Insurance Scheme

1. Amount of Fee Contribution

   • To benefit from the insurance scheme, rural cooperative members need to pay an annual allowance of ₹500 per family of four members. For a family with more than four members, an additional 20 per cent, i.e. ₹100, is required for the fifth member onwards. 

   • Families living in the urban cooperative societies must make an annual contribution of ₹1000 per family of four members. Similar to rural-cooperative societies, an additional 20 per cent i.e. ₹200 is required for each member in a family of more than four members. 

   • Families belonging to the SC/ST caste do not need to pay the premium cost as it is borne by the government. 

   • You can also avail up to 200 rupees for outpatient department (OPD) services when seeking care at network hospitals. Network hospitals are prohibited from levying charges exceeding this amount.

2. Registration Period: Members can join this scheme starting on November 1, 2022, and can begin applying for its benefits on that date.

3. Operational Duration of the Scheme: Individuals who sign up within the designated time frame can start enjoying the scheme’s advantages beginning on January 1, 2023.

What are the Eligibility Criteria for the Yeshasvini Health Scheme?

Every member of cooperatives and their family members are eligible to participate in the insurance program. Below is the detailed information on the eligibility criteria for the health insurance.
 

1. Age: There is no specific age requirement to qualify for the benefits of the Yeshasvini Scheme.

2. Membership duration: To qualify for the health scheme, at least one family member needs to be a member of the specified cooperative Societies for a minimum duration of three months.

3. Details of member groups who are eligible:

   • Cooperative society members enrolled under the Karnataka Cooperative Societies Act, 1957, Karnataka Souhardha Sahakari Act, 1997, or Multi-State Cooperative Societies Act, 2002

   • Cooperative society or rural self-help group members.

   • Individuals enrolled under self-help groups set up by the District Central Cooperative Banks/Primary Agriculture Cooperative Societies.

   • Cooperative society members are Beedi rollers, weavers, and fishermen.

How to Register for the Yeshasvini Health Insurance Online

Registration for this program is open annually, from July to October, at all eligible cooperative organisations. Applicants should have been affiliated with the cooperative societies for a minimum of three months. After meeting this requirement, you can proceed to the official website of the Yeshasvini Health Insurance Scheme and complete the registration process.
 

Documents Required for Registration

Generally, the Yeshasvini Health Insurance Scheme necessitates the submission of the following documents for registration:
 

• Proof of age 

• Certificate from rural or urban cooperative member societies

• Proof of residential address

• Caste certificate

How to Get a Yeshavini Health Card?

Any local cooperative society is a medium for enrolling new members and their information on the health insurance scheme. Members must pay a premium and submit a photograph to the nearest cooperative bank. In exchange, they will receive a receipt. 
 

The cooperative society may also provide a Unique Health Identification (UHID) registration form. The registration process requires submitting individual details such as name, address, Aadhar card number, society membership number (if applicable) etc., along with photographs of family members. 
 

Following the enrollment, the Family Health Plan Insurance Limited (FHPL) registers all members in their system and issues the ID card with the member’s photograph.
 

Note: The cardholders of the Yeshasvini Health scheme are eligible for treatment at the network hospitals after 15 days of receiving the Yeshasvini Health card.

Step-by-Step Guide to the Claim Process of the Yeshasvini Health Scheme

1. Locate the nearest network hospital for your medical treatment.

2. A medical coordinator or Third Party Administrator (TPA) at the hospital will review your health card. The main responsibility of the TPA is to facilitate communication between the patient, the healthcare provider, and the insurance scheme.

3. Next, the TPA will confirm if the required treatment or surgery is covered under the scheme.

4. Upon confirmation, pay the enrollment fee (if applicable) for pre-diagnostic and medical tests related to your illness.

5. Based on the doctor's initial diagnosis, a request for approval is forwarded to the Management Support Service Provider if surgery is necessary.

6. After verification, the patient is approved for cashless treatment per the scheme's coverage.

7. Once discharged from the hospital, the patient's medical bills, discharge summary, and other essential documents are sent to the Management Service Provider (MSP) for processing the claim.

8. Ultimately, the Yeshasvini Health Insurance Scheme trust settles the health insurance claim, and the hospital receives the funds.
    

Wrapping Up

The Yeshasvini Health Scheme is a medical insurance scheme launched by the Government of Karnataka, which can be availed by the cooperative members. The Yeshaswini health card holders benefit from an insured sum for treatment and diagnostic costs at the listed network hospitals.
 

In addition to the Yeshasvini Scheme, you can opt for standalone health and life insurance plans offered by private insurance providers for all-round coverage and added benefits.