Yeshasvini Health Insurance Scheme by the Karnataka Government

Getting access to quality healthcare is a challenge for many, especially those in rural or economically vulnerable sections of society. Recognising this, the Karnataka government introduced the Yeshasvini Health Insurance Scheme to provide affordable and effective health coverage for members of cooperative societies. This blog explores every aspect of this initiative, from its benefits to its eligibility criteria, so you clearly understand how the Yeshasvini Scheme works.

What is the Yeshasvini Health Insurance Scheme?

The Yeshasvini Health Insurance Scheme is a community-driven health coverage programme designed for members of cooperative societies in Karnataka. It aims to offer financial assistance for medical expenses, making healthcare services more accessible to rural and urban cooperative society members.

The scheme operates through the contributions of cooperative society members, pooled into a fund managed by the Yeshasvini Cooperative Members Health Care Trust. This trust offers cost-effective treatment for over 1,650 medical procedures at network hospitals.

Benefits of the Yashaswini Scheme

The Yeshasvini Scheme is tailored to provide maximum benefit to its members. Here’s what it offers:

• Annual Coverage of INR 5 Lakh: Beneficiary families can avail of cashless treatment up to the revised coverage amount under the scheme’s structure.
• Extensive Medical Coverage: Covers over 1,650 procedures, including cardiac, orthopaedic, ENT, paediatric surgeries, and more.
• Discounts on Diagnostics: Members receive cost-effective rates for diagnostic tests at network hospitals.
• Cashless Claims Facility: Beneficiaries can get cashless treatments at registered hospitals by presenting their Yashaswini Card.
• Affordable Premiums: Premiums for rural members are INR 500 annually for a family of four, with INR 100 per additional member. Urban members pay INR 1,000 annually, with INR 200 for each additional member.

Also Read: Types and Benefits of Health Insurance Policies in India

Why do Rural Communities Benefit Most from the Yashaswini Scheme?

The Yashaswini Yojana is beneficial for rural populations, who often lack access to affordable health insurance plans for families.

• Affordable Premiums: With INR 500 annually for rural members, the scheme offers affordability even for low-income households.
• Wider Accessibility: Network hospitals span rural areas, eliminating the need for costly urban healthcare visits.
• Customised Benefits: Coverage for emergencies like snake bites and agricultural-related injuries addresses specific rural healthcare challenges.

This rural-centric focus makes the Yashaswini Scheme a lifeline for many families.

Features of the Yeshasvini Health Insurance Scheme

This scheme stands out because of its inclusivity and benefits tailored to the cooperative sector:

• Open to Cooperative Society Members: You must be a member of a cooperative society for at least three months, and that will qualify an individual and their family for the scheme.
• Age Restrictions: While there is no upper age limit to become a beneficiary, there is an age restriction of 75 for eligibility.
• Wide Network of Hospitals: Beneficiaries can access treatment at designated network hospitals across Karnataka.
• Inclusion of Families: Dependents such as spouses, children, and even nieces or nephews can be included under the scheme.

Coverage Offered by the Yeshasvini Scheme

The Yashaswini Scheme provides comprehensive coverage for various medical treatments, offering financial support in critical times. Below are some highlights:

• In-patient Hospitalisation: Includes surgeries, ICU charges, and pre/post-hospitalisation expenses.
• Specialised Surgeries: Covers cardiac, vascular, orthopaedic, oncology, and paediatric surgeries.
• Emergency Treatment: Addresses emergencies like snake bites, dog bites, and drowning incidents.
• Obstetrics and Gynaecology: Includes maternity care and newborn intensive care.
• General Ward Access: Members receive treatment in general wards, with optional upgrades to private wards for an additional cost.

Exclusions of the Yeshasvini Health Insurance Scheme

While the Yeshasvini Health Insurance Scheme covers a broad range of treatments, some exclusions apply:

• Cosmetic and dental surgeries unless caused by injury.
• Dialysis and transplant-related expenses.
• Road accident-related medical costs.
• Pre-existing conditions diagnosed before enrolment.

Eligibility Criteria for the Yashaswini Scheme

To enrol in the Yeshasvini Scheme, you must meet this criteria:

• Membership Duration: You must be a member of a cooperative society for at least 90 days to be eligible for the scheme. This ensures that only active participants of cooperative societies benefit from the programme.
• Age Restrictions: Members up to 75 years old can enrol; those above this age are not eligible.
• Family Inclusion: Spouses, children, parents, and other dependents can be included.
• Income Restrictions: Government or private employees earning over INR 30,000 per month are not eligible.
• Special Groups: Self-help groups (SHGs), beedi workers, weavers, and fishermen linked to cooperative societies can enrol.

Also Read: Health Insurance Plans for Diabetes Patients

How to Register for the Yeshasvini Scheme and Get a Yeshasvini Health Card?

Getting a Yeshasvini Health Card is a straightforward process that makes sure you can access the benefits of the Yeshasvini Health Insurance Scheme. This card acts as a gateway to affordable and quality healthcare at network hospitals. Here’s how you can get it:

1. Membership Requirement

• You must be a member of a recognised cooperative society under the Karnataka Cooperative Societies Act, Souhardha Sahakari Act, or Multi-State Cooperative Societies Act.
• Membership should have been held for at least three months before applying for the card.

2. Enrolment Through Cooperative Societies

• Visit your local cooperative society or self-help group (SHG) branch where you are a registered member.
• Collect the Unique Health Identification (UHID) enrolment form, which includes sections for both the primary applicant and their family members.

3. Provide Necessary Documents

Make sure you have the following documents ready:

• Proof of Membership: Certificate or proof of membership in the cooperative society.
• Aadhaar Card: For identification and address verification of all family members.
• Ration Card: To validate the family details provided.
• Photographs: Two passport-sized photographs of each member to be enrolled.
• Caste Certificate (if applicable): For eligible beneficiaries under specific categories.

4. Pay the Annual Premium

• Rural cooperative members must pay INR 500 for a family of up to four members and INR 100 for each additional member.
• Urban cooperative members must pay INR 1,000 for a family of four, with INR 200 per extra member.

5. Card Issuance

Once the documents are submitted and the premium is paid, the cooperative society will process your enrolment. After verification, you will receive your Yeshasvini Health Card, which includes details like your UHID, name, and family member details.

6. Renewal

Renew the card annually by paying the premium to continue enjoying the scheme’s benefits.

Having the Yeshasvini Card provides cashless healthcare at network hospitals, making it an invaluable resource for managing medical expenses efficiently.

How to Claim Benefits Under the Yeshasvini Scheme?

Claiming benefits under the Yeshasvini Health Insurance Scheme is designed to be a seamless process, making sure that members can focus on receiving the necessary medical care without worrying about the financial aspects. Here’s a detailed step-by-step guide:

1. Visit a Network Hospital

• Choose a Network Facility: Make sure that the hospital you visit is part of the Yeshasvini network. The list of network hospitals is extensive and includes facilities offering specialised treatments across Karnataka.
• Carry Your Yeshasvini Card: Always bring your Yeshasvini Health Card and supporting documents, such as an Aadhaar or other identification, for verification.

2. Registration at the Hospital

• Provide your Yeshasvini Card at the hospital registration desk.
• The hospital staff will confirm your details and check your eligibility for the scheme.

3. Pre-Authorisation Process

• Verification by TPA: The hospital’s Third-Party Administrator (TPA) will verify your eligibility for the scheme. This involves confirming that the scheme's guidelines covers your medical condition and treatment.
• Submit Required Documents: You may need to provide additional documents, such as medical history or diagnostic reports, to support the treatment request.
• Pre-Authorisation Request: Based on the doctor’s initial diagnosis, the hospital sends a pre-authorisation request to the scheme’s Management Services Provider (MSP). This request includes details of the proposed treatment, estimated costs, and other necessary documentation.
• Approval Timeline: The MSP typically processes the pre-authorisation request within 24 hours to ensure no delays in treatment.

4. Treatment and Cashless Facility

• Once the pre-authorisation is approved, the treatment proceeds without any upfront payment from the patient.
• The scheme covers expenses such as hospitalisation costs, surgery fees, medicines, diagnostic tests, and other approved charges directly.
• For patients opting for enhanced services, like private rooms or upgraded implants, the additional cost will need to be borne by the individual.

5. Post-Treatment Procedures

• Hospital Discharge: After the treatment, the hospital generates a final bill and sends it to the TPA for settlement.
• No Out-of-Pocket Payment (for covered services): Members can leave the hospital without paying for covered services under the scheme.

Conclusion

With a Yeshasvini health card, members can access coverage for treatment and diagnostic expenses at approved network hospitals. Along with this scheme, you can consider private health and life insurance plans for more comprehensive coverage and additional benefits. Bajaj Allianz General Insurance Company offers a range of options to ensure you and your family are fully protected.

FAQs

1. How does the Yeshasvini Health Insurance Scheme differ from other health plans?

The Yeshasvini Scheme is specifically for cooperative society members in Karnataka, offering low premiums and extensive coverage for over 1,650 procedures. Unlike standard health plans, it focuses on community-based contributions and cashless treatments at network hospitals.

2. Can urban residents enrol in the Yeshasvini Scheme?

Yes, urban cooperative society members can enrol. However, their premium rates are slightly higher than rural members, at INR 1,000 for a family of four.

3. Does the scheme cover critical illnesses?

Yes, it covers certain critical surgeries like cardiac and oncology procedures. However, specific exclusions, such as dialysis and transplant surgeries, apply.

4. How can I compare health insurance plans to choose the best one?

When comparing plans, look at premiums, coverage, and cashless claim options. The Yeshasvini Scheme is a great choice for cooperative members due to its affordability and extensive benefits.

5. Is the Yashaswini Card mandatory for treatment?

Yes, the card is essential for getting cashless treatment under the scheme. It acts as proof of membership and eligibility.

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**Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.

***The information provided is for general purposes only and is not intended as a substitute for professional advice. Please consult relevant authorities for specific concerns.