Yashasvini Health Insurance Scheme:- State governments all around the nation have made continuous efforts to provide high-quality healthcare to the general public, especially the economically disadvantaged segment of the population. Due to the cost, rural workers and farmers are denied access to healthcare services. Therefore, numerous government initiatives have been developed to improve citizens’ health and lower medical costs.
The Government of Karnataka’s Yeshasvini Health Insurance Scheme is one such program. It is one of the most often used forms of health insurance for Indian farmers by the Karnataka government. Read the post below to get detailed information related to the Yeshasvini Health Insurance Scheme like Features and Benefits, Eligibility Criteria, Coverage provided, Registration, List of Medical Services Covered, Network Hospitals Included, and much more
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About Yashasvini Health Insurance Scheme
The Yashasvini Health Insurance Scheme is a community-based medical insurance program to assist employees in Karnataka’s informal economy that 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.
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.
Yeshasvini Health Insurance Scheme Administration
The administration of this program is described in full in the table below:
|Department of Cooperation||Along with keeping an eye on the entrance of beneficiaries, it reviews the total publicity needed for the program.|
|Cooperative societies||To Enroll beneficiaries in the scheme|
|Network hospitals||To Provide all medical resources to program beneficiaries, with restrictions|
|Management Support Service Provider (IRDA licensed)||oversees the resolution of claims and other administrative issues matters|
|Yeshasvini Cooperative Farmers Health Care Trust Board||Meets once every three months to discuss key policy issues and to examine the distribution of funds under the scheme.|
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.
Yeshasvini Health Insurance Scheme Financing
One of India’s largest self-funded healthcare programs is the Yeshasvini Co-operative Farmers Health Care Scheme. To receive the advantages provided by the Yeshasvini Co-operative Farmers Health Care Scheme, beneficiaries must make minor annual contributions, making it a contributory scheme. The fixed contribution for 2013–14 was Rs. 210 per year.
Yeshasvini Health Insurance Scheme Eligibility Criteria
The eligibility criteria for Yashasvini Health Insurance Scheme are given in the table below:
|Age Limit||People who are younger than 75 years old can apply for the program|
|Period||Beginning on August 1 and ending on July 31|
|Eligible members||Before the start of the scheme’s first six months, a person can join a cooperative society. Members of rural cooperative societies Members of cooperative societies for weavers Self-help organizations addressing cooperative society Beedi Workers Cooperative Societies members Fisherman cooperative society members|
|Availability||Even if they are not members of the rural cooperative society, the family members of the primary recipient are nonetheless entitled to receive benefits under this program.|
|Coverage||Karnataka Cities and Corporations’ rural areas are not covered.|
|Enrolment||The following information is provided regarding enrollment under this program: Every year, the Government of Karnataka’s Department of Cooperation releases enrolment and renewal rules. The enrollment of beneficiaries and premium collection is assisted by the Deputy Registrar of Cooperative Societies and Cooperative Development Officers, among others. The funds are sent from District Central Cooperative Banks to Apex Bank in Bangalore after being collected. In the first year, a letter was issued by the district registrar of cooperatives. Photo ID cards were distributed during the second year. Since 2008, main members have received enrollment paperwork for Unique Health Identification. Details about the primary beneficiary, his or her family, relationships, and other information are included in the enrollment form.|
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.
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|
|Neurological Surgery||Neonatal Intensive Care|
|Normal Delivery||Dog bite|
|Surgical Oncology||Accidents during operation of agricultural implements|
Yeshasvini Health Insurance Scheme Exclusions
Any of the following medical procedures are not covered by the Yeshasvini Health Insurance Scheme.
|Kidney transplant||Heart transplant|
|Diagnostic investigations||Road accidents|
|Burns||Vaccination or inoculation|
|Dialysis||Skin treatment or grafting|
|Cosmetic surgery||Cost of vitamins, or sanitary items|
|Dental surgery||Joint replacement surgery|
|Post-surgery follow-up treatment||Inpatient medical treatment|
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|
Steps to Register for Yeshasvini Health Insurance Scheme?
- The applicant must have been a member of the cooperative societies for at least three months to register for this program.
- Every year, from May to June, new enrollment for the Karnataka Yeshasvini plan is completed at all relevant corporative organizations.
Implementation Strategy for the Yeshasvini Health Insurance Scheme:
When a beneficiary visits one of the Network Hospitals, a coordinator examines the beneficiary’s UHID card, pays the enrollment fee, and approves the preliminary diagnosis. An application for pre-authorization is sent to MSP if surgery is necessary. The request is examined by experts. Subject to the established limits, the beneficiary may receive cashless treatment for any surgery. The network hospitals send the patient’s signed bill summary and other necessary papers to MSP for claims processing. The network hospitals are paid by the Yeshasvini Health Insurance Scheme Trust via MSP within 45 days after receiving the invoices.
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 in order to settle the claim.
- Within 45 days of receiving the documentation, the trust will resolve the claim with the network hospital through the MSP.