A guide to the Yeshasvini Health Insurance Scheme

• The Yeshasvini Health Insurance Scheme is a low-cost medical insurance scheme for low to middle income families
• The scheme covers eligible members of co-operative societies and their families
• Coverage of up to ₹5 lakhs is available for 1650 medical treatments and 823 surgeries on a cashless basis
• You can enroll under the scheme online and get a Yeshasvini Health Card which serves as your identity proof
• To claim, visit the nearest networked hospital, present the Yeshasvini Health Card and get cashless treatments if the claim is approved

Medical expenses are rising consistently. In such cases, it becomes difficult for the economically weaker sections of the society to afford quality healthcare. The Karnataka Government understands this and has launched a health insurance scheme called the Yeshasvini Health Insurance Scheme. Through this scheme, the government aims to provide quality and affordable healthcare to all.Let's understand what the scheme is all about.

The Yeshasvini Health Insurance Scheme is a cooperative medical insurance scheme launched by the Karnataka Government. The scheme provides health insurance coverage at affordable premiums to low or middle income families in Karnataka.The government launched the scheme in 2003 with a view to providing quality healthcare facilities to the unorganised sector of the State. The Yeshasvini scheme covers cooperative weavers, Beedi workers, fishermen, and Stree Shakti groups.In November 2002, the then Chief Minister of Karnataka introduced the Yeshasvini Health Insurance Scheme . However, it was implemented in June 2003. Since its launch, the scheme has allowed eligible individuals to enrol and enjoy affordable health insurance coverage. Also Read: Health Insurance: Advantages, Disadvantages, and Important Considerations

The vulnerable sections of Karanataka do not have the financial means to get medical treatments for their illnesses or injuries. Per the latest Census, 61.3% of the State's population were found to live in rural areas.
To promote healthy living among such rural farmers, peasants and unorganised workers, the Karnataka Government introduced the Yeshasvini Health Insurance Scheme .

Features of the Yeshasvini Health Insurance Scheme

Given below are the salient features of the Yeshasvini Scheme -

• Wide range of surgical procedures The members and their families are covered by a wide range of surgical procedures, including cardiac surgeries, orthopedic surgeries, radiation oncology, orthopaedics, neuro surgeries, and more.
• Contribution fees Members of rural co-operative societies need to pay a premium of ₹250 annually per insured member. Similarly, the members of urban co-operative societies must pay a premium of ₹710 per year.
• Subsidy for SC/ST The Karnataka government offers a premium subsidy of up to ₹600 for families belonging to the SC/ST category.
• Online enrolment Eligible members can enroll in the scheme online through the official website or authorised centers located across Karnataka.
• Enrolment period The enrolment or registration in the scheme is open from January or February and closes by 31st May.
• Operation Period Members enlisted during the enrolment period can enjoy the benefits of the scheme beginning from 1st June and ending on 31st May.
• OPD Services The members of the scheme can also avail of outpatient department (OPD) services for up to ₹200 at a Yeshasvini Card hospital .

Benefits of the Yeshasvini Health Insurance Scheme

Check out the benefits which the Yeshasvini Health Insurance Scheme provides -

• Optimal coverage The Yeshasvini scheme offers insurance coverage of up to ₹5 lakhs which is optimal to cover major treatments and surgeries. Moreover, with a wide range of illnesses and treatments covered, the scheme provides affordable healthcare facilities.
• Affordable The Yeshasvini scheme is a self-funded scheme wherein the premiums are exceptionally low. This makes the scheme pocket-friendly.
• Low-cost treatments Insured members can enjoy fixed rates of specific treatments. These rates are lower than normal treatment rates making such treatments cost-effective.
• Cashless facility You can get cashless hospitalisation across a vast network of hospitals across the State. This frees you from the financial burden of hospitalisation and the subsequent medical attention.
• Discounted diagnostics You can enjoy discounts on diagnostic tests and save money on pre-hospitalisation expenses.

Also Read: Tips to Choose the Health Insurance Plan in India

The Yeshasvini Health Insurance Scheme provides coverage for 1650 medical treatments and 823 surgical procedures. The specialties covered under the scheme are as follows -

• General surgery
• Cardiovascular surgery
• Polytrauma
• Cardiology
• Neurosurgery,
• Cardiothoracic surgery
• Obstetrics and Gynaecology
• General Medicine
• ENT (Ear, Nose, Throat) Infections/Diseases
• Neonatal and Paediatrics
• Ophthalmology
• Mental Disorders
• Urology
• Surgical, Medical and Radiation Oncology
• Orthopaedics

The coverage level is ₹5 lakhs for a family of five.

While the Yeshasvini Health Insurance Scheme provides a comprehensive scope of coverage, it has specific exclusions too. Some of the commonly excluded treatments and procedures are as follows -

• Organ transplants
• Burns
• Follow-up medical treatment
• Vaccinations
• Dental surgeries
• Spectacles, lenses, or hearing aids
• Skin grafting required for wounds
• Dialysis
• Biopsy
• Injuries sustained in road accidents
• Angioplasty
• Medical implants which includes valves, mesh, grafts, screws, nails, etc.
• Joint replacement surgeries and treatments

Not every resident of Karnataka can enroll under the Yeshasvini Health Insurance Scheme . The scheme specifies a list of eligibility criteria and members fulfilling the specified criteria can enroll. Check out the eligibility parameters to assess whether you can enroll for the scheme -

• Members enrolled under the Karnataka Cooperative Societies Act, 1957
• Members enrolled under the Karnataka Souhardha Sahakari Act, 1997
• Members enrolled under the Multi-State Cooperative Societies Act, 2002
• Members of a cooperative society
• Members of rural self-help groups
• Members enrolled under self-help groups established by the District Central Cooperative Banks/Primary Agriculture Cooperative Societies.
• Members of a cooperative society who are Beedi rollers, fishermen, and weavers

• Age limit The scheme does not have a minimum age limit to enroll. However, the maximum age limit is 75 years. You should be less than 75 years to qualify for enrollment.
• Membership of co-operative society Individuals who are existing members of specified co-operative societies can enroll for the Yeshasvini scheme . Family members of eligible individuals can also enroll under the scheme for the health insurance coverage.Member groups who are eligible for the scheme are as follows -
• Residential address You should live in a rural area which does not fall under Karnataka City and corporation limits.
• Family members Family members of the primary insured can also be covered under the scheme. Five members, including the primary member, spouse, children, parents, nieces, and nephews, can be covered. However, married daughters will not be eligible under the scheme.

Also Read: How To Upgrade Health Insurance Coverage?

You can register to get coverage if you are eligible for the Yeshasvini Health Insurance Scheme. The registration is opened yearly between July and October at eligible cooperative organisations.To qualify for registration, you should be a member of the eligible cooperative society for at least three months. To register, visit the official government website at https://sahakarasindhu.karnataka.gov.in/page/YESHASVINI/en . Complete your registration by providing the necessary information.The registration process is as follows -

• Eligibility check First, check whether you are eligible for the Yeshasvini Health Insurance Scheme . Apply for the enrollment only if you qualify on the specified eligibility parameters to avoid a rejection.
• Form fill-up Visit the official website and click on 'Register'. A registration form will open which you should fill out with your information like name, age, address, relationship with the primary insured member (for family members), enrollment date (when you joined the co-operative society), member registration number (of the society whose membership you have), etc.
• Document upload Once the form is filled, attach your documents in the soft copy by uploading them on the website.
• Complete registration Cross-check the information entered in the registration form for errors. Check all the information and see whether you have uploaded all the necessary documents. Once you are satisfied, click on 'Submit' and complete the registration process.
• UHID Form After you complete the registration, you will get a Unique Health Identification (UHID) form. This form will contain your registration details. Save this form for later use. Moreover, the Yeshasvini Health Card will also be issued based on this form.

To register, you will have to submit a set of specified documents to the co-operative society. These documents are as follows -

• A valid age proof
• A Certificate from the rural or urban cooperative society with whom you are affiliated
• A valid proof of residential address
• A caste certificate

After you complete the registration, the Family Health Plan Insurance Limited will register your details and issue ID cards for all covered members. The ID card contains the insured member's photograph and is called the Yeshasvini Health Card. Once you receive the card, you can get the covered treatments at the networked hospitals after 15 days of receiving the Yeshasvini Card details .To get the Yeshasvini Card online, apply online and download the card. This would serve as a proof of identity of the insured members. It will allow you to take cashless treatments at networked hospitals. Also Read: Buying Private Health Insurance

It is very easy to make a claim under the Yeshasvini Health Insurance Scheme . Here are the steps that you should follow for raising a claim -

• Find a network hospital nearest to your location for availing of cashless medical treatments
• Present your Yeshasvini Health Card at the hospital as identity proof
• A Third Party Administrator (TPA) or a medical coordinator present at the hospital will check your health card
• The main responsibility of the coordinator or the TPA is to act as a bridge between you, the hospital, and the health insurance scheme
• The TPA will check and confirm if the treatment that you need or the surgery you require is covered under the scope of the Yeshasvini Health Insurance Scheme
• If the treatment or the surgery is covered, you have to pay an enrollment fee (if applicable) for undergoing any pre-diagnostic and medical tests
• A doctor will diagnose your medical condition and outline the course of treatment
• Depending on the doctor's diagnosis, a request for approving the treatment is sent to the Management Support Service Provider (MSSP) if a surgery is required
• Once the provider sends an approval, you can get cashless treatment based on the scope of the scheme's coverage.
• After you are discharged from the hospital, your medical bills, discharge summary, and other essential documents should be sent to the MSSP for claim processing
• The Yeshasvini Health Insurance Scheme Trust settles the claim, and the hospital gets the funds for the treatments or surgeries provided

The Yeshasvini Health Insurance Scheme covers all the districts of Karnataka. Many hospitals operating in the districts are partnered with the scheme to provide cashless treatments and surgeries. Following is a table which contains the number of network hospitals in each district of Karnata

The Yeshasvini Cooperative Farmers Health Care Trust has been established for smooth implementation of the Yeshasvini Health Insurance Scheme . Established and registered under the Indian Trust Act of 1882, the Yeshasvini Cooperative Farmers Health Care Trust deals with the financial aspect of the scheme.The chief patron of the Trust is the Chief Minister of Karnataka and the Minister of Cooperation also contributes to the Trust's affairs.The Trust also embodies renowned doctors, five senior officers, and a principal secretary. These individuals form the governing body of the Yeshasvini Cooperative Farmers Health Care Trust.The current members of the Trust are as follows -

The citizens of Karnataka can make contributions to the Trust. The Karnataka government also makes considerable donations to keep Trust going. These contributions build up a kitty which is, then, used to pay for the medical costs of the insured members.The Department of Cooperation under the Karnataka Government issues the guidelines for the monitoring and renewal of enrollments annually. The enrollment process and contribution management is conducted by the Deputy Registrar of Cooperative Societies and Cooperative Development Officers.The Trust collects the respective premiums from insured members. This collected premium is sent to the District Central Cooperative Banks, which, in turn, forwards the amount to the Apex Bank of Bangalore. The collected premium is used to fund the medical costs of insured members.

If you are living in Karnataka and you fulfil the specified eligibility parameters, you can enroll under the Yeshasvini Health Insurance Scheme . Pay a nominal premium and enjoy cashless treatments and surgeries at networked hospitals. With the scheme's coverage, health insurance has become affordable for all. But what if you do not qualify under the eligibility parameters? In such cases, you can choose a comprehensive health insurance plan of your own. Choose a suitable policy based on your coverage needs. Get your family covered under a family floater plan and face medical emergencies without financial challenges. What's more, you can also claim a tax benefit on the health insurance premium paid. So, make health insurance a part of your financial portfolio, with or without the Yeshasvini scheme and get financially secured. Also Read: Health Insurance for Senior Citizens