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Yeshasvini Health Insurance Scheme: Features & Advantages

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The increasing healthcare costs are a cause of concern for many, especially the economically weaker section of society. Keeping this in mind, the state and central governments have introduced important health schemes that make healthcare accessible and affordable. Yeshasvini Health Insurance Scheme is one such scheme introduced by the Karnataka Government. Let’s look at the features, eligibility criteria, advantages, and claim process of the Yeshasvini Scheme.

What is the Yeshasvini Health Insurance Scheme?

The Yeshasvini Health Insurance Scheme is a medical insurance scheme of the State Government of Karnataka. It was launched on 1st June 2003 by Mr S.M. Krishna, the then Chief Minister of Karnataka. However, the scheme was discontinued in 2018 and relaunched in 2022.

The scheme covers farmers, fishermen, weavers, and other members of the cooperative societies and self-help groups organised by co-operatives in the state. It provides an annual medical coverage of INR 5 lakhs to each family covered under the scheme and helps them access quality healthcare services.

This comprehensive healthcare scheme is managed by the Yeshasvini Cooperative Farmers Healthcare Trust. It operates across 30 districts in Karnataka and covers over 2128 medical procedures. This includes 1650 medical treatments and 478 ICU procedures.

Key features of the Yeshasvini Health Insurance Scheme

The key characteristics of the Yeshasvini Health Insurance Scheme are —

1. Beneficiaries:

The scheme is available to Karnataka farmers and members of different cooperative societies, such as cooperative fishermen, weavers and beedi workers. However, they must complete at least 3 months as a member of a cooperative society to get coverage under the Yeshasvini Health Insurance Scheme.

2. Family members:

The scheme also covers the family members of the principal applicant. Therefore, the principal applicant can include his/her spouse, parents, sons, unmarried daughters, daughters-in-law, and grandchildren in the scheme.

3. Procedures covered:

The scheme covers over 2128 medical procedures, including diseases related to the heart, nerves, stomach, intestines, bones, joints, muscles, eyes, etc.

4. Maximum limit:

The maximum treatment expenses for each family covered under the scheme is INR 5 lakhs per year.

5. Cashless treatment:

Beneficiaries covered under this health insurance scheme can opt for cashless treatment at any Yeshasvini network hospital across Karnataka. Each member family is given a plastic card with a unique ID number. He/she can use this card to avail of cashless treatment at any network hospital.

6. Scheme tenure:

The annual tenure of the scheme is between 1st August to July 31st.

Eligibility criteria under Yeshasvini Scheme

The eligibility criteria under the Yeshasvini Scheme are:

• The person should be a member of a self-help group or cooperative society in Karnataka for at least 3 months.

• The dependent eligible family members of the primary member can also be included in this health insurance scheme.

• The primary member must pay the prescribed annual subscription.

• The added family members must pay an additional subscription to be a part of the scheme.

• Cooperative societies comprising fishermen, weavers, beedi workers, self-help groups, and Stree Shakti groups are also eligible.

• Married daughters and their children staying with parents can be covered under the scheme for an additional membership subscription.

• If the daughter of the principal applicant gets married after paying the annual subscription, she is eligible for treatment under the scheme till her subscription is valid.

How to apply for the Yeshasvini Health Insurance Scheme?

One can apply for the Yeshasvini Health Insurance Scheme by visiting the nearest cooperative society/bank, filling out the application form and submitting the following documents:

• A copy of the ration card

• Active mobile number

• Aadhaar card of all family members to be covered under the scheme

• Two passport-size photographs of all members

• An official document (certificate) certifying that the applicant is a member of a rural or urban cooperative society for at least 3 months

• Copy of the caste certificate with each member’s RD number (for SC/ST family)

• Prescribed annual subscription (there is no subscription fee for SC/ST families)

The cooperative society/bank will verify the documents. If everything looks fine, they will add the individual and his/her family members to the scheme.

Network hospitals and services covered

Yeshasvini Health Insurance Scheme has tied up with around 700 hospitals in different parts of the state for cashless medical treatment. The scheme has network hospitals in Bengaluru, Mysore, Raichur, Udupi, Bagalkot, Belagavi, Bellary, Bidar, Chikkamagaluru, Dakshina Kannada, Davanagere, Gadag, Hassan, Haveri, Kalaburagi, Kodagu, Kolar, Koppal, Mandya, Shimoga, and other districts.

The services or treatments covered under the Yeshasvini Health Insurance Scheme are:

• General and cardiac diseases and surgeries

• Orthopaedic diseases and surgeries

• Neurological Surgery

• Surgical oncology

• Vascular surgery

• ENT or ear, nose and throat diseases

• Nerve-related diseases

• Ophthalmology diseases

• Obstetrics and Gynaecology

• Urology

• Neonatal and paediatrics

• Drowning

• Dog bite

• Snakebite

• Cuts and accidents suffered while operating agricultural tools

• General medicine

• General emergency

• Some types of burns

How to renew the policy?

The Yeshasvini health insurance policy can be easily renewed at any valid cooperative society. Members must fill out the renewal form and submit it to the cooperative society along with the annual renewal fee. The policy is renewed between May to June every year.

Claim process under the Yeshasvini Scheme

The claim process under the Yeshasvini Health Insurance Scheme is as follows:

1. The insured (patient) must locate a network hospital where he/she can opt for the medical procedure.

2. A medical coordinating officer or TPA at the hospital will check the patient’s health card and supporting documents before confirming enrolment.

3. Once the enrolment is confirmed, the patient must submit an enrolment fee for pre-diagnosis and medical tests.

4. If the test reports suggest that the person needs surgery, the Management Support Service Provider verifies and approves the same.

5. After approval, the patient can avail of cashless treatment up to the scheme’s coverage limit.

6. Once the patient gets discharged from the hospital, his/her discharge summary, medical bills, and other supporting documents are submitted to the Management Support Service Provider.

7. The claim is then verified and settled by the Yeshasvini Health Insurance Scheme trust.

Advantages of the Yeshasvini Health Insurance Scheme

The following are the advantages of the Yeshasvini Health Insurance Scheme —

1. High sum insured:

The scheme offers an annual sum insured of INR 5 lakhs per family. This amount can help meet their regular medical expenses as well as expensive surgeries.

2. Cashless treatment:

The covered families can opt for cashless treatment at any network hospital around the state and save themselves from paying huge bills from their savings. The network hospitals cover a range of expenses, such as hospital bills, operation theatre rent, surgery costs, surgeon’s fees, room rent, medicine bills, the cost of consumables, etc.

3. Wide coverage:

The scheme covers 1650 medical treatments and 478 ICU procedures. These include conditions related to the heart, brain, eyes, nose, throat, ears, stomach, intestines, bones, and other organs in the body. The scheme also covers expenses related to pregnancy and childbirth, knee replacement, cost of cataract surgery lens, etc.

4. No age limit:

There is no age limit to be a part of the scheme. One can become a member of the Yeshasvini Health Insurance Scheme at any age.

5. Discounts:

The scheme offers discounts to members on lab investigations and diagnostic tests.

6. Reasonable annual contribution:

Members of rural and urban cooperative societies must pay a small annual allowance to be a part of this health insurance scheme. Rural cooperative members must pay INR 500 annually for a family of 4 members. Every additional eligible member must contribute INR 100 annually.

Members of the urban cooperative societies must contribute INR 1000 annually for a family of 4 members. Each additional eligible member must pay INR 200 annually.

Limitations and exclusions under the scheme

While the Yeshasvini Health Insurance Scheme offers many benefits, it has some limitations as well.

1. The scheme does not offer coverage to the following people:

• Members of defunct or liquidated cooperative societies

• Members of employees’ cooperative societies

• Government or private sector employees earning more than INR 30,000 per month

• Individuals covered under any insurance scheme are not included under the Yeshasvini Scheme

• Married daughters who are not enrolled under a cooperative society and staying away from their parent’s house or in another state cannot be covered under their parents’ Yeshasvini Health Insurance Scheme.

2. Pre-existing conditions:

The scheme does not cover pre-existing conditions, such as diabetes, heart diseases, kidney ailments, and hypertension.

3. Excluded medical procedures:

The following procedures are excluded from the Yeshasvini Health Insurance Scheme —

• Heart, kidney, or any other transplants

• Cosmetic surgeries

• Dental surgeries

• Nasal septum

• Skin treatment or grafting

• Autoimmune diseases

• Joint replacement surgeries

• Dialysis

• Angioplasty

• Follow-up treatment

• Cost of hearing aids and spectacles

• Vaccination

• Chemotherapy

• Road accidents

FAQs

1. What is the Yeshasvini Health Insurance Scheme?

Yeshasvini Health Insurance Scheme is a special healthcare program. It assures affordable healthcare to farmers, weavers, beedi workers, and other middle- and lower-income groups of people who are members of a working cooperative society in Karnataka. It is like a family health insurance policy that covers the medical bills of the insured families. However, the scheme does not cover members of employees’ cooperative societies and private sector employees with a monthly salary of over INR 30,000.

2. Is there any age limit to become a member of the Yeshasvini Health Insurance Scheme?

No, there is no age limit to become a member of the Yeshasvini Scheme.

3. How to avail of cashless treatment under the scheme?

Individuals and families covered under the scheme can avail of cashless treatment at any network hospital in Karnataka. This health insurance scheme has tied up with around 700 hospitals in different districts around the state, so members can easily find healthcare establishments nearby.

4. Should members file cashless claims?

Members are not required to file a cashless claim or do any paperwork. All they must do is show their cashless card at their chosen network hospital, and the medical coordinating officer or TPA at the hospital will do the rest.

5. Is there any waiting period for the Yeshasvini Health Insurance Scheme?

No, there is no waiting period for this health insurance scheme. Members are covered from day one of the policy period.

6. How to renew this health insurance scheme?

The policy is renewed from May to June every year. Members can renew their Yeshasvini insurance card by paying the annual premium during the renewal period to stay covered under the scheme for the next year.

7. What is the maximum sum insured by the Yeshasvini Health Insurance Scheme?

The maximum annual sum insured by this health scheme is INR 5 lakhs. Families covered under the scheme can avail of treatment for up to the sum insured.

Conclusion

Yeshasvini Health Insurance Scheme offers wide coverage to members and helps them opt for cashless treatment in any network hospital in Karnataka. It functions with the aim of making healthcare affordable and accessible for farmers, weavers, and other economically weaker sections of society. The members are given a card to avail of cashless treatment at any network hospital in the state. The scheme also covers the insured’s family members and ensures quality and timely healthcare without financial setbacks.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.

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