The Karnataka Government’s Yeshasvini Health Insurance Program

Accessing quality healthcare is difficult for many people, particularly those in remote areas or low-income groups. The Karnataka government, recognizing this, launched the Yeshasvini Health Insurance Scheme to offer members of cooperative organizations affordable and efficient health coverage. This blog covers every detail of the Yeshasvini Scheme, including its advantages and eligibility requirements, so you can fully comprehend how it operates.

What is the Yeshasvini Health Insurance Plan?

The Yeshasvini Health Insurance Scheme is a community-based health insurance program aimed at cooperative society members in Karnataka. It seeks to make healthcare services more accessible to members of urban and rural cooperative societies by providing financial support for medical costs.

The plan is funded by the donations of members of cooperative societies, which are combined into a fund that the Yeshasvini Cooperative Members Health Care Trust oversees. This trust provides affordable care for more than 1,650 medical treatments at participating hospitals.

Advantages of the Yeshasvini Program

The Yeshasvini Scheme is designed to provide its members with the greatest possible advantage. This is what it provides:

• Annual Coverage of INR 5 Lakh: Under the scheme’s framework, beneficiary families are eligible for cashless treatment up to the updated coverage limit.
• Comprehensive Medical Coverage: Includes more than 1,650 treatments, such as pediatric, ENT, orthopedic, and cardiac surgeries.
• Discounted Diagnostics: Members pay reduced rates for diagnostic procedures at partner hospitals.
• Cashless Claims Facility: By showing their Yeshasvini Card at participating hospitals, beneficiaries may receive cashless treatment.
• Affordable Premiums:
  • Rural members: INR 500 per year for a family of four, with INR 100 for each extra member.
  • Urban members: INR 1,000 per year, plus INR 200 for every extra member.

Why Do the Yeshasvini Scheme’s Benefits Mostly Favor Rural Areas?

The Yeshasvini Yojana is advantageous for rural communities since they typically have limited access to inexpensive family health insurance.

• Affordable Premiums: The plan is affordable even for low-income families, costing only INR 500 per year for rural members.
• Broader Access: Network hospitals are spread out across rural areas, eliminating the need for expensive trips to urban medical facilities.
• Tailored Advantages: Coverage for emergencies such as snake bites and injuries related to agriculture addresses particular issues in rural healthcare.

The Yeshasvini Plan is a lifeline for many households because of this rural-centered emphasis.

Features of the Yeshasvini Health Insurance Plan

This program is notable for its inclusivity and membership sector-specific advantages:

• Available to Members of Cooperative Societies: To be eligible, you and your family must be members of a cooperative society for at least three months.
• Age Limits: There is no upper age limit to become a beneficiary, although eligibility is restricted to those under 75.
• Extensive Hospital Network: Recipients can receive treatment at appointed network hospitals throughout Karnataka.
• Family Inclusion: The program may include dependents like nieces or nephews, as well as spouses and kids.

Coverage Provided by the Yeshasvini Plan

The Yeshasvini Scheme offers financial assistance during emergencies and extensive coverage for a range of medical procedures. Here are some highlights:

• In-patient Hospitalization: Covers pre and post-hospitalization costs, ICU fees, and surgeries.
• Specialized Surgeries: Includes cardiac, vascular, orthopedic, oncology, and pediatric procedures.
• Emergency Treatment: Deals with urgent situations such as drowning, dog bites, and snake bites.
• Obstetrics and Gynecology: Covers newborn intensive care and prenatal care.
• General Ward Access: Members receive treatment in general wards, with the possibility of paying more to switch to private wards.

Yeshasvini Health Insurance Plan Exclusions

The Yeshasvini Health Insurance Scheme offers a wide variety of treatments, but there are certain exclusions:

• Cosmetic and dental operations (unless due to an accident).
• Costs associated with transplantation and dialysis.
• Medical expenses from car accidents.
• Pre-existing conditions that were identified prior to enrollment.

Eligibility Requirements for the Yeshasvini Program

To join the Yeshasvini Scheme, you must satisfy the following requirements:

• Membership Period: You must have been a member of a cooperative organization for at least 90 days before applying.
• Age Limitations: Members must be under 75 years old to join; those over this age are ineligible.
• Family Inclusion: Dependents, such as parents, spouses, children, and others, may be included.
• Income Restrictions: Government or private sector employees earning more than INR 30,000 each month are ineligible.
• Special Groups: Self-help groups, fishermen, weavers, and beedi laborers connected to cooperative organizations are eligible to register.

How to Apply for the Yeshasvini Health Card and Register for the Program?

Obtaining a Yeshasvini Health Card is a simple procedure. This card serves as a portal to quality and inexpensive medical care at networked hospitals. Here’s how you can obtain it:

1. Requirement for Membership
   • Join a recognized cooperative society under relevant cooperative laws.
   • Maintain membership for at least three months before applying.
2. Enrollment via Cooperative Societies
   • Visit the branch of your cooperative society or self-help group.
   • Collect the Unique Health Identification enrollment form.
3. Submit Required Documents
   • Membership Verification Certificate
   • Aadhaar Card for identity and address verification
   • Ration Card for family details confirmation
   • Two passport-sized photos of each member
   • Caste Certificate (if applicable)
4. Make the Annual Premium Payment
   • INR 500 for rural members (family of four), INR 100 per extra member.
   • INR 1,000 for urban members (family of four), INR 200 per extra member.
5. Issuance of Cards
   • After verification, the Yeshasvini Health Card will be issued with member details.

How to Receive Benefits from the Yeshasvini Program?

Claiming benefits under the Yeshasvini Health Insurance Scheme is a straightforward process:

1. Visit a Network Hospital
   • Ensure the hospital is part of the Yeshasvini network.
   • Carry your Yeshasvini Health Card and identity proof.
2. Hospital Registration
   • Present your card at the hospital’s registration desk.
   • Hospital staff will verify your eligibility.
3. Pre-Authorization Procedure
   • Submit required documents and medical reports.
   • The hospital will send a pre-authorization request to the scheme’s Management Services Provider (MSP).
   • Approval usually takes 24 hours.
4. Treatment and Cashless Service
   • Once approved, treatment proceeds without upfront payment.
   • The scheme directly covers hospitalization, surgery, medications, and diagnostics.
5. Post-Treatment Process
   • Hospital submits final bill to the TPA.
   • Members leave without paying for covered services.

Conclusion

The Yeshasvini Health Card ensures members receive coverage for medical expenses at accredited network hospitals. For broader coverage, individuals can also explore private health and life insurance policies.

FAQs

1. How is the Yeshasvini Scheme different from other health insurance plans?
   • It offers community-based, affordable coverage with over 1,650 treatments.
2. Can urban residents join?
   • Yes, urban cooperative society members can enroll.
3. Are critical illnesses covered?
   • Yes, except for dialysis and transplant surgeries.
4. How to compare health insurance policies?
   • Consider premiums, coverage, and claim options.
5. Is the Yeshasvini Card required for treatment?
   • Yes, for cashless benefits.