Yeshasvini Health Insurance Scheme: Features, Coverage, Eligibility And How To Claim

Health Insurance

Everyone should have access to quality, affordable healthcare. Yeshasvini Health Insurance Scheme is a Karnataka State Government initiative that primarily focuses on rural healthcare. Launched on June 1, 2003, under former Chief Minister S.M. Krishna, it aims to provide affordable medical insurance coverage to individuals belonging to the low and middle-income segment of Karnataka’s informal sector.

Read on to know the facilities, treatments covered, exclusions, eligibility, list of districts the Yeshasvini Health Insurance Scheme is applicable, how to get a Yeshasvini card and claim insurance.

Facilities under the Yeshasvini Health Insurance Scheme

This scheme extends to 30 districts in Karnataka. Mentioned below is a list of benefits that it offers:

1. Yeshasvini scheme covers approximately 823 surgical procedures at the network hospitals. 
2. This scheme offers free medical surgery worth Rs. 1.25 Lakh to Rs. 2 Lakh for its rural members. 
3. It offers medical treatment costing up to Rs. 1.75 Lakh for one-time hospitalisation to its urban members. For multiple hospitalisations, individuals covered under this scheme can claim up to Rs. 2.50 Lakh
4. The fixed tariff that an insuree has to pay is 40%-50% less than the regular tariff of private hospitals.
5. Under this scheme, a beneficiary can get treatment at a reduced cost from any of the network hospitals. 
6. This scheme offers diagnosis to outpatients free of cost. 
7. Benefits under this plan also include stabilisation of specific medical emergencies requiring outdoor treatment.
8. Yeshasvini Health Insurance Scheme covers normal delivery expenses. It also covers the cost of paediatric care for the first five days after birth. 
9. This scheme also provides medical facilities to weavers, Beedi workers, Stree Shakti groups and fishermen cooperative societies. 

Features of the Yeshasvini Health Insurance Scheme

1. Annual member contribution fee

The beneficiary of the rural health scheme has to pay a fee of Rs. 300 annually. Whereas every beneficiary of the urban health scheme has to pay a fee of Rs. 710 annually. 

2. Subsidy for Scheduled Caste and Scheduled Tribe

The State Government of Karnataka pays a subsidy of up to Rs. 600 for individuals belonging to Scheduled Caste and Scheduled Tribes. 

3. Enrolment period

It begins in July and extends to October every year.

4. Operational period

Members who have enrolled within the period mentioned above are eligible to avail the scheme’s benefits from June 1 to May 31 of the following year. 

5. Network Hospitals

The benefits mentioned in the Yeshasvini scheme can be availed from any network hospital listed by the State Government. 

Treatments Covered under Yeshasvini Health Insurance Scheme

The cost of over 800 treatments and ailments are covered under this scheme. Here are some of them:

• Drowning, dog bite and snake bite
• Accidents occurred during agricultural implementations
• Vascular surgery
• Surgical oncology
• Gastroenterology
• Ophthalmology
• Neurological surgery
• General surgery
• Neonatal intensive care and more.

Yeshasvini Health Insurance Scheme Exclusions

The following treatments are excluded from the Yeshasvini Health Insurance Scheme:

• Joint replacement surgery
• Kidney or heart transplant
• Diagnostic investigations
• Follow-up treatments
• Cosmetic surgery
• Burns, implants, prostheses and skin grafting
• Chemotherapy
• Auto-immune diseases and inpatient medical treatment
• Dental surgery
• Deviated nasal septum
• Dialysis
• Road traffic accidents 

Eligibility Criteria 

Any Indian citizen can avail of the benefits under the Yeshasvini Health Insurance Scheme. However, they must meet the criteria listed below: 

1. Age limit

The upper age limit for applying for this scheme is 75 years. It means individuals below this age are eligible to apply.

2. Cooperative society membership

An applicant must become a member of a cooperative society at least 6 months before the commencement of the Yeshasvini scheme. Here are certain groups/cooperative societies whose members are eligible for enrolment.

• Stree Shakti groups 
• Self-help groups 
• Fishermen cooperative societies 
• Weavers cooperative societies 
• Beedi workers cooperative societies.

3. Members covered

Family members of the beneficiary can avail the policy benefits under this scheme. They need not be a member of a cooperative society.

Districts Covered under the Scheme

There are 730 network hospitals in Karnataka which have a tie-up with the Yeshasvini Health Insurance Scheme. The table below provides a list of districts with the respective number of network hospitals: 

How is Yeshasvini Health Insurance Scheme Implemented?

If a beneficiary needs to avail of the benefits under this scheme, he/she first needs to approach any of the hospitals under the network. The coordinator reviews the application and approves the preliminary diagnosis after payment of enrolment fees. If any further surgery or treatment is required which comes under the available list of treatments, pre-authorisation requests are sent to MSP.

The hospital sends the bill to the MSP for settlement of fees along with the other necessary documents. The hospitals receive the payment from the trust within 45 days.

Steps to Apply for Yeshasvini Card Online

You can apply for Yeshasvini Card Online by following these steps: 

Step 1: Visit the official website of SAHAKARA SINDHU, the official website of the Department of Cooperation, Karnataka.

Step 2: Register for the co-operative society.

Step 3: Click on ‘Apply online for Yeshasvini Health Card’

Step 4: Fill up the registration form

Step 5: After submission of the form you will get a user ID and password

Step 6: Go back to the homepage and login with the user ID and password 

Step 7: You will see the Yeshasvini Health Card form

Step 8: Fill up the form with the required information and submit it.

What Is Yeshasvini Card?

Yeshasvini is the first cooperative health care scheme, launched by the Government of Karnataka. It has been launched to improve the health care of farmers in the cooperative society. The farmers can avail the benefits by using the Yeshasvini Card which one can apply for on the government website.

Evolution of Yeshasvini Health Insurance Scheme

Yesahasvini Health Insurance Scheme was first launched in 2002 by the then Chief Minister of Karnataka, S.M. Krishna. The scheme became operational from June 1 2003. Cooperative farmers of Karnataka are given quality and affordable treatment through this scheme through a network of hospitals available in the state of Karnataka. 

The idea of ‘Rural health care scheme’ was first launched by Dr. Devi Prasad Shetty of Narayan Hrudayalaya, Bangalore. Later some modifications were made to this concept by Sri A Ramaswamy, former Principal Secretary of Karnataka Government and the Cooperation Department.

Documents Needed to Register for Yeshasvini Health Insurance Scheme

These documents are needed to register for the Yeshasvini Health Insurance Scheme:

• Address proof
• Age proof
• Proof that the individual is a member of Rural or Urban Cooperative Societies

Steps to File a Claim under this Scheme

If you are a beneficiary of the Yeshasvini Health Insurance Scheme, follow the steps listed below to file a claim:

1. Visit a nearby network hospital authorised by the Yeshasvini Cooperative Farmers Health Care Trust.
2. The coordinating officer will examine your Unique Health identification card.
3. You have to pay an enrollment fee for pre-diagnosis and other medical tests.
4. Based on this diagnosis, the hospital shall send a pre-authorisation request to the MSP (Management Support Service Provider), along with other documents.
5. You will receive approval after the review process within 24 hours. 
6. The hospital will provide cashless treatment as per the limits of this scheme. 
7. The hospital authority will send the bills, discharge summary, and other necessary documents to the MSP post-discharge. 
8. Yeshasvini Cooperative Farmers Health Care Trust will settle the claim within 45 days of receiving the documents. 

Also Read: How To Safeguard Your Family With PMSBY (Pradhan Mantri Suraksha Bima Yojana)

Administration Process of Yeshasvini Health Insurance Scheme

Yeshasvini Cooperative Farmers Health Care Trust is registered under the Indian Trust Act, 1882. It is chaired by the Chief Minister of Karnataka who is also the chief benefactor of this trust. Principal Secretary of the Minister of Cooperation, Karnataka is the co-chairman. 

Principal Secretary of the Health and Family Welfare Department, Karnataka looks after the governing body which consists of 9 senior state government officers and 5 doctors from different states. 

How Does Yeshasvini Health Insurance Scheme’s Funding Take Place?

Yeshasvini Health Insurance Scheme is the largest self-funded health care scheme in India. It is a contributory scheme where contributions are made annually to avail of the benefits of this scheme.

Yeshasvini Cooperative Farmers Health Care Trust

Yeshasvini Cooperative Farmers Health Care Trust was established and registered under the Indian Trust Act, 1882. This trust was established to make sure that the Yeshasvini Health Insurance Scheme is adeptly executed. This trust is backed by the government. One of the chief benefactors is the Chief Minister of Karnataka. It is supported by the Minister of Cooperation. The following table will give you the list of the members of the trust.

Final Word

Yeshasvini Health Insurance Scheme is a comprehensive health care plan that aims to provide medical treatment to the underprivileged sections of society. Now that you know everything about this healthcare initiative, make sure to enrol under the scheme to reap the benefits.

In case you are not eligible to fulfil the eligibility criteria, you choose to consider health insurance policies offered by leading insurers in India, for example, Navi. This company approves cashless claims in 20 minutes and has more than 10,000 network hospitals in India. To avail of the above benefits, download the Navi App on Android or iOS now.  

FAQs on Yeshasvini Health Insurance Scheme

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Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.