Yeshasvini Health Insurance Scheme - Eligibility, Benefits And More

Karnataka is like a hidden gem, shining bright with its rich culture and delicious food. Imagine crispy dosas and mouth-watering curries- all part of the state's vibrant culinary scene. From the graceful moves of Bharatanatyam to the soothing melodies of classical music, Karnataka tells a captivating story of its heritage and cuisine.

But Karnataka cares much more than just its culture. The government wants that everyone can get good healthcare. One big way they do this is with the Yeshasvini Health Insurance Scheme. This program provides affordable health insurance to the people of Karnataka so everyone can get top-quality healthcare when they need it most.

Today, in this article, we will have a detailed outlook on the Yeshasvini Health Insurance Scheme. We will discuss its working, beneficiaries, and, most importantly, how you can make the most of this program. So, let’s begin!
 

What Is YCFHS - Yeshasvini Health Insurance Scheme?

The Yeshasvini Health Insurance Scheme is a medical insurance program designed to support workers in Karnataka's unorganised sector, focusing on those with middle and lower-middle incomes. This community-based initiative is managed by the Department of Co-operatives in collaboration with the Government of Karnataka. Its main aim is to provide affordable healthcare to rural informal workers.

Funds for the scheme are collected by Cooperative societies through the Yeshasvini trust. These funds help deliver high-quality medical services at reduced costs. The primary goal of the Yeshasvini Health Insurance Scheme is to ensure accessible and affordable healthcare for people across Karnataka.
 

Who launched the Yeshasvini Scheme, and Who are the Beneficiaries?

The Yeshasvini Insurance Scheme was launched by the then Chief Minister of Karnataka, Mr. S.M. Krishna. This scheme, implemented by the Karnataka Government, is an important initiative aimed at providing affordable and accessible healthcare services.

The main beneficiaries of the Yeshasvini Health Insurance Scheme are rural workers and farmers. This program ensures that these individuals, who often have limited access to healthcare, receive the medical services they need at lower costs.
 

Karnataka Yeshasvini Health Insurance Scheme: Scope of Coverage

The Yeshasvini Health Insurance Scheme is a comprehensive health insurance program that covers 823 surgical procedures. It operates across all 30 districts of Karnataka, ensuring wide-reaching benefits. The scheme is managed by the Yeshasvini Cooperative Farmers Health Care Trust, which is registered under the Indian Trust Act of 1882.
 

Important Features Of the Yeshasvini Health Insurance Scheme

The Yeshasvini Health Insurance Scheme offers several important benefits -

• Cashless Benefits
  Members can avail of approximately 800 medical procedures without any cash payment at network hospitals.
   
• Fixed Treatment Tariffs
  Specific treatments have fixed tariffs, significantly reducing overall medical costs.
   
• Discounts On Diagnostic Tests
  Insured members receive discounts on diagnostic tests, making essential medical screenings more affordable.
   
• Comprehensive Coverage
  The scheme covers newborn babies and individuals up to 75 years of age, ensuring healthcare for all eligible members.
   
• Annual Contribution
  Members pay Rs. 300 per year in rural areas and Rs. 710 per year in urban areas.
   
• Subsidies
  The Karnataka State Government provides a subsidy of up to Rs. 600 for individuals belonging to Scheduled Castes and Scheduled Tribes.
   
• Enrollment Period
  Members who enrol within the specified period are eligible to receive the scheme’s benefits from June 1 to May 31 of the following year.
   
• Wide Reach & Extensive Coverage
  Currently, nearly 30 lakh people benefit from the scheme. It covers an extensive range of 823 procedures, from paediatric surgeries to treatments for dog bites.
   
• Network Hospitals
  You can avail yourself of the benefits at any network hospital listed by the State Government.
   

Benefits Of The Yeshasvini Health Insurance Scheme

The Yeshasvini Health Insurance Scheme offers several important benefits that make it a vital healthcare solution for rural workers in Karnataka –

• Annual Insurance Coverage
  The scheme provides annual insurance coverage of Rs. 5 Lakhs, ensuring substantial financial protection against medical expenses.
   
• Extensive Medical Procedure Coverage
  It covers over 800 medical procedures, including cardiac surgery, orthopaedic surgery, gynaecology, and many more. This wide range of coverage ensures that beneficiaries receive the necessary treatments without worrying about the costs.
   
• Cashless Claim Facility
  The scheme offers a cashless claim facility at network hospitals. This feature considerably reduces the financial burden on beneficiaries during medical emergencies, as there is no need to pay upfront for the treatments.
   
• Coverage For Family Members
  The scheme extends benefits to family members, allowing them to use the coverage even if they are not members of a rural cooperative society., which in turn ensures medical coverage of whole family, when needed.
   
• Reduced Treatment Costs
  One of the scheme's significant highlights is the fixed cost for specific medical treatments, which is significantly lower than the standard costs. This helps reduce the financial strain on beneficiaries.
   
• Discounts On Diagnostic Tests
  Usually, health insurance does not cover the costs of diagnostic tests. However, beneficiaries of this insurance scheme can undergo these tests at a discounted rate, making essential medical screenings more affordable.
   

Treatments Covered Under Yeshasvini Health Insurance Scheme (YCFHS)

The Yeshasvini Health Insurance Scheme offers extensive coverage for over 800 medical procedures, ensuring beneficiaries can access a wide range of essential treatments. Some of the key facilities under the scheme include –

1. Cardiac Procedures
   The scheme allows beneficiaries to undergo various heart surgeries, like CABG (Coronary Artery Bypass Grafting), heart valve repair or replacement, and other heart-related operations. This ensures that those with heart conditions receive the necessary medical interventions.
    
2. Orthopaedic Treatments
   Coverage includes orthopaedic procedures like bone fracture treatments, joint replacements, spinal surgeries, etc. This is particularly important for beneficiaries with musculoskeletal issues, as these treatments often require long-term recovery and rehabilitation. The scheme provides a crucial financial safety net for these extensive medical needs.
    
3. General Surgical Procedures
   Beneficiaries can undergo various general surgical procedures, such as hernia repair, appendectomy, and gallbladder removal. These surgeries address a wide range of conditions that require medical intervention for optimal recovery.
    
4. Gynecology And Obstetrics Care
   Female beneficiaries have access to gynaecological treatments and obstetric care. This includes prenatal and postnatal care, normal deliveries, caesarean sections, and treatments for various gynaecological conditions.
    
5. Surgical Oncology
   If beneficiaries are diagnosed with cancer, they can get surgical oncology treatments. These treatments include procedures to remove cancer or tumours, providing crucial help for people fighting cancer.
    
6. Neurological Surgery
   Coverage also includes neurological surgeries, like removing brain tumours, treating neurological disorders, and addressing spinal conditions. This support is important for those facing complex neurological health issues.
    
7. Neonatal Intensive Care
   The scheme covers neonatal intensive care for newborns. This includes critical support for premature babies or those born with health issues, giving them the best possible start for healthy development.
    
8. Gastroenterology
   Comprehensive coverage for gastroenterological treatments is included in the scheme. This addresses issues related to the gastrointestinal tract, liver diseases, and digestive disorders and is crucial for maintaining overall well-being.
    
9. Agricultural Accidents
   The scheme also provides coverage for accidents that happen during agricultural operations. This includes injuries from things like electrical shocks, drowning incidents, or accidents involving agricultural equipment. This coverage is really important for farmers, helping to safeguard them against unexpected emergencies while working in the fields.
    

Exclusions Of The Yeshasvini Health Insurance Scheme

While the Yeshasvini Health Insurance Scheme offers broad coverage, there are certain things it does not cover. Here are some exclusions beneficiaries should know about –

• Continued Care
  The scheme is designed for primary and essential medical treatments. However, it does not cover follow-up treatments, like subsequent visits or care related to a previous procedure. Beneficiaries will need to pay for these follow-up consultations, tests, or medications themselves.
   
• Dental Procedures
  Procedures related to your dental health, such as tooth extractions, root canals, and implants, are not included in the Yeshasvini Health Insurance Scheme.
   
• Implants And Prostheses
  While the scheme covers essential surgeries, it does not pay for implants like joint replacements, dental implants, or prosthetic devices. Beneficiaries who need these medical devices will have to pay for themselves.
   
• Cosmetic Procedures
  Elective surgeries done for cosmetic reasons, like nose reshaping or fat removal, are not included in the Yeshasvini Health Insurance Scheme.
   
• Chemotherapy
  Even though the scheme covers surgical treatments for cancer, it does not include chemotherapy, which involves medication for cancer treatment. Beneficiaries will need to consider other financial options for chemotherapy.
   
• Autoimmune Disorders
  The Yeshasvini Health Insurance Scheme does not cover treatments for autoimmune diseases that include Rheumatoid Arthritis or Multiple Sclerosis. These conditions need specialised and ongoing medical care, which the scheme does not cover.
   
• Organ Transplants
  Expenses for organ transplant surgeries, like kidney and heart transplants, are not covered by the scheme due to their complexity and high costs.
   
• Dialysis And Road Accidents
  Dialysis for kidney failure and expenses related to road accidents are not included in the Yeshasvini scheme. Beneficiaries needing these treatments or facing emergencies from road accidents should look into other financial arrangements.
   

Eligibility For Yeshasvini Health Insurance Scheme

To qualify for the Yeshasvini Health Insurance Scheme, individuals need to meet these criteria –

• Membership
  You must be a member of a rural cooperative society for at least six months before joining the scheme.
   
• Residency
  You must live outside the rural areas of Karnataka cities and corporations.
   
• Family Inclusion
  Your family members can also get coverage under the scheme.
   
• Age Requirement
  The maximum age to apply for this scheme is 75. So, someone who meets this age limit and follows other requirements is eligible to apply.
   

Documents Required For Registration

To join the Yeshasvini Health Insurance Scheme and access its benefits, you will need a Yeshasvini Health Card. You should ensure that you have both original and photocopies of these documents ready when applying for the health card to avoid any delays –

• Proof of Age
• Proof of Address
• Official documentation showing your membership in a rural or urban cooperative society for the required period.
   

How To Claim Yeshasvini Health Scheme?

Here's how you can claim benefits under the Yeshasvini Health Insurance Scheme –

Step 1: Go to a Network Hospital
First, you should visit one of the network hospitals that are part of the Yeshasvini scheme.

Step 2: Verification By TPA
At the hospital, the Third-Party Administrator (TPA) will check if you are a Yeshasvini beneficiary and ensure that the treatment or surgery needed is covered by the scheme. Once confirmed, you can proceed with the necessary medical tests.

Step 3: Pre-Authorization Request
After the initial diagnosis, the network hospital will send a pre-authorization request along with necessary documents to the Management Services Provider (MSP) online.

Step 4: Approval
The MSP will review and approve the hospital's request, and this should be done within a day.

Step 5: Treatment And Payment
Once approved, the doctors can start treatment at the network hospital. After treatment, the MSP will verify and pay the hospital accordingly.
 

How Can You Register For Yeshasvini Health Insurance Scheme Online?

Here's how you can register for the Yeshasvini Health Insurance Scheme online –

Step 1: Visit the Official Website
You will be able to start your registration process by visiting the official website of the Yeshasvini Health Insurance Scheme or the Karnataka Cooperative Department.

Step 2: Find The Registration Section
Look for the section dedicated to new registrations or enrollment. It might be labelled as "New Enrollment" or "Register."

Step 3: Fill Out The Registration Form
The next step is to complete the online registration form with all the required details. This usually includes your personal information, details of your cooperative society membership, and information about your family members.

Step 4: Upload Required Documents
You can then upload the necessary documents, such as proof of cooperative society membership, identification proof, and any other documents required.

Step 5: Submit The Form
After filling out the form and uploading the documents, you can submit it online.

Step 6: Payment Of Premium
If a premium has to be paid, you can also pay it online. Just make sure you get a receipt or confirmation of payment.

Step 7: Confirmation And Acknowledgment
After submitting your registration, you should keep an eye out for your confirmation message or email. This will acknowledge your registration and may include your policy details along with a registration number.

Step 8: Receive Membership Card
Once your registration is completed, processed, and approved, you will receive a membership card. This will reach you either by mail or digitally, and you can use it to access the scheme's benefits.

For more information or updates on the registration process, consider visiting the official website or contacting the helpline provided by the Yeshasvini Health Insurance Scheme or the Karnataka Cooperative Department.
 

How To Get A Yeshasvini Health Card?

Getting a Yeshasvini Health Card is easy if you follow these simple steps –

1. Visit the government website and register under a cooperative society in Karnataka.
2. Look for the 'Register for the Cooperative Society' option and click on it.
3. Find the 'Apply Online for Yeshasvini Health Card' link and click on it.
4. Fill in all the required details on the online registration form and submit it.
5. Go back to the Home Page.
6. Log in to the website by making use of your credentials.
7. You will be directed to the Yeshasvini Health Card form.
8. Fill out the form, double-check all the details, and submit it to complete your application.
    

Evolution Of Yeshasvini Health Insurance Scheme

The Yeshasvini Health Insurance Scheme was launched in 2002 by S.M. Krishna, the then Chief Minister of Karnataka. It officially started operating on June 1, 2003. This scheme aims to offer high-quality and affordable healthcare to cooperative farmers in Karnataka. It does so by establishing a network of hospitals throughout the state.

Dr. Devi Prasad Shetty of Narayana Hrudayalaya in Bangalore initially suggested the idea of a 'Rural Health Care Scheme'. Sri A. Ramaswamy, the former Principal Secretary of the Karnataka Government and the Cooperation Department, further developed the idea and put it into action with some adjustments.
 

Number Of Network Hospitals Under The Scheme

The Yeshasvini Health Insurance Scheme has close to 900 hospitals in different districts of Karnataka. This wide-reaching network makes it simple for beneficiaries to get healthcare services, particularly in emergency situations. These hospitals are located in both urban and rural areas, catering to the medical needs of many beneficiaries.
 

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

The Yeshasvini Health Insurance Scheme stands as India's largest self-funded Health Insurance Plan. It operates on a contributory basis, meaning members contribute annually to access its benefits.
 

Yeshasvini Cooperative Farmers Health Care Trust

To ensure the smooth implementation of the Yeshasvini Health Insurance Scheme, the Yeshasvini Cooperative Farmers Health Care Trust was launched and registered under the Indian Trust Act of 1882. This trust, backed by the government, includes key figures like the Chief Minister of Karnataka and receives support from the Minister of Cooperation.

Let’s get to know the important contact details –

Headquarters

Office of the Registrar of Cooperative Societies,

#1, Ali Asker Road, Vasant Nagar,

Bangalore-560052

Phone: 080 22269637 / 22251238

Regional Offices

To Conclude,

The Yeshasvini Health Insurance Scheme by Karnataka is a valuable initiative that ensures affordable and quality healthcare for the state's unorganised sector workers and rural families. With extensive coverage for various medical treatments and a network of nearly 900 hospitals, it provides essential medical support. The scheme operates with straightforward processes for registration, claims, and immediate coverage. By offering this support, the Yeshasvini Health Insurance Scheme helps improve the health and well-being of people in Karnataka.
 

FAQs