Yeshasvini Health Insurance Scheme: Explained

Rural workers in the informal sector, like farmers, are deprived of several government healthcare benefits extended towards formally employed individuals. The Karnataka government launched the Yeshasvini Health Insurance Scheme to help these individuals avail affordable medical facilities amidst adverse financial crisis.

Wondering if this initiative can benefit you?

Keep reading to understand this insurance scheme in detail.

What is the Yeshasvini Health Insurance Scheme?

The Yeshasvini health insurance scheme is a community-based medical coverage scheme that aims to help workers belonging to middle and lower-middle income groups in the informal sector in Karnataka. The Department of Cooperatives implements this scheme in partnership with the Government of Karnataka. It uses the capital raised by cooperative societies via the Yeshasvini trust so that the rural informal workers can enjoy required healthcare facilities at a reduced cost.

When was the Yeshasvini Health Insurance Scheme launched?

The former Chief Minister of Karnataka, S.M. Krishna, launched this medical insurance scheme on 14th November 2002. However, its actual implementation started in 2013. Since then, farmers have been allowed to enroll themselves under this scheme and avail of its several benefits from network hospitals. This can be termed as the genesis of the Yeshasvini Health Insurance Scheme.

What are the benefits and features of the Yeshasvini Health Insurance Scheme?

Before delving into the various benefits of the Yeshasvini Health Insurance Scheme, let’s first understand some of its salient features.

Availability: This scheme is available only in Karnataka and covers the entire state.
Membership requirement: In order to avail of the benefits of this insurance plan, you must be a member of Karnataka’s Rural Co-operative Society for at least 3 months. This will make you the main member. Thereafter, all your family members will be able to enjoy the scheme benefits, regardless of themselves being the society’s member or not. Also, members of Stree Shakti Group, fisherman cooperative societies, self-help groups, weavers, and Beedi workers conducting financial transactions with cooperative societies/banks can enroll under this scheme.
Contribution charges or premium: Every beneficiary of this scheme has to pay a fixed annual member contribution fee. The last updated contribution amount for Rural Yeshasvini is Rs. 300, and that for Urban Yeshasvini is Rs. 710.
Enrollment period: Every year, enrollment under this scheme remains open from July to October.
Operational period: The individuals enrolling within the mentioned period can avail of its benefits any time between 1st June and 31st May of the following year.

Now that you are aware of what the Yeshasvini Health Insurance Scheme entails, it is time to know about the various advantages you can enjoy once you make it through its requirements.

This scheme offers cashless benefits against approximately 823 surgical procedures at network hospitals.
The scheme sets a fixed tariff to be paid by the insured against specific procedures, which is 40%-50% lower than the hospitals’ regular tariff.
Beneficiaries can also get specific diagnostic tests done at rebated prices under this insurance plan.
You can also avail of hospital stays at discounted rates at certain network hospitals under this scheme.

Now, you might be wondering how a self-help scheme can provide such immense benefits.

The answer is in how the financial reservoir funding this scheme is maintained.

What is Yeshasvini Cooperative Farmers Health Care Trust?

The Yeshasvini Cooperative Farmers Health Care Trust is the financial reservoir that ensures the seamless implementation of this health insurance scheme. It was established and registered under the Indian Trust Act 1882. While the Chief Minister of Karnataka is the chief patron of this Trust, the Minister of Cooperation is also a contributor.

Besides these 2 designations, there are renowned doctors, 5 senior officers, and a principal secretary forming this trust’s governing body.

In addition to the contributions by citizens, the Karnataka government also makes significant donations to this trust. This helps in delivering all the said benefits to the individuals insured under this scheme.

The Department of Cooperation under the Government of Karnataka, issues the guidelines monitoring these enrollment and renewal requirements every year. The Deputy Registrar of Cooperative Societies and Cooperative Development Officers are responsible for conducting the enrollment process and contribution collection.

They then send the total collected premium to the District Central Cooperative Banks, which further transfer the amount to the Apex Bank of Bangalore.

This amount is then used to finance the medical coverage required by policyholders.

However, to benefit from the scheme’s offerings, you must first meet its eligibility requirements.

Are you eligible for Yeshasvini Health Insurance Scheme?

Here is a list of eligibility requirements for this scheme you need to meet to enroll.

Age: You must be under 75 years of age.
Membership: As already mentioned, you must become a member of Karnataka’s cooperative societies at least 6 months prior to scheme commencement for successful enrollment. You can also enjoy scheme benefits if you are a family member of any such primary beneficiary.
Coverage: You must not be a resident of rural areas under Karnataka Cities and Corporations.

These factors determine your eligibility for Yeshasvini Health Insurance Scheme.

Which medical procedures are covered under the Yeshasvini Health Insurance Scheme?

It is natural for you to be curious about which medical facilities you will receive by investing in this scheme. To help clarify your doubts, here is a list of health care procedures included in Yeshasvini Health Insurance Scheme coverage.

Up to 823 surgical procedures, including general surgery, ophthalmology surgery, cardiac and cardiothoracic surgery, paediatric surgeries, genitourinary surgeries, orthopaedic surgeries, neurosurgery, vascular surgery, surgical gastroenterology, angioplasty, and surgical oncology
Medical emergencies like accidents caused while operating agricultural equipment, electric shocks, snake bite, dog bite, and drowning
Other procedures requiring hospital stays like gynaecology and obstetrics, normal delivery, and neonatal intensive care

You can use the Yeshasvini card facility to avail treatment at affordable rates against any of the above-mentioned medical inconvenience. Since 2008, applicants are provided with Unique Health Identification enrollment forms comprising the details of the main beneficiary and his/her family members, which act as proof of enrollment.

However, like all other insurance plans, the Yeshasvini Health Insurance Scheme comes with certain exclusions.

Which treatment procedures are not covered under the Yeshasvini scheme?

The Yeshasvini health care scheme does not cover any of the following medical requirements.

Cosmetic surgeries like implants, skin grafting, prosthesis, etc.
Other surgical procedures including heart transplant, kidney transplant, dental surgery, and joint replacement surgery
Treatment for autoimmune diseases, chemotherapy, and inpatient medical treatment
Follow-up treatment post-surgery
Road accidents
Diagnostic investigations
Burns
Dialysis
Vaccination or inoculation
Cost of tonics, vitamins, or sanitary items

Frequently Asked Questions

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What is the maximum coverage limit under the Yeshasvini Health Insurance Scheme?

You can get coverage of up to Rs. 1.25 lakh for one hospital admission and a maximum of Rs. 2 lakh for more than one surgery under rural Yeshasvini. On the other hand, urban Yeshasvini will provide you with up to Rs. 1.75 lakh coverage for one medical procedure and a maximum of Rs. 2.5 lakh for multiple surgical procedures.

How will hospital expenses be settled under the Yeshasvini Health Insurance Scheme?

After receiving your medical treatment, the hospital will send the final bill to the Management Service Provider (MSP), who will verify all expense details before forwarding it to the Yeshasvini Trust. The trust needs to approve this amount at sub-committee meetings before transferring it to the MSP, which, in turn, will forward the amount to the mentioned hospital.

How many recognised hospitals are there under the Yeshasvini scheme in Karnataka?

As of now, there are 730 private and government hospitals in Karnataka, which are recognised under this insurance scheme.

Which charges during surgery does the Yeshasvini insurance scheme cover?

The financial coverage provided during a surgery under this scheme includes costs incurred in operation theatre, medicines, food, anaesthesia, surgeon’s fee, nursing fee, consultation charges, professional charges, and general ward bed charges during a hospital stay.