The Yeshasvini Health Insurance Scheme, launched on June 1, 2003, is a significant initiative by the Karnataka State Government. This scheme primarily targets rural healthcare, aiming to make quality medical insurance accessible to individuals in the low and middle-income segments of Karnataka’s informal sector.
Under the leadership of former Chief Minister S.M. Krishna, this initiative seeks to provide affordable healthcare coverage, addressing the healthcare needs of the rural population.
In this overview, we will explore the facilities, covered treatments, exclusions, eligibility criteria, the list of districts where the Yeshasvini Health Insurance Scheme is applicable, and the process for obtaining a Yeshasvini card and claiming insurance. Let’s delve into the details of this impactful healthcare initiative.
Yeshasvini Healthcare Insurance Scheme Coverage:
The Yeshasvini Healthcare Insurance Scheme provides coverage for various surgical procedures and medical incidents. The coverage includes:
- Cardiothoracic Surgery: Surgical procedures related to the heart and chest.
- Cardiac Arrest: Medical emergencies involving the heart.
- General Surgery: Coverage for a range of general surgical procedures.
- Paediatric and Orthopaedic Surgery: Surgical interventions for children and orthopaedic procedures.
- Obstetrics and Gynaecology Surgery: Surgical procedures related to pregnancy, childbirth, and female reproductive health.
- Vascular, Neurological, Ophthalmology, Genito-urinary Surgery: Coverage for surgeries in these specific medical areas.
- Normal Delivery: Coverage for uncomplicated, natural childbirth.
- Snake bite: Treatment expenses arising from snake bites.
- Dog bite: Medical expenses related to injuries caused by dog bites.
- Accidents while doing agricultural activities: Coverage for accidents occurring during agricultural work.
Facilities under the Yeshasvini Health Insurance Scheme
Key Features of Yeshasvini Health Insurance Scheme:
- Extensive Coverage: The scheme covers approximately 823 surgical procedures at network hospitals.
- Free Medical Surgery: Rural members receive free medical surgery worth Rs. 1.25 Lakh to Rs. 2 Lakh.
- Urban Member Coverage: Urban members can avail medical treatment costing up to Rs. 1.75 Lakh for one-time hospitalization and up to Rs. 2.50 Lakh for multiple hospitalizations.
- Affordable Tariffs: The fixed tariff for insured individuals is 40%-50% less than the regular tariff of private hospitals.
- Network Hospitals: Beneficiaries can receive treatment at a reduced cost from any of the network hospitals.
- Free Diagnosis for Outpatients: Outpatients can avail free diagnosis under this scheme.
- Emergency Stabilization: The scheme covers the stabilization of specific medical emergencies requiring outdoor treatment.
- Maternity Coverage: Coverage includes normal delivery expenses, and paediatric care for the first five days after birth.
- Inclusive Beneficiaries: The scheme extends medical facilities to weavers, Beedi workers, Stree Shakti groups, and fishermen cooperative societies.
Online Registration Process for Yeshasvini Healthcare Insurance Scheme:
- Membership Eligibility: Ensure you are a member of Rural or Urban Cooperative Societies at least three months before registration.
- Registration Period: New registration and membership renewal occur annually from May to June.
- Visit the Official Website:
- Go to the official website of Yeshasvini Health Insurance Scheme.
- Fill the Registration Form:
- Complete the online registration form with accurate personal details.
- Submit Necessary Documents:
- Upload required documents, such as proof of cooperative society membership and other relevant documents.
- Payment of Premium:
- Pay the applicable premium for enrollment in the scheme.
- Confirmation and Card Issuance:
- After successful registration and payment, you will receive confirmation.
- Receive Yeshasvini Card:
- The Yeshasvini Health Insurance Card will be issued to you, providing access to the scheme benefits.
Claim Process for Yeshasvini Health Scheme:
- Identify Network Hospital:
- Locate the nearest authorized network hospital listed under the Yeshasvini scheme.
- Document Verification:
- Present the health card or required documents to the medical coordinating officer for verification.
- Enrollment Fee:
- Submit the enrollment fee for pre-diagnosis and medical tests, as applicable.
- Pre-Authorization for Surgery:
- If surgery is required, a pre-authorization request is sent to the Management Support Service Provider (MSP).
- Verification and Cashless Approval:
- The MSP verifies the request and provides cashless approval according to the scheme’s terms.
- Cashless Treatment:
- Receive cashless treatment up to the specified limit under the Yeshasvini Health Scheme.
- Document Submission Post Discharge:
- After discharge, the hospital submits bills, discharge summary, and related documents to the MSP for settlement.
- Claim Settlement:
- The Yeshasvini Health Insurance Scheme Trust settles the claim based on the submitted documents.
Implementation Process of Yeshasvini Health Insurance Scheme:
- Beneficiary Approach:
- A beneficiary seeking benefits under the Yeshasvini Health Insurance Scheme should visit any network hospital.
- Preliminary Diagnosis Approval:
- The coordinator reviews the application and approves the preliminary diagnosis upon payment of enrollment fees.
- Pre-Authorization for Surgery/Treatment:
- If further surgery or treatment is needed and falls within the covered list, pre-authorization requests are sent to the Management Support Service Provider (MSP).
- Document Submission:
- The hospital submits bills, discharge summary, and necessary documents to the MSP for settlement of fees.
- Payment to Hospitals:
- The hospitals receive payment from the Yeshasvini Health Insurance Scheme Trust within 45 days.
The implementation process involves a systematic approach, including beneficiary interaction, preliminary diagnosis approval, pre-authorization for specific treatments, and timely settlement of fees to hospitals. This ensures a streamlined process for beneficiaries to access healthcare benefits under the scheme.
Steps to Apply for Yeshasvini Card Online:
- Visit Official Website:
- Go to the official website of SAHAKARA SINDHU, the Department of Cooperation, Karnataka.
- Cooperative Society Registration:
- Register for the cooperative society.
- Apply Online for Yeshasvini Health Card:
- Click on the option “Apply online for Yeshasvini Health Card.”
- Fill Registration Form:
- Complete the registration form with the necessary details.
- User ID and Password:
- Upon submission, you will receive a user ID and password.
- Login to the Portal:
- Return to the homepage and log in using the provided user ID and password.
- Access Yeshasvini Health Card Form:
- Locate the Yeshasvini Health Card form on the portal.
- Complete Form:
- Fill in the required information on the Yeshasvini Health Card form.
- Submission:
- Submit the completed form.
Conclusion:
In conclusion, the Yeshasvini Health Insurance Scheme stands as a commendable initiative by the Karnataka State Government to provide accessible and affordable healthcare to the low and middle-income segments of society. With a wide coverage of surgical procedures, fixed tariffs at reduced rates, and benefits extending to various categories of individuals, including weavers, Beedi workers, Stree Shakti groups, and fishermen cooperative societies, the scheme addresses the healthcare needs of diverse communities.
The implementation process, including the online registration and claim settlement procedures, adds to the user-friendly nature of the scheme. By facilitating cashless treatments, covering a multitude of surgeries, and offering financial assistance for medical emergencies, Yeshasvini plays a crucial role in improving healthcare outcomes for its beneficiaries.
For those eligible to enroll, taking advantage of the Yeshasvini Health Insurance Scheme can contribute significantly to securing quality medical care without imposing a heavy financial burden. It serves as a model for inclusive healthcare initiatives that prioritize the well-being of individuals in need.
