Yeshasvini Health Insurance Scheme: Benefits, Eligibility & Coverage

In rural areas of Karnataka, accessing quality healthcare can be challenging for workers in the informal sector, such as farmers, due to their variable income and lack of formal healthcare benefits. To bridge this healthcare gap and provide affordable medical facilities, the Karnataka government launched the Yeshasvini Health Insurance Scheme. This community-based medical coverage program aims to support middle and lower-middle-income workers in the informal sector, ensuring they can access essential healthcare services without financial burdens.

Under the scheme, the beneficiaries contribute INR 300 yearly if they reside in rural areas. For the urban population, the yearly amount is INR 710. Currently, close to 30 lakh people are benefitting from the scheme. From paediatric surgery to dog bites, the scheme covers an extensive number of 823 procedures. Read on to find more details about the scheme and how you can become a beneficiary.

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Facilities of the Yeshasvini Health Insurance Scheme:

The Yeshasvini Health Insurance Scheme offers a wide range of facilities to its beneficiaries, which include:

• Cashless benefits for approximately 800+ medical procedures at network hospitals.

• Fixed tariffs for specific treatments significantly reduce overall medical costs.

• Discounts on diagnostic tests for insured members, making essential medical screenings more accessible.

• Coverage for newborn babies and individuals up to the age of 75 years, ensuring comprehensive healthcare for all eligible members.

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Benefits of the Yeshasvini Health Insurance Scheme:

The Yeshasvini Health Insurance Scheme has several benefits, making it a valuable healthcare solution for rural workers in Karnataka. Key benefits include:

• Annual insurance coverage of Rs. 5 Lakhs.

• Coverage for more than 800 medical procedures, including cardiac surgery, orthopaedic surgery, gynaecology, and many more.

• Cashless claim facility at network hospitals, reducing the financial burden on beneficiaries during medical emergencies.

• Special consideration for family members, allowing them to avail of the scheme’s benefits even if they are not members of a rural cooperative society.

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Eligibility for Yeshasvini Health Insurance Scheme:

To be eligible for the Yeshasvini Scheme, individuals must meet the following criteria:

• Membership in a rural cooperative society for at least six months before scheme enrollment.

• Residing outside the rural areas of Karnataka cities and corporations.

• Family members of the primary insured member can also qualify for coverage under the scheme.

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List of Treatments Covered Under Yeshasvini Health Insurance Scheme:

The Yeshasvini Health Insurance Scheme covers more than 800 medical procedures, ensuring beneficiaries can access a wide range of essential treatments. Some of the Yeshasvini Scheme facilities include:

1. Cardiac SurgeryBeneficiaries of the Yeshasvini scheme can undergo various cardiac surgical procedures. These include coronary artery bypass grafting (CABG), heart valve repair or replacement, and other heart-related surgeries. Access to such critical cardiac treatments ensures that individuals receive the necessary medical interventions to manage heart-related conditions.

2. Orthopaedic SurgeryThe scheme provides coverage for orthopaedic surgical procedures, encompassing treatments for bone fractures, joint replacements, spinal surgeries, and more. With orthopaedic surgeries often requiring long-term recovery and rehabilitation, the Yeshasvini Health Insurance Scheme offers a financial safety net for beneficiaries facing musculoskeletal issues.

3. General SurgeryThe Yeshasvini Health Insurance Scheme covers various general surgical procedures such as appendectomy, hernia repair, gallbladder removal, and more. General surgery is a crucial aspect of healthcare, addressing a wide range of conditions that require surgical intervention for optimal recovery.

4. Gynecology and ObstetricsFemale beneficiaries can avail themselves of gynaecological treatments and obstetric care under the Yeshasvini scheme. This includes coverage for prenatal and postnatal care, normal deliveries, cesarean sections, and treatments for various gynaecological conditions.

5. Surgical OncologyBeneficiaries diagnosed with cancer can access surgical oncology treatments through the Yeshasvini Health Insurance Scheme. Surgical procedures for cancer removal or tumour resection are included, providing crucial support to individuals battling cancer.

6. Neurological SurgeryThe scheme extends coverage to neurological surgeries, encompassing procedures such as brain tumour removal, treatment for neurological disorders, and surgeries to address spinal conditions. With neurological ailments requiring specialized expertise and care, the scheme assists those dealing with such health challenges.

7. Neonatal Intensive CareNewborn babies covered under the Yeshasvini Health Scheme receive neonatal intensive care benefits. This includes critical medical support for premature infants or those born with health complications, ensuring they have the best chance for healthy development.

8. GastroenterologyBeneficiaries requiring gastroenterological treatments, such as procedures for gastrointestinal issues, liver diseases, and digestive disorders, can access comprehensive medical coverage under the scheme. Gastroenterology plays a significant role in maintaining overall well-being, and this coverage is a boon for those with related health concerns.

9. Accidents During Agricultural OperationsThe Yeshasvini Insurance Scheme also covers accidents that occur during agricultural operations. This includes injuries caused by electrical shocks, drowning incidents, or accidents related to the operation of agricultural equipment. Such coverage is essential for the farming community, safeguarding them against unforeseen emergencies while working in the fields.

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Exclusions to the Karnataka Yeshasvini Scheme

While Yeshasvini Insurance offers comprehensive coverage, there are certain exclusions that beneficiaries should be aware of. The scheme does not cover expenses related to:

1. Follow-up TreatmentsThe Yeshasvini scheme focuses on providing primary and essential medical treatments to beneficiaries. However, follow-up treatments involving subsequent visits and care related to a previous medical procedure are not covered. Beneficiaries should be prepared to bear the expenses for any follow-up consultations, tests, or medications.

2. Dental SurgeryDental health is an integral part of overall well-being. However, dental surgeries, including procedures like tooth extractions, root canals, and implants, are not covered under the Yeshasvini Health Insurance Scheme.

3. Implants and ProsthesisThe Yeshasvini Scheme offers coverage for essential surgical procedures. However, it does not extend to the cost of implants, such as joint replacements or dental implants, and prosthesis devices. Beneficiaries requiring these medical devices will have to bear the expenses themselves.

4. Cosmetic SurgeryWhile Yeshasvini Health Care focuses on essential and life-saving medical treatments, it does not cover elective procedures like cosmetic surgery, performed solely for aesthetic purposes. Cosmetic surgeries, such as rhinoplasty or liposuction, fall outside the scope of the scheme’s coverage.

5. ChemotherapyThough the Yeshasvini scheme covers surgical oncology treatments for cancer, it does not include chemotherapy, a common cancer treatment involving medication. Beneficiaries seeking chemotherapy for cancer management will need to explore alternative financial options for this treatment.

6. Autoimmune DiseasesAutoimmune diseases involve the immune system attacking healthy cells and tissues and require specialized and ongoing medical care. However, the Yeshasvini Health Insurance Scheme does not cover treatments for autoimmune diseases like rheumatoid arthritis or multiple sclerosis.

7. Kidney and Heart Transplant SurgeriesOrgan transplant surgeries are complex and involve significant medical costs. While the Yeshasvini scheme offers extensive coverage for various treatments, it does not include expenses related to kidney or heart transplant surgeries.

8. Dialysis and Road Traffic AccidentsDialysis, a procedure for individuals with kidney failure, and expenses related to road traffic accidents are not covered under Yeshasvini Health Care. Beneficiaries requiring dialysis treatments or facing medical emergencies due to road accidents should consider alternative financial arrangements.

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Documents Required for Yeshasvini Health Insurance Scheme:

To enrol in the Yeshasvini Health Scheme, individuals need to provide the following documents:

• Proof of membership in a rural or urban cooperative society.

• Age proof

• Address proof

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How to Register Online for Yeshasvini Health Insurance Scheme:

The online registration process for the Yeshasvini Insurance Scheme is straightforward.

1. Visit the Official WebsiteTo initiate the online registration process, visit the official website of the Yeshasvini Health Insurance Scheme. The website provides comprehensive information about the scheme, its benefits, and the registration procedure.

2. Check Eligibility CriteriaBefore proceeding with the registration, ensure that you meet the eligibility criteria for the Yeshasvini Scheme. Cooperative society members, including members of rural cooperative societies, weavers’ cooperative societies, self-help groups dealing with cooperative societies, beedi workers’ cooperative societies, and fishermen’s cooperative societies, are eligible to apply for the scheme.

3. Gather Required DocumentsEnsure you have all the necessary documents ready for the registration process. The typical documents required include proof of membership in a cooperative society, age proof, and address proof.

4. Click on “Register” or “Renew Membership”On the official website’s homepage, look for the option to “Register” or “Renew Membership.” Click on this option to begin the registration process.

5. Fill in the DetailsYou will be directed to a registration form where you need to provide essential details such as your name, age, relationship to the primary member, society membership number, and enrollment date. Fill in the required information accurately and double-check for any errors before proceeding.

6. Upload DocumentsOnce you have filled in the necessary details, you will be prompted to upload the required documents. Ensure the documents are clear and in the specified formats to facilitate smooth processing.

7. Review and SubmitAfter uploading the documents, carefully review all the information you have provided. Cross-verify the details to ensure accuracy. Once you are satisfied that all the information is correct, click on the “Submit” button to complete the registration process.

8. Obtain UHID FormUpon successful submission of the registration form, the system will generate a Unique Health Identification (UHID) form for you. This UHID form proves your enrollment in the Yeshasvini Health Insurance Scheme. Make sure to save and print the UHID form for your records.

9. Seek Healthcare ServicesCongratulations! You are now a registered member of the Yeshasvini Health Insurance Scheme. You can present your UHID form at any network hospital to avail of cashless healthcare services for covered medical treatments.

It is important to note that the online registration window for the Yeshasvini Health Scheme is typically open between May and June each year.

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How to Get Yeshasvini Health Card:

Earlier, beneficiaries received a Yeshasvini Health Card to signify their association with the scheme. However, from 2008-2009, the card was replaced with a Unique Health Identification (UHID) form, containing essential details of the primary member and their family. The UHID form serves as proof of enrollment for availing of healthcare services.

Here is a step-by-step guide on how to obtain the Yeshasvini Card, now in the form of a UHID form:

1. Complete the Registration ProcessTo be eligible for the Yeshasvini Health Card, ensure that you have completed the Yeshasvini Health Insurance Scheme registration process. This entails meeting the eligibility criteria and providing all the required information and documents during the registration.

2. Receive the UHID FormUpon successful registration, the system will generate a Unique Health Identification (UHID) form for you. This form contains important details such as the name, age, relationship to the primary member, society membership number, enrollment date, and photographs of the primary member and their family members.

3. Save and Print the UHID FormOnce you receive the UHID form, it is crucial to save it electronically and print a physical copy for your records. The UHID form serves as proof of enrollment in the Yeshasvini Health Insurance Scheme and will be required for availing of cashless healthcare services at network hospitals.

4. Present the UHID Form at Network HospitalsWhenever you or any of your family members need medical treatment covered under the Yeshasvini Health Insurance Scheme, simply present the UHID form at any of the network hospitals. The hospital authorities will verify your enrollment and facilitate cashless treatment for the covered medical procedures.

5. Keep the UHID Form HandyAs the UHID form serves as a crucial document for availing healthcare services, it is advisable to keep it handy at all times. Store a copy of the UHID form in your wallet or purse so that you can present it quickly whenever necessary.

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How to Claim Yeshasvini Health Insurance Scheme:

The process of claiming benefits under the Yeshasvini Health Scheme is simple. If you find yourself in need of medical treatment or face a medical emergency, follow these simple steps to claim the benefits of the Yeshasvini scheme and receive the care you need without any worries.

Step 1: Visit a Network Hospital

The first thing you should do is head to any of the network hospitals associated with Yeshasvini Health Insurance. These hospitals are in partnership with the scheme and are fully equipped to provide you with cashless medical services, making it easier for you to get the care you require.

Step 2: Verify Your Membership and Coverage

When you arrive at the network hospital, let the hospital staff know that you are a Yeshasvini Health Insurance Scheme member. They will then verify your enrollment status in the scheme and check if the treatment you need is covered under the scheme.

Step 3: Undergo Initial Diagnosis and Medical Tests

After the verification process, the hospital’s medical team will conduct an initial diagnosis and may perform necessary medical tests to determine the best course of treatment for you.

Step 4: Submit a Pre-Authorization Request to the Management Services Provider (MSP)

Once the diagnosis is complete, the network hospital will prepare a pre-authorisation request for your medical treatment. This request includes all the essential medical documents and information needed to establish the necessity of the treatment and its coverage under the Yeshasvini Health Insurance Scheme. The hospital will then send this request to the Management Services Provider (MSP).

Step 5: Verification and Approval by MSP

The MSP is responsible for overseeing the claims process of Yeshasvini Health Insurance. They will carefully evaluate the pre-authorisation request and verify its validity. Suppose everything aligns with the scheme’s coverage and criteria. In that case, the MSP will approve your treatment within a short period, usually within a day.

Step 6: Commence Your Treatment

Once the pre-authorisation request is approved, you can proceed with your prescribed medical treatment as advised by the doctors at the network hospital. The best part is that the approved treatment will be covered under the Yeshasvini Health Insurance Scheme, and you won’t have to worry about making any upfront payments for the approved procedures.

Step 7: Payment Settlement

After your treatment, the network hospital will submit all the necessary medical bills and documents to the MSP for reimbursement. The MSP will then process the payment and settle the medical expenses directly with the hospital. This means you won’t have to bear the financial burden of paying for the treatment upfront.

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Hospital List under the Yeshasvini Health Insurance Scheme:

The Yeshasvini Health Insurance Scheme boasts a network of nearly 900 hospitals across various districts in Karnataka. This extensive network ensures beneficiaries easily access healthcare services, especially during emergencies. Yeshasvini Scheme hospitals from urban and rural areas, providing medical assistance to numerous beneficiaries.

Here is a list of the number of hospitals available in each district that accept the Yeshasvini Health Insurance Scheme.

Bagalkote	12
Bangalore Rural	19
Bangalore Urban	61
Belgaum	22
Bellary	16
Bidar	11
Bijapur	8
Chamrajnagar	23
Chikkaballapura	25
Chikkamagalur	11
Chitradurga	8
Dakshina Kannada	6
Davanagere	4
Dharwad	44
Gadag	7
Gulbarga	5
Hassan	22
Haveri	18
Kodagu	27
Kolar	22
Koppal	20
Mandya	26
Mysore	16
Raichur	11
Ramanagar	7
Shimoga	21
Tumkur	49
Udupi	11
Uttara Kannada	8

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Conclusion:

The Yeshasvini Health Insurance Scheme, implemented by the Karnataka government, is an impressive initiative that provides affordable and accessible healthcare services to rural workers and farmers. Enrollment is open to anyone below 75 years of age and covers a variety of medical treatments. The scheme has a vast network of 900 hospitals across the state, resulting in tremendous success. However, it is worth noting that the program may not cover some medical situations.

In cases where medical procedures require significant financial investment, Ketto may provide the necessary aid. Ketto is committed to assisting wherever possible, but it is essential to understand the limitations of the program.

You can raise a campaign for your needs with Ketto‘s Social Impact Plan (SIP). Contributing to the SIP makes you eligible for reimbursement of your medical expenses. It is truly inspiring to witness the community of donors coming together to support Ketto’s Social Impact Plan, which prioritises the betterment of the community.