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Overview of the Yeshasvini Health Insurance Scheme by the Karnataka Government

Team AckoFeb 27, 2024

According to the Institute for Social and Economic Change report, there are 13.74 million farmers in Karnataka. Most of them cannot access quality healthcare, as they do not have a fixed income and depend on variable factors like weather, the quantity of produce, sales, etc., for income. The Karnataka government introduced the Yeshasvini Health Insurance Scheme to enable such farmers to access healthcare services.

This article discusses the benefits and features of this health insurance scheme.

Contents

What is the Yeshasvini Health Insurance Scheme (YCFHS)?
Benefits of the Yeshasvini Health Insurance Scheme
Important features of Yeshasvini Health Insurance Scheme
Coverages offered by Yeshasvini Health Insurance Scheme (YCFHS)
Exclusions of the Yeshasvini Health Insurance Scheme
Eligibility for Yeshasvini Health Insurance Scheme
- Who is not eligible for the Yeshasvini Health Insurance Scheme?
- Documents required for registration
How to register for Yeshasvini Health Insurance Scheme online
How to claim Yeshasvini Health Scheme
How to get a Yeshasvini Health card
Contact address
- Head office
- Regional office
Wrapping up!
Frequently asked questions

What is the Yeshasvini Health Insurance Scheme (YCFHS)?

The Yeshasvini Health Insurance Scheme is a community-based medical insurance program that seeks to assist workers in Karnataka's unorganised sector who fall into the middle and lower-middle income brackets.

The Department of Co-operatives runs this programme in collaboration with the Government of Karnataka. In order to provide the necessary healthcare facilities for the rural informal workers at a lower cost, it leverages the cash raised by Co-operative Societies through the Yeshasvini trust. The objective of the Yeshasvini Health Insurance Scheme is to offer cost-effective, high-quality healthcare throughout the state of Karnataka.

Benefits of the Yeshasvini Health Insurance Scheme

Here are the benefits offered by the Yeshasvini Health Insurance Scheme.

Rs. 5 lakh sum insured: The Yeshasvini Health Insurance Scheme offers an annual sum insured of Rs. 5 lakh. Insured members can also avail cashless facilities in any of the network hospitals.
Wide number of diseases covered: The health insurance scheme provides cashless claim benefits for 1,650 diseases at select network hospitals.
Discounts on treatment costs: One of the major advantages of this scheme is the fixed cost for certain medical treatments that are significantly lower than the standard costs.
Discounts on diagnostic tests: The costs of diagnostic tests are usually excluded from health insurance claims. However, the beneficiaries of the Yeshasvini Health Insurance Scheme can undergo these tests at a discounted rate.
Availability for cashless claims: The Yeshasvini scheme allows members to access treatment at network hospitals without paying upfront. You just show your card and the hospital bills the scheme directly. It's super convenient not to handle payments during a health crisis.

Important features of Yeshasvini Health Insurance Scheme

Following are the benefits of the Yeshasvini Health Insurance Scheme.

Benefits for members of other groups: You need to be a Karnataka Rural Co-operative Society member for at least three months to benefit from this insurance plan. You'll become the primary participant as a result of this. After that, regardless of whether they are society members, every member of your family will be able to use the scheme's benefits. Additionally, participants in this programme may be Stree Shakti Group members, members of self-help organisations, Co-operative Societies for fishermen, weavers, or Beedi employees that transact with Co-operative Societies or banks.
Contribution fee: For SC/ST families, the government will pay the premium amount. Members of Rural Co-operative Societies or SHGs must pay a premium of Rs. 500 for a family of four members and Rs. 100 each for the fifth member onwards. Members of Co-operative Societies in urban areas must pay a premium of Rs. 1,000 for a family of four members and Rs. 200 each for the fifth member onwards.
Period of enrollment: Enrollment in this scheme is open from 01, November 2022. Members can apply for the scheme benefits from this date.
Period of operation: Individuals who enlist during the specified period can take advantage of its benefits starting from 01, January 2023.

Coverages offered by Yeshasvini Health Insurance Scheme (YCFHS)

As mentioned earlier, the Yeshasvini Health Insurance Scheme offers coverage for more than 1,600 medical procedures. Following are the types of medical treatment that the insured members can avail of.

Cardiac, orthopaedic, general, and paediatric surgery
Ear, nose, throat diseases
Surgical oncology, vascular surgery, and gastroenterology
Ophthalmology, neurosurgery, and genito-urinary medicine
Drowning, dog bites, snake bites, and so on
Treatment for electrical shocks suffered when operating agricultural implements
Obstetrics, gynaecology, and newborn intensive care

The Yeshasvini Health Insurance Scheme includes the cost of medicines, in-patient hospitalisation, surgery cost, operation theatre rent, anaesthetist fees, surgeon fees, consultant fees, bed charges, nurse fees, etc. Members are eligible for treatment in the General Ward of a hospital. For out-patient treatment (OPD), a limit of Rs. 200 (for a period of three months) can be claimed under the scheme. OPD treatment can be availed at any of the network hospitals.

Exclusions of the Yeshasvini Health Insurance Scheme

Yeshasvini Health Insurance Scheme does not cover you for the expenses incurred on the following.

The cost of follow-up treatments
Dental surgery
Medico-legal cases
Implants
Deviated nasal septum surgery
Skin grafting
Burns
Cosmetic surgery
The cost of prosthesis
Dialysis
Road accidents
Joint replacement surgery
The expenses related to kidney and heart transplant surgeries

List of Treatments Covered Under Yeshasvini Health Insurance Scheme

Eligibility for Yeshasvini Health Insurance Scheme

Here is a list of prerequisites you must meet in order to sign up for this health insurance scheme.

Co-operative Society members enrolled under the Karnataka Co-operative Societies Act, 1957, Karnataka Souhardha Sahakari Act, 1997, or Multi-State Co-operative Societies Act, 2002, can take advantage of the Yeshasvini Health Insurance Scheme.
People enrolled under self-help groups set up by the District Central Co-operative Banks/Primary Agriculture Co-operative Societies are eligible.
Co-operative Society or rural self-help groups members can register under this health insurance scheme.
Co-operative Society members who are beedi rollers, weavers, and fishermen by profession are eligible.
You must not be a resident of Karnataka Cities and Corporations' rural areas.
There is no upper age limit to being a beneficiary.
Family members of people registered under the above-mentioned Co-operative Societies are eligible.
One member of the family must spend at least 3 months as a member of the mentioned Co-operative Societies so that the family becomes eligible for the Yeshasvini Health Insurance Scheme.

Note that one family can include the primary insured person, spouse, parents, children, and nieces and nephews of the insured member.

Who is not eligible for the Yeshasvini Health Insurance Scheme?

Here is a list of people who are not eligible to register for the Yeshasvini Health Insurance Scheme.

Married daughters who are not members of the specified Co-operative Societies and live outside the jurisdiction of this health scheme are not eligible for this benefit.
Members of Employees’ Co-operative Society are not eligible.
Members of liquidated or defunct Co-operative Society are not eligible.
Employees of the government sector or a private company that draws salary cannot apply.

Documents required for registration

The following documents are usually required to register for the Yeshasvini Health Insurance Scheme.

Age proof : Age proof, like an Aadhaar card or birth certificate, is needed to confirm you meet the scheme's 18-60 age requirement.
Rural or urban co-operative societies certificate: A local co-op certificate proves you live and work in Karnataka, making you eligible to participate.
Address Proof: An address proof document officially verifies where you reside so they can assign your coverage appropriately.
Caste certificate: Submitting a caste certificate cues them into any special discounts or provisions you may qualify for under your community designation.

How to register for Yeshasvini Health Insurance Scheme online

The process of registering for the Yeshasvini Health Insurance Scheme online is fairly simple. The registration process for 2022-23 began from 01 November 2022. You need to be ready with the softcopies of the necessary documents before visiting the portal. Then visit the official website of Yeshasvini Health Insurance Scheme and follow the registration process.

How to claim Yeshasvini Health Scheme

Here is how to claim Yeshasvini Health Scheme.

The patient must go to one of the network hospitals.
If the patient is a Yeshasvini beneficiary, the Third Party Administrator (TPA) of this hospital will confirm that the necessary treatment/surgery is covered by the scheme. Once confirmed, the patient must go through medical testing.
The network hospital will share a pre-authorisation request with supporting papers to the Management Services Provider (MSP) online based on the initial diagnosis. After that, the MSP will confirm the request that the hospital shared. The request should get approved within a day.
The doctors at the network hospital can start the treatment after it has been approved. The MSP will then pay the hospital after verification.

How to get a Yeshasvini Health card

You can get the Yeshasvini Health Insurance Scheme card in the following manner.

Any Co-operative Societies can register new members for the scheme and renew existing members. Here they issue a receipt and deposit the premium in a nearby Co-operative bank. The Co-operative Society also provides a UHID (Unique Health Identification) enrollment form.
Each enrollment form provides information about the primary member and his or her family members, including the primary member's name, age, relation, society membership number, enrollment date, and photo.
Once all the information is processed, the society will issue the Yeshasvini Health Card.

Contact address

The following are the contact addresses for the Yeshasvini Health Insurance Scheme.

Head office

Office of Registrar Of Co-operative Societies

#1,

Ali Asker Road,

Vasant Nagar,

Bangalore-560052

Contact number: 080 22269637/ 22251238

Regional office

Ashwathnarayan

Joint Registrar Of Co-operative Societies, Bengaluru Division

No 146, 8th Cross

3rd Main Road, Margosa Road,

Malleshwaram,

Bengaluru 560003

Contact number: 080-26612911

Email Address: [email protected]

Dr Umesh G

Joint Registrar Of Co-operative Societies, Mysore Division

Public offices building,

Opp Corporation Office,

New Sayyaji Rao road ,

Mysore 570024.

Contact number: 0821-2520823

Email Address: [email protected]

Patil G M

Joint Registrar Of Co-operative Societies, Belgaum Division

No.5,

Udaya building S.P.M Road

Shahapur

Belgaum -590001

Contact number: 0831-2489760

Email Address: [email protected]

Kantharaju R J

Joint Registrar Of Co-operative Societies, Kalburgi Division Raichur

Venkateshwara Colony,

House No,1-11-55/56,

Lingasuguru Road,

Raichur – 584101.

Contact number: 08532-221753

Email Address: [email protected]

Wrapping up!

The Yeshasvini Health Insurance Scheme is an excellent initiative by the Karnataka government to make quality healthcare accessible and affordable for poorer sections like farmers, informal workers, and middle-income families. Leveraging co-operatives to provide cashless treatment at fixed rates eases the financial burden during medical crises. This community-based program has benefited lakhs so far. More states should implement similar schemes for vulnerable populations without regular incomes. It can make a substantial positive impact on lives.

Frequently asked questions

Here are some common questions about the Yeshasvini Health Insurance Scheme.

What is the Yeshasvini Health Insurance Scheme?

The Yeshasvini Health Insurance Scheme is a community-based health insurance program that provides affordable healthcare to workers in Karnataka's unorganised sector, especially those in the middle and lower-middle income brackets.

Can a beneficiary of the Ayushman Bharat Yojana enrol under the Yeshasvini Health Insurance Scheme?

Yes, the beneficiary of the Ayushman Bharat Yojana can enrol under the Yeshasvini Health Insurance Scheme. However, they will be allowed to claim under any one of these schemes. Multiple claims for one medical event are not permissible.

What does the word “Yeshaswini/Yashaswini” mean?

The word “Yashaswini” refers to being successful.

When was the Yeshasvini Health Insurance Scheme introduced?

Initially, the Yeshasvini Health Insurance Scheme was launched in 2003 and discontinued in 2018. However, the scheme was relaunched in 2022 to give rural families access to high-quality medical facilities.

What's the maximum claim amount per year?

Each enrolled family can claim benefits of up to Rs. 5 lakh in a policy year for covered medical expenses.

Does this policy cover pre-existing conditions?

Unfortunately, like most health plans, pre-existing illnesses diagnosed earlier are not covered under Yeshasvini.

Is there any paperwork needed for cashless claims?

No, Just show your Yeshasvini membership card at the network hospitals. The rest is taken care of by the insurer and hospital.

How long does the claim process take?

It is fairly quick - the hospital usually sends pre-auth requests online and gets approval within a day. From your end, it's seamless as you must show your membership card without worrying about payments during your medical emergency. The entire claim process is designed to be fast and cashless for members.

What is the renewal process every year?

You pay the annual premium before January 1st and get your card renewed seamlessly for that year's coverage.

Can employed urban people also take this policy?

No, it is mainly targeted at rural folks who don't have regular salaries - farmers, informal workers, etc.

Who is not eligible for the Yeshasvini Health Insurance Scheme?

Married daughters living outside the scheme's jurisdiction, members of Employees' Co-operative Society, and employees of the government or private sector drawing a salary are not eligible.

Is there a waiting period after buying the policy?

No, there are no waiting periods. Coverage begins from day one of the policy period.

What is the premium for the Yeshasvini Health Insurance Scheme?

Premiums vary; rural Co-operative Societies or SHGs pay Rs. 500 for a family of four, with additional charges for more members. Urban co-operative society members pay Rs. 1,000 for a family of four, with additional charges for extra members.

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on several secondary sources on the internet. Please consult a doctor before making any health-related decisions.