Yeshasvini Farmers Health Care Scheme

The Government of India places a high priority on improving rural healthcare through various schemes. One such initiative is the Yeshasvini Farmers Health Care Scheme, launched by the State Government of Karnataka. This scheme aims to provide the farmers of Karnataka with essential healthcare facilities and insurance coverage. It is a self-funded model that operates on the collective efforts of its members. Completely managed by the Karnataka State Government, it offers coverage for numerous medical conditions at an affordable cost. This article delves into the intricate details of the Yeshasvini Farmers Health Care Scheme.

Yeshasvini Cooperative Farmers Health Care Trust

The Yeshasvini Cooperative Farmers Health Care Trust was officially formed under the Indian Trust Act of 1882. With an objective to ensure efficient execution of the Yeshasvini Scheme, the Trust plays a pivotal role. The Chief Minister of Karnataka typically serves as the Chief Patron while the Minister for Cooperation acts as the Patron. Notably, the Karnataka State Government makes substantial contributions to this Trust. The governing body comprises five senior officers, all of whom report to the Principal Secretary of the Cooperation Department.

Features of the Yeshasvini Health Care Scheme

The Yeshasvini Health Care Scheme includes several key features:

• Annual membership contribution is INR 300 for rural members and INR 710 for urban members.
• The State Government provides subsidies up to INR 600 for Scheduled Caste/Scheduled Tribes members.
• Eligible participants include:
• Members of every cooperative society
• Members of Self Help Groups
• Members engaging with cooperative societies
• Members belonging to Fishermen, Weavers, and Beedi Workers Cooperative Societies
• This Scheme primarily offers surgicare coverage, excluding in-patient medical expenses unless surgery is necessary.
• Coverage commences on June 1 each year and concludes on May 31 the following year.
• Cashless treatments are available across more than 730 network hospitals.
• Benefits are accessible only through State Government listed network hospitals.

Eligibility Criteria

To avail of the benefits of the Yeshasvini Scheme, the following eligibility criteria must be met:

• The applicant must be a member of Karnataka's Rural Cooperative Society.
• The scheme is inclusive, with no age restrictions, benefiting applicants from newborns to senior citizens.
• Family members of enrolled individuals can also join the scheme.
• Enrollment is open annually from July to October.

Benefits of the Yeshasvini Health Care Scheme

The Yeshasvini Scheme offers numerous healthcare benefits:

Exclusions

The Yeshasvini Health Care Scheme does not include:

• Follow-ups or post-surgery medical treatments
• Kidney and Heart Transplants
• Joint Replacement Surgeries
• Road Traffic Accidents
• Cosmetic Surgery
• Surgical Screws and Stents
• Orthopedic and Urological Surgeries
• Heart Operation Valves
• Vaccination or Inoculation expenses
• Vitamins, Tonics, or Sanitary Product expenses
• Diagnostic Investigation expenses

Claim Procedure

The Yeshasvini Health Care Scheme operates on a cashless basis. From admission to discharge, the process involves the Management Support Service Provider (MSP) collaborating with network hospitals. Upon hospital admission, members need to present an identity card. If surgical intervention is necessary following the preliminary diagnosis, the hospital will seek pre-authorisation from the Yeshasvini Trust. Pre-authorisation is typically secured within 24 hours. After treatment, medical bills and summaries are submitted to the MSP, which verifies claims and facilitates payment.

Yeshasvini Health Insurance

The Yeshasvini Co-operative Farmers Health Insurance offers affordable medical coverage to farmers in Karnataka, facilitated by registered cooperative societies. Nidhi Companies can benefit similarly from collective resource utilization. Primarily aimed at informal workers from lower-middle and middle-income groups, any peasant affiliated with a cooperative society is eligible.

Salient Features of Yeshasvini Health Insurance

The following highlight the offerings of the Yeshasvini Health Insurance Scheme:

• Every member of the Karnataka Rural Co-operative Society is eligible.
• Family members of registered Rural Co-operative Society members can also access benefits.
• The rural health scheme requires an annual contribution of INR 300; the urban scheme costs INR 710 annually.
• Enrollment is limited to the July-October window each year.
• Eligible participants include Stree Shakti Group members, Udyam registered entrepreneurs, and members of Self Help Groups with financial transactions with cooperative societies and banks.
• The scheme year runs from June 1 to May 31 of the next year.

Eligibility Criteria

Conditions for joining the Yeshasvini Health Insurance Scheme:

• The age limit is set at 75 years.
• Applicants must be part of any Karnataka cooperative society.
• Residence in Karnataka’s rural areas is essential.
• Family members of the primary beneficiary can access the scheme's benefits.

Implementation Procedure

With over 730 affiliated network hospitals, including private medical facilities, the Yeshasvini Health Insurance Scheme is robustly implemented. The MSP coordinates with these hospitals for cashless hospitalization:

• The scheme beneficiaries should visit network hospitals approved by the Trust.
• Hospital coordinators will verify the beneficiary's Unique Health Identification card.
• Enrollment fees must be paid by beneficiaries.
• Initial diagnosis and basic medical tests are conducted.
• The hospital, based on diagnosis, sends a pre-authorisation request to the MSP, including all supporting documents.
• MSP review ensures a 24-hour approval turnaround.
• Subject to coverage limits, the network hospital facilitates necessary cashless treatments.
• Post-discharge, the submission of medical documentation to MSP within 45 days ensures claim processing.