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Yeshasvini Farmers Health Care Scheme

The Central Government of India has always focussed on the implementation of rural healthcare schemes in various States across the country. The Yeshasvini Farmers Health Care Scheme was bought about by the State Government of Karnataka and aims to offer the farmers of the State with proper healthcare amenities and insurance coverage. This scheme is self-funded and works on the collective ability of its members. The scheme is completely managed by the Karnataka State Government and offers coverage for various medical conditions at an affordable price. This article talks about the various aspects of the Yeshasvini Farmers Health Care Scheme.

Yeshasvini Cooperative Farmers Health Care Trust

The Yeshasvini Cooperative Farmers Health Care Trust was established under the Indian Trust Act of 1882. The main objective of this Trust was to ensure that the implementation of the Yeshasvini Farmers Health Care Scheme was executed efficiently. The Chief Patron of the Trust is typically the Chief Minister of the State, and the Patron is the Minister for Cooperation. It is essential to note that the Karnataka State Government makes significant contributions to the Trust. The governing body of the Yeshasvini Cooperative Farmers Health Care Trust comprises of 5 senior officers, who in turn, is to report to the Principal Secretary of the Cooperation Department.

Features

The following are the features of the Yeshasvini Health Care Scheme:

• Each member’s contribution to the rural health scheme is INR 300 annually, and the contribution to the urban health scheme is INR 710 annually.
• The State Government offers a subsidy up to INR 600 for members of Scheduled Caste/ Scheduled Tribes.
• The following individuals may avail this Scheme:
  • Members of every cooperative society
  • Members of Self Help Groups
  • Members having transactions with cooperative societies.
  • Members of Fishermen Cooperative Societies. The same goes for cooperative societies for Weavers, Beedi Workers and more.
• This Scheme is a surgicare cover. However, it does not cover in-patient medical costs unless surgical intervention is essential for the treatment.
• The coverage of this health scheme begins from the 1st of June of a year and ends on the 31st of May of the following year.
• More than 730 network hospitals provide cashless treatments under the Yeshasvini Health Scheme.
• Benefits offered under this Scheme may only be availed in the network hospitals listed by the State Government.
• Benefits are implemented and may be availed by members of the Scheme in the form of cashless treatments.

Eligibility

Individuals who wish to avail the benefits under this Scheme must meet the eligibility criteria listed below:

• Applicant must be a member of Karnatak’s Rural Cooperative Society.
• This Scheme may be availed by anyone, starting from a newborn baby to a senior citizen. No age limit is applicable under this Scheme.
• Family members of the enrolled member may also join the Scheme.
• Enrolment for this Scheme is open between July and October of every year only.

Benefits

The Yeshasvini Health Care Scheme offers various medical benefits, such as the following:

Exclusions

Yeshasvini Health Care Scheme does not include any of the following:

• Follow-ups or post-surgery medical treatments
• Kidney and Heart Transplants
• Joint Replacement Surgeries
• Road Traffic Accidents
• Any Cosmetic Surgery
• Screws and Stents
• Orthopedic and Urological Surgeries
• Valves for Heart Operations
• Expenses incurred from Vaccination or Inoculation.
• Expenses incurred by Vitamins, Tonics, or Sanitary Products.
• Expenses incurred for Diagnostic Investigations.

Claim Procedure

The Yeshasvini Health Care Scheme is a completely cashless scheme, starting from admission to discharge. This health scheme is implemented by the Management Support Service Provider/ MSP with the help of various network hospitals. During hospital admissions, the enrolled member has to provide an identity card. After the preliminary diagnosis, the requirements for surgical intervention will be determined based on the diagnosis. The network hospital will forward the pre-authorisation requirements to the Yeshasvini Trust for further approval.

The Trust generally provides Pre-authorisation within 24 hours at maximum. Post authorisation, the doctors and surgeons of the network hospital may proceed with the necessary medical treatments. After the treatment is complete, the network hospital shall send all the incurred medical bills and discharge summary of the relevant patient to the MSP. After the claim is verified, the Trust will arrange the funds to pay the network hospital for the expenses incurred.

Yeshasvini Health Insurance

The Yeshasvini Co-operative Farmers Health Insurance offers cost-effective medical coverage to farmers across the State of Karnataka with the help of cooperative societies registered under the Department of Cooperatives. This Scheme aims to help informal workers of the lower-middle-income and middle-income groups. In other words, any peasant in the State of Karnataka may avail these benefits provided that they are a member of a cooperative society of their choosing.

Salient Features

Every member of the Karnataka Rural Co-operative Society is eligible to be a part of the Yeshasvini Health Insurance Scheme.

• Family members of the enrolled member of the Rural Co-operative Society may avail these benefits.
• Each member’s contribution to the rural health scheme is INR 300 annually, and the contribution to the urban health scheme is INR 710 annually.
• Enrolment for this Scheme is open between July and October of every year only.
• The coverage of this health scheme begins from the 1st of June of a year and ends on the 31st of May of the following year.
• The following individuals may avail this Scheme:
  • Members of every cooperative society
  • Members of Stree Shakti Group
  • Members of Self Help Groups
  • Members having transactions with cooperative societies and banks.
  • Members of Fishermen Cooperative Societies. The same goes for cooperative societies for Weavers, Beedi Workers and more.

Eligibility Criteria

The following are the eligibility criteria for an individual to be a part of the Yeshasvini Health Insurance Scheme.

• Individuals not more than 75 years of age.
• Individual must be a member of any Karnataka cooperative society.
• Individual must be living in any of the rural areas in Karnataka.
• Family members of the main beneficiary of the Scheme may avail benefits of the Scheme as well.

Implementation Procedure

More than 730 network hospitals in the State has tied-up with the Trust in order to implement the Yeshasvini Health Insurance Scheme. This also includes private hospitals, as well. The MSP arranges for cashless hospitalisation with the help of these network hospitals. The implementation of Yeshasvini Health Insurance is as follows:

• The beneficiary of the Scheme visits a network hospital recognised and approved by the Trust.
• First, a coordinating officer in the network hospital will review and examine the beneficiary’s Unique Health Identification card.
• The beneficiary will be required to pay an enrollment fee.
• Next, the patient has to undergo an initial diagnosis and a few basic medical tests.
• After the initial diagnosis, the network hospital shall send a pre-authorisation request, based on the diagnosis, on the online portal with all the relevant supporting documents to the MSP.
• Doctors, on behalf of the MSP, shall review and examine the request. The approval for the same will be given within 24 hours.
• Subject to the limits specified under the insurance, the network hospital will provide cashless treatments to the beneficiary.
• Post-discharge, the network hospital is required to submit the original bills, discharge summary, and any other medical documents to the MSP in order to settle the claim.
• The Trust will settle the claim within 45 days of receipt of the mentioned documents.