Yeshasvini Health Insurance Scheme- Karnataka

Why Was Yeshasvini Introduced

Farmers and informal sector workers in Karnataka had no access to any form of structured health cover enjoyed by the formally employed people. In case of serious illness, such as cardiac surgery, orthopaedic surgery, or any emergency surgery, there was no backup, and they found that the cost of treatment in private hospitals was too expensive.

Yeshasvini was conceived as a community-based scheme whereby small amounts were paid annually by cooperative society members and supplemented by the government through Yeshasvini Trust, thus providing cashless surgical treatment to the poorest of rural Karnataka's workers.

Under the scheme, TB patients can claim assistance under the Nikshay Poshan Yojana worth Rs. 1,000 per month. Additionally, pregnant women can get JSY benefits for institutional deliveries. RAN will give one-time assistance of up to ₹15 lakh beyond the coverage limit of the Yeshasvini Scheme at Government Super Speciality Hospitals.

Yeshasvini Health Insurance Scheme- Key Highlights

Yeshasvini Eligibility — Who Can Apply

To join the Yeshasvini Health Insurance Scheme:

• Must be a member of any rural cooperative society in Karnataka for a period of 3 months before enrollment.
• Persons who are members of the Stree Shakti Groups, Fisherman Cooperative Society, Self Help Groups, Weavers, and Beedi workers who transact with the Cooperative Societies are eligible.
• The family members of a primary member are insured, even if they are not part of a cooperative society.
• Must not be over 75 years of age
• Must not be a member of the rural population under the administration of Karnataka Cities and Corporations.

Who is NOT allowed:

• Married daughters of the members of the scheme who are not cooperative society members and living outside the coverage area of the scheme.
• To motivate the members of the Employees' Cooperative Society.
• Members of a liquidated or dissolved cooperative.
• All salaried employees except those working for the government.

What Does Yeshasvini Cover

What is NOT covered:

Cosmetic surgeries, heart and kidney transplants, dental surgery, joint replacement, chemotherapy, inpatient medical treatment without surgery, follow-up post-surgery, road accidents, dialysis, burns, diagnostic investigations, and vaccination.

How to Apply for Yeshasvini Health Insurance Scheme

Online Registration:

• Refer to the official website of the Karnataka Cooperative Department or the Yeshasvini Scheme website.
• Find the "Register" or "New Enrollment" choice.
• Complete the Registration form with personal information, details of the cooperative society membership, and family information.
• Upload required documents
• Annual Premiums can be paid online, and keep a copy of the confirmation.
• Fill out and submit the form, and await receipt of a membership card (card will be issued upon approval)

Offline Registration:

• Go to your local Deputy Registrar of Cooperative Societies / Cooperative Development Officer.
• Gather and complete the enrollment form, including all information.
• Provide documentation in addition to the annual premium payment.
• A form of enrollment is provided containing a Unique Health Identification (UHIN) number. A Unique Health Identification (UHIN) enrollment form is awarded as enrollment evidence.

It is open to enrollment only during the summer term (July - October) annually. The coverage period is from 1st June until 31st May of the next year.

Documents Required

• Age proof — Aadhaar card or birth certificate confirming age eligibility
• Certificate from rural or urban cooperative society — confirming membership
• Address proof — confirming Karnataka residency
• Caste certificate — if applicable for specific benefits
• Photographs of all family members
• Mobile number — for updates and notifications

How to Check Status and Get a Yeshasvini Health Card

• Click on the official portal for the Yeshasvini Scheme.
• Log in using your registered credentials.
• Select “Apply Online for Yeshasvini Health Card”
• Submit the application form for the health card.

Health cards are either obtained online or delivered via post after the process of application From 2008 onwards, the enrolled individuals are given an enrolment form for Unique Health Identification with details of the primary member and the other family members.

How the Claim Process Works

It is a cashless scheme that operates in network hospitals:

• Come to any Yeshasvini network hospital with your member card.
• Your eligibility and coverage of the procedure will be checked by the TPA (Third Party Administrator).
• The hospital makes the pre-authorisation request online to the Management Service Provider (MSP).
• The MSP responds to the application within one day.
• Treatment becomes a cashless process after approval, as MSP pays the hospital directly.
• You only pay for procedures which are not covered by the scheme.

In case of planned hospitalisation, get pre-authorisation before admission at the hospital's insurance counter.

Grievance and Rejection Process

If your request is rejected by the Yeshasvini scheme or any hospital refuses to provide treatment without cash:

Step 1: Get information about the reasons for rejection from TPA at a network hospital.

Step 2: Speak to the Yeshasvini scheme officials on 080-22269637/ 080-22251238

Step 3: Pay a visit to the Office of the Registrar of Cooperative Societies

Some common reasons for rejection include:

• Treatment is being conducted in a non-network hospital
• Procedure not listed among the 823 Surgical Package.
• Enrollment is not done during the months of July to October (enrollment period)
• Membership eligibility criteria were not fulfilled during enrollment.

Yeshasvini and Other Schemes

• Arogya Karnataka (AB-ArK)- Karnataka's health insurance programme (AB) for BPL households up to ₹5 lakh and linked to PM-JAY.
• Nikshay Poshan Yojana- ₹1,000 per month for TB patients will be paid along with the hospitalisation under the Yeshasvini scheme.
• Janani Suraksha Yojana (JSY)- is a cash incentive programme for institutional delivery.
• Rashtriya Arogya Nidhi (RAN)- up to ₹15 lakh (as per the scheme)
• Niramaya Health Insurance Scheme- For family members with Autism, Cerebral Palsy or Multiple Disabilities
• Paralleled scheme for Tamil Nadu residents- Chief Minister's Comprehensive Health Insurance Scheme (CMCHIS) (Tamil Nadu)
• The children in institutional care can avail hospitalisation benefits at the empanelled hospitals under Mission Vatsalya. Under Mission Vatsalya, the children in institutional care can avail hospitalisation benefits at empanelled hospitals.

Helpline and Support

The dedicated health insurance programme for cooperative society members, farmers and informal sector workers is back and running in Karnataka, with the name changed to Yeshasvini, after being discontinued in 2018. It offers a real surgical cover at as low a rate as ₹500 per year to a rural family, with 823+ cashless surgical procedures, 1,650 medical packages at select hospitals and a network of around 800 hospitals across Karnataka. It is part of the multi-layered health support system in Karnataka along with Rashtriya Arogya Nidhi for the extreme costs and Nikshay Poshan Yojana for TB patients. Join the cooperative society near to you or go to the official Karnataka Cooperatives portal between July & October. Register your ABHA card on the website of ABDM.gov.in to get a single digital health profile.