Yeshasvini Health Insurance Scheme: Coverage & Benefits

There’s a silent stress that weighs on many working families, the fear of a sudden illness or accident. It's the realisation that one unexpected hospital bill can wipe out years of savings. For the backbone of our economy, farmers, weavers, and members of rural cooperatives, this worry is worsened by the seasonal and often unpredictable nature of their income. Health insurance isn’t a luxury; it's an essential safety net that enables families to seek care without risking their financial future for a diagnosis.

This fundamental need for accessible and affordable healthcare led to the creation of one of Karnataka’s most transformative social security programmes: the Yeshasvini Health Insurance Scheme.

In this blog, we will discuss everything you need to know.

What is the Yeshasvini Health Insurance Scheme?

The Yeshasvini Health Insurance Scheme is a unique, community-based health insurance programme specifically designed for members of cooperative societies in Karnataka, predominantly targeting the state’s vast population of farmers and rural workers.

It was first launched in 2003, paused for a period, and was relaunched to provide a comprehensive, low-cost medical safety net. The scheme operates on a cooperative model, where members pay a minimal, highly subsidised annual contribution, and in return, they receive extensive coverage for a wide range of surgical and medical procedures.

The idea behind the scheme is simple: members of cooperative societies come together to share resources and protect each other from high medical costs during serious health problems. This way, everyone gets access to healthcare, no matter how much money they have at the time. The scheme is run by the Department of Co-operation and the Yeshasvini Health Insurance Scheme Trust, making sure the money is used directly for members' treatment. It works through a large network of government and private hospitals across the state.

What Makes the Yeshasvini Scheme Stand Out?

The strength of the Yeshasvini scheme lies in its design, which is tailored to the financial and geographical realities of its target demographic. It moves beyond a simple insurance policy to become an integral part of the cooperative society's benefits.

Cooperative Membership Model

Unlike commercial insurance, the scheme is deeply tied to cooperative societies. To be eligible, the primary beneficiary must be an active member of a recognised cooperative society for a minimum continuous period (typically three months) before enrollment. This unique criterion ensures the scheme benefits the people it was originally intended for: those connected to the state's cooperative structure, including farmers, fishermen, weavers, and members of self-help groups (SHGs).

Extremely Low Annual Contribution

The premiums are the most compelling feature. They are highly subsidised, making the scheme incredibly accessible. Currently, members pay a very nominal annual contribution, which is fixed and significantly lower than any commercial insurance policy. The government also bears the full premium for Scheduled Caste (SC) and Scheduled Tribe (ST) families, emphasising the scheme’s focus on social equity.

Cashless Treatment Facility

A crucial feature is the cashless treatment facility. Once pre-authorisation is approved, the beneficiary doesn't have to worry about paying large hospital bills upfront. The scheme directly settles the costs with the network hospital, dramatically reducing the financial stress during a medical emergency.

Wide Network of Hospitals

The scheme boasts an extensive network of empanelled hospitals across Karnataka, encompassing both government and quality private healthcare institutions. This wide reach ensures that beneficiaries in both rural and semi-urban areas can access specialised and high-quality medical services without having to travel excessively long distances.

Family Coverage

A single membership covers the entire family of the primary member, including the spouse, dependent children, and parents. This is a critical provision that secures the health of the whole household under a single, affordable contribution.

Coverage Under the Yeshasvini Health Scheme

The Yeshasvini scheme is primarily focused on surgical and major medical procedures, offering coverage that is robust and comprehensive in its specific domain.

Maximum Sum Insured

The scheme provides an annual health insurance coverage typically up to ₹5,00,000 per family, or an amount fixed based on the type of procedure, for all covered treatments availed in the network hospitals.

Procedures and Treatments Covered

The scheme covers an exhaustive list of major surgeries and medical procedures. These generally fall under the following specialities:

• General Surgery: Including hernia repair, appendectomy, and various abdominal surgeries.
• Cardiology and Cardiothoracic Surgery: Procedures related to the heart and chest.
• Orthopaedics: Treatments for bone and joint-related issues, including fractures and some joint surgeries (though complex replacements might have limitations).
• Neurological Surgery: Procedures concerning the brain and nervous system.
• Gynaecology and Obstetrics: Coverage for women's health issues, normal and Caesarean deliveries.
• Paediatric Surgery: Surgical care for children.
• Surgical Oncology: Cancer-related surgical procedures.

Inclusions in Treatment Costs

The coverage is comprehensive for the authorised procedure and includes:

• Surgeon’s and Anaesthetist’s fees.
• Operation Theatre (OT) charges.
• Room/Bed charges (generally for the General Ward).
• Cost of medicines, consumables, and implants (up to a specified limit).
• Hospital charges during the hospitalisation period for the covered procedure.

Outpatient Department (OPD) Benefits

The scheme may also offer a limited benefit for OPD consultation and diagnostic tests at network hospitals, often with a fixed ceiling per visit, ensuring initial consultation and diagnosis are also made affordable.

Securing Your Health: Key Advantages of the Yeshasvini Scheme

The real impact of the Yeshasvini Health Insurance Scheme is felt not in the clauses of the policy document, but in the lives it transforms.

Financial Risk Protection

This is the scheme's greatest benefit. By providing coverage up to ₹5 lakhs, it acts as a massive financial buffer, protecting low and middle-income families from being pushed into poverty due to medical costs. It ensures that a health crisis doesn't become a debt crisis.

Access to Quality Care

The scheme empanels quality private hospitals that rural members might otherwise never afford. This democratizes access to sophisticated medical technology and expert surgical teams, ensuring that beneficiaries receive timely, high-standard treatment.

Fixed and Reduced Tariffs

For many covered procedures, the scheme operates on a fixed tariff model. This means the cost of a surgery is pre-negotiated and significantly lower than the market rate, benefiting both the insurer and the hospital network and guaranteeing fair pricing for the beneficiaries.

Zero Age Barrier

For the most part, the scheme has no upper age limit, which is rare in commercial insurance. This ensures that elderly parents and retired members of cooperative families, who often have the greatest health needs, are not excluded.

Pre-existing Conditions Coverage

Crucially, the scheme often provides coverage for pre-existing diseases from day one, which is an invaluable benefit, as it removes a major barrier to healthcare for individuals with chronic or long-term ailments.

How to Apply for the Yeshasvini Health Scheme?

The application process is designed to be streamlined through the local cooperative structure. Here’s how you can do that:

Step 1: Confirm Eligibility and Membership

First, ensure you and your family meet the eligibility criteria, especially the minimum continuous membership period in your cooperative society.

Step 2: Visit Your Cooperative Society

The application is handled offline through your local cooperative society or the bank associated with your self-help group. Visit the branch where you are a member.

Step 3: Collect and Fill the Enrollment Form

Request the Unique Health Identification (UHID) enrollment form. This form will require details for the primary member and all family members to be covered.

Step 4: Submit Required Documentation

Prepare and submit the following documents for all family members:

• Proof of Membership: A certificate from the cooperative society confirming active membership and duration.
• Aadhaar Card: For identity and address proof of all enrolling members.
• Ration Card: To confirm family structure and details.
• Passport-Sized Photographs: Of all members to be included.
• Caste Certificate (if applicable): For SC/ST beneficiaries to avail of the premium exemption.

Step 5: Pay the Annual Contribution

Submit the applicable annual premium fee based on your cooperative type (rural or urban) and family size. Ensure you receive an official receipt for the payment.

Step 6: Receive the Yeshasvini Health Card

Once the application is processed and verified, the cooperative society will issue your Yeshasvini Health Card (often a plastic card with a unique ID). This card is essential for availing cashless treatment at network hospitals.

Renewal is an annual process and is completed by simply paying the annual contribution to the cooperative society during the specified enrollment period.

Wrapping Up

The fear of a medical emergency should never dictate the quality of life or the financial stability of a family. The Yeshasvini Health Insurance Scheme is a remarkable testament to the power of state and cooperative collaboration, providing a crucial health safety net that directly impacts the lives of millions in Karnataka’s unorganised and rural sectors. It is a beacon of affordable, quality healthcare, proving that with political will and community spirit, comprehensive health coverage can be a right, not a privilege.

At Niva Bupa, we offer health insurance plans that offer protection and cover everything from pre-and post-hospitalisation to daycare procedures. With our health insurance plans, we try and add an additional layer of security, ensuring no health need, big or small, goes unmet.

People Also Ask

1. Who is eligible for this scheme?

   The scheme is primarily for members of cooperative societies in Karnataka, including farmers, weavers, and fishermen. You need to be a member of a cooperative society for a certain period before you can enrol.

2. What documents are needed for enrollment or renewal?

   You will need to provide proof of your cooperative society membership, age proof, and address proof. For enrollment or renewal, you'll need to submit these documents to your cooperative society branch.

3. Is there a cashless facility, and how does it work?

   Yes, the scheme offers cashless treatment at its network hospitals. You just need to show your Yeshasvini Health Card at the hospital, and they will handle the pre-authorisation and claim process directly with the trust.

4. Does my whole family need to be a part of the cooperative society?

   No, only one member of the family (the primary applicant) needs to be a member of the cooperative. Once enrolled, the benefits of the scheme are extended to the entire family, including the spouse, dependent children, and parents.

5. Is there a waiting period for pre-existing diseases?

   Unlike many commercial policies, the Yeshasvini scheme generally covers pre-existing diseases from the day of enrollment. This is a huge benefit for members who have chronic health conditions and need immediate care.