“Yeshasvini Scheme” (Yeshasvini Cooperative Farmers Health Care Scheme)”

NANDISH VASTRAD

NANDISH VASTRAD

Consultant Pathologist/Nephropathologist & Assistant Professor

MBBS, MD, CNC, (PGDHE),

Peer Reviewed By

Dr.Sajjan Madappady


Article Views: 135

Published On: Wednesday December 13, 2017



“Yeshasvini Scheme” (Yeshasvini Cooperative Farmers Health Care Scheme)”

Introduced by the State Government to the Co-operative farmers of Karnataka.

This scheme was inaugurated on 14th of November 2002 by then the Hon’ble Chief Minister of Karnataka Sri S.M.Krishna and was operationalised with effect from 1st June 2003.

With the introduction of ‘Yeshasvini Self Funded Health Care Scheme’ Karnataka has become role model state.

Dr. Devi Prasad Shetty of Narayana Hrudayalaya, Bangalore, initiated the concept of “rural health care scheme” and with suitable modifications by Sri A Ramaswamy, then the Principal Secretary to Government of Karnataka, Co-operation Department and band of officers of Co-operation Department with the financial assistance of Government of Karnataka Yeshasvini Health Care Scheme was implemented through network hospitals to provide cost effective quality healthcare facilities to the Co-operative farmers spread across the state of Karnataka.

YESHASVINI SCHEME:

  • It is one of the largest Self-Funded Healthcare Scheme in the country.
  • Offers about 823 defined surgical procedures to farmers and their families at lower costs.
  • The beneficiaries need to contribute a small amount of money every year to avail health facilities in this “contributory scheme”.
  • Subject to conditions of the scheme it offers cashless treatment at Network Hospitals spread across the state.

 

ELIGIBILITY:

  • One should be a member of Rural Co-operative Society of the State.
  • All family members of the main member are eligible to avail the benefit of the scheme though they are members (with 3 months) of a rural co-operative society.
  • Each beneficiary is required to pay prescribed rate of annual contribution every year.
  • Presently [2017-18] member contribution is
    • Rs.300/- for Rural Yeshasvini.
    • Rs.710/- for Urban Yeshasvini.
  • The period of each enrollment commences from July and closes by October every year.
  • The scheme is open to
    • All rural co-operative society members.
    • Members of self-help group/Sthree Shakti Group having financial transaction with the Cooperative Society/Banks.
    • Members of Weavers, Beedi Workers and Fisherman Cooperative Societies.
  • The Scheme Commences from 1st of June and ends 31st of may every year.
  • The Scheme covers entire state of Karnataka particularly Rural Areas and Urban cities.

 

IMPLEMENTATION PROCEDURE

  • Through the recognized Network Hospitals of the Trust the Scheme is implemented.
  • Includes 730 Network Hospitals (Private and Govt. hospitals) throughout the state.
  • As per the approved empanelment criteria, the Trust identifies and approves Network Hospitals to provide medical/surgical facilities.
  • Management Support Service Provider (MSP) through network hospitals implements cashless hospitalization under this scheme .
  • Benefits of the Scheme are available only at the Network Hospitals recognized by the Trust.
  • The yeshasvini beneficiary approaches the Network Hospitals.
  • Network Hospitals Coordinator examines the UHID card of the beneficiary; enrollment fee paid by the beneficiaries for the current period and facilitates the patients to undergo preliminary diagnosis and basic tests.
  • Based on the diagnosis if the surgical intervention is required hospital admits the patients and sends pre-auth request to the MSP online along with proof of documents.
  • Doctors/Specialists of the MSP examine the preauthorization request received from Network Hospitals and approval is given to preauthorizations within 24 hours, if all the conditions are satisfied.
  • The Network Hospital extends cashless treatment and surgery to the beneficiary subject to the limits prescribed under the scheme.
  • Network Hospitals after discharge forwards the original bill, discharge summary with signature of the patient and other relevant documents to MSP for processing and settlement of their claims.
  • Trust arranges payment to Network Hospitals through MSP within forty five days of the receipt of the bills from the Network Hospital.
  • Yeshasvini beneficiary is required to produce Enrollment Card and other documents at the time of admissions, so that the Network Hospitals can send preauthorization for approval. If the beneficiary does not produce the identity card at the time of admission he is not entitled to avail the benefits under the scheme.
  • In case of emergency, the coordinating officer of the Network Hospital will take undertaking letter from the beneficiary or his/her ward, that in case he/she is not covered under the scheme the cost of the surgery will be paid by the beneficiary only.
  • Network hospitals in the State have adopted web enabled issue of E-preauths. The Network hospitals are obtaining E- Preauthorisation from the MSP for all ailments /surgeries.
  • Daily 85% of the E- preauthorization proposals received by the Management Support Service Provider from various Network hospitals are approved on the very same day.

 

MEDICAL BENEFITS COVERED UNDER THE SCHEME

  • 823 types of surgical procedures identified by the Yeshasvini Trust, defined in the list of surgeries, subject to the certain exclusions, at tariffs pre-negotiated with participating hospitals.
  • From 2006-07 the following defined medical benefits have been included: Medical emergencies such as:
    • Dog bite
    • Snake bite
    • Drowning and accidents occurred while operating agricultural implements
    • Bull gore injures and electrics shocks
    • Normal Delivery
    • Neo natal care
    • Angioplasty procedure.

 

PRODUCT FEATURES

  • Surgery Package includes: Cost of Medicines, Consumables during hospital stay, Cost of Operation Theater, Anesthesia, Surgeons fee, Professional Charge, Consultant fee, Nursing fee, General Ward Bed Charge, etc are included in the package and Yeshasvini Trust reimburses this expenditure to the Network Hospitals. Package rates for each of the surgery is fixed under the scheme.
  • Free Out Patient consultation at all participating hospitals.
  • Discounted tariffs for lab investigations and tests.
  • The plan excludes coverage for: Medical and Follow up Treatment, Implants, Prosthesis, Joint replacement surgeries, Kidney and Heart Transplants, Chemotherapy, Cosmetic surgery, Burns Cases, Dental Surgeries, Road Traffic Accidents and Medico Legal Cases, Diagnostic Investigations, Autoimmune diseases, Skin Grafting, Dialysis, Artificial Limb, Deviated Nasal Septum, Nails, Screws and Stents, etc for Orthopedic and Urological Surgeries.
  • The Yeshasvini Scheme is a surgicare scheme does not cover inpatient medical treatment where surgical intervention is not required. If the beneficiary avails inpatient medical treatment at the Network Hospital, it is his responsibility to pay the charges as per hospital rates and the Trust is not liable to reimburse the treatment charges.
  • Yeshasvini beneficiaries are entitled only for general ward admission. If the beneficiaries opt for a higher category of bed, he will have to pay the differential amount to the hospital.
  • No specific time for inpatient is prescribed to the Network Hospitals for surgical procedures.
  • In normal health care scheme pre-existing diseases like Diabetes, Hypertension, Heart related diseases, Kidney diseases etc., are not covered.
  • Most novel feature of the scheme is that entire transaction from the time of admission till discharge of the patient is cashless limited to the package rates.

For more details Call us on 8100-999-111 for  FREE Medical Assistance or visit our website www.DynamicMedicare.com for all information on Doctors, Hospitals, Treatments and Healthcare.

 

 

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