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ABOUT THE SCHEME EVOLUTION
“Yeshasvini Cooperative Farmers Health Care Scheme” (Yeshasvini Scheme) was introduced by the State Government to the Co-operative farmers of Karnataka. Then the Hon’ble Chief Minister of Karnataka Sri S.M.Krishna inaugurated the scheme on 14th of November 2002 and the scheme was operationalised with effect from 1st June 2003. Karnataka has become role model state with the introduction of ‘Yeshasvini Self Funded Health Care Scheme’.
The concept of “rural health care scheme” was initiated by Dr. Devi Prasad Shetty of Narayana Hrudayalaya, Bangalore, 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.
The Yeshasvini Cooperative Farmers Health Care Trust was registered under the Indian Trust Act 1882. The Hon’ble Chief Minister of Karnataka is Chief Patron and Hon’ble Minister for Cooperation is Patron. The Government of Karnataka provides matching contribution to the Trust for implementation of the scheme.
SELF FUNDED SCHEME:
Yeshasvini is one of the largest Self Funded Healthcare Scheme in the country. Offering a low priced product for a wide range of surgical cover, nearly 805 defined surgical procedures to the farmer cooperators and his family members. It is a contributory scheme wherein the beneficiaries contribute a small amount of money every year to avail any possible surgery during the period.
The beneficiaries are offered cashless treatment subject to conditions of the scheme at the Network Hospitals spread across the State of Karnataka.
To avail the benefit of Yeshasvini Scheme, a person should be a member of Rural Co-operative Society of the State for a minimum period of 6 months.
All family members of the main member are eligible to avail the benefit of the scheme though they are not members of a rural co-operative society.
Each beneficiary is required to pay prescribed rate of annual contribution every year. Presently [2012-13] member contribution is Rs.210/-.
The period of each enrollment commences from January/February and closes by June 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 higher age limit fixed is 75 years for availing benefit under the scheme.
The Scheme Commences from 1st of June and ends 31st of May every year.
The Scheme covers entire state of Karnataka particularly Rural Areas excluding Corporation and Urban cities.
OTHER SCHEMES :
“Yeshasvini Cooperative Farmers Health Care Trust also implements Suvarna Arogya Chaitanya Scheme for School Going Children studying in Government and Aided schools from 1st to 10th standard across the State and PPTCT Scheme sponsored by the National Rural Health Mission through the Dept. of Heath and Family Welfare and Education Govt. of Karnataka. These schemes are also administered by existing TPA.
The Scheme is implemented through the recognized Network Hospitals of the Trust.
There are 458 Network Hospitals throughout the State including Private and Govt. hospitals.
The Trust identifies and approves Network Hospitals to provide medical/surgical facilities as per the approved empanelment criteria.
The entire scheme is being implemented as cashless hospitalization arranged by Third Party Administrator (TPA) through network hospitals.
A Yeshasvini beneficiary is eligible for benefits of the Scheme 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 TPA online along with proof of documents.
Doctors/Specialists of the TPA 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 TPA for processing and settlement of their claims.
Trust arranges payment to Network Hospitals through TPA 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 TPA for all ailments /surgeries.
Daily 85% of the E- preauthorization proposals received by the Third Party Administrator from various Network hospitals are approved on the very same day.
MEDICAL BENEFITS COVERED UNDER THE SCHEME
805 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 and Angioplasty procedure.
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.
ADMINISTRATION OF THE SCHEME:
The Yeshasvini Cooperative Farmers Health Care Trust was registered under the Indian Trust Act 1882. The Hon’ble Chief Minister of Karnataka is Chief Patron and Hon’ble Minister for Cooperation is Patron. The Trust Governing Body consists of 6 Senior Officers of the Government of Karnataka, headed by the Principal Secretary to Government, Cooperation Department and 5 Reputed Doctors representing different areas of the State. Details are as follows:
Principal Secretary to Government of Karnataka, Cooperation Department – Chairman of the Trust.
Registrar of Cooperative Societies, Bangalore.
Managing Director, Karnataka State Cooperative Apex Bank Ltd., Bangalore.
The Commissioner for Cane Development and Director of Sugar, Bangalore.
Managing Director Karnataka State Cooperative Milk Producers Federation Ltd. Bangalore
Additional. Registrar of Co-operative Societies (C&M), Bangalore.
Sri. Dr. Deviprasad Shetty, Narayana Hrudayalaya, Bangalore.
Dr. Manjunath Shetty, Head of Nephrology Department, J.S.S College, Mysore
Dr. C.N. Manjunath Director, Jayadeva Institute of Cardiology, Bangalore.
Dr.L.H.Bidri, Bidri’s Ashwini Hospital, Bijapur & Trustee.
Dr. Chandra Mouli, MBBS, M.S, Consultant Surgeon, Fortis Hospital,Bangalore.
The Trust board meets once in a quarter and reviews the scheme implementation, takes policy decision, fund management, disbursement and other financial control of the scheme.
The Trust subcommittee meets at least once in a calendar month and reviews the scheme implementation and accords approval for network hospital claims.
The Department of Cooperation supports communication, publicity and admission of beneficiaries to the scheme.
The Cooperative societies take responsibility of enrolling members.
Third Party Administrator licensed under the Insurance Regulatory and Development Authority of India (IRDA) renders administration of scheme including approval of preauthorization and claims settlement.
Network hospitals deliver the surgical benefits to the members of the scheme subject to conditions.