Yeshaswini Co-operative farmers health care scheme

http://www.yeshasvini.kar.nic.in Surgeries performed till date : 70,887 Target population : all poor farmers in state of Karnataka

Contact Information
Yeshasvini Trust
No.607, 3rd Gate, 6th Floor
M.S.Building, Bangalore - 560 001. Ph: 080 22032046

TPA
Medi Assist India TPA ltd. No. 41, 16th Main, 2nd cross,2nd stage, 1st phase, BTM Layout, Bangalore-560076 Help Line No:080-26783111, 080-26784111, Fax No:080 26782622

Introduction of the scheme

Introduced by State Government for the Co-operative farmers of Karnataka in

2003
Self Funded Health Care Scheme The concept: initiated by Dr. Devi Prasad Shetty of Narayana Hrudayalaya, Bangalore Trust : The Yeshasvini Cooperative Farmers Health Care trust Implemented through: network hospitals to provide cost effective quality healthcare facilities Chief Patron and Patron: The Honble Chief Minister of Karnataka and Honble Minister for Cooperation. Govt contribution to the Trust : provides matching amount collected through

premiums, for implementation

Information about the scheme

Parameter Model of scheme Administration Responsibility Scheme implementation Unit of enrolment Details Self funded scheme Yeshaswini trust and TPA TPA (Medi Assist India TPA Pvt ltd) The scheme will encompass all the family members of the farmers registered under any cooperative farmers society in Karnataka. Cashless Surgical procedures covered are 1600

Nature of transaction Conditions covered

Follow up package Insurance Cover

Premium

No 1,50,000 to 2,00,000
Rs 210

Parameter Inclusions in package

Details Only tertiary surgical procedures

Exclusions

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.
492 hospitals (Public and private) Contractual agreement with network hospitals

Network hospitals Type of agreement with network hospitals

Total number of people registered

Total number of health camps till date Age Limitations Insurance Company

30,70,000
4 camps per year per hospital Till 75 years of age No insurance company

Health benefits provided under the scheme

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 It is a Surgicare scheme and does not cover inpatient medical treatment where surgical intervention is not required

Some highlights of the scheme

Eligibility : Main member should be a member of Rural Co-operative Society of the

State for a minimum period of 6 months

Period of enrolment: January/February till June every year 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 Scheme duration: 1st of June till 31st of May every year

Scheme coverage: Entire state of Karnataka particularly Rural Areas excluding

Corporation and Urban cities

Key stakeholders
The Honble Chief Minister of Karnataka is Chief Patron and Honble 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 Network hospitals 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.

Patient Process Flow

Scheme implementation
Implemented through the recognized Network Hospitals of the Trust

492 Network Hospitals throughout the State including Private and Govt. hospitals
Cashless hospitalization arranged by Third Party Administrator (TPA) through network hospitals

Network hospitals in the State have adopted web enabled issue of Epreauthorisations. The Network hospitals are obtaining E- Preauthorisation from the TPA for all ailments /surgeries

Daily 85% of the E- preauthorization proposals received by the TPA from various Network hospitals are approved on the very same day

Beneficiary approaches network hospital

NH Coordinator examines and verifies the UHID card of the beneficiary

NH coordinator facilitates the patients to undergo preliminary diagnosis and basic tests.

Settlement of claims
Trust arranges payment to Network Hospitals through TPA within forty five days

Based on the diagnosis, if surgery is required

Processing of claims NH sends relevant documents to TPA for processing and settlement of their claims.

Pre-Authorization request

hospital admits the

Cashless Treatment Hospital extends cashless treatment and surgery to the beneficiary Approval of Pre- Authorization Doctors/Specialists of the TPA examine the preauthorization request and approval is given patients and sends preauth request to the TPA online along with proof of

documents