NEWS –  Yeshasvini scheme to cover 2,191 medical procedures

HIGHLIGHTS

• The Yeshasvini Health Insurance Scheme is a community-driven initiative in Karnataka.
• Designed for cooperative society members, especially in rural and semi-urban areas.
• Aims to provide affordable healthcare through pooled member contributions.

Key Features of the Scheme

• Annual Coverage: Up to ₹5 lakh per family for medical treatments.
• Cashless Treatment: Available at empanelled network hospitals.
• Premiums:
  • Rural: ₹500/year for a family of 4; ₹100 for each additional member.
  • Urban: ₹1,000/year for a family of 4; ₹200 for each additional member.
• Hospital Network: 786 private and government hospitals currently empanelled.

Recent Developments

• Increased Procedure List: Total procedures covered raised from 2,128 to 2,191.
• Outdated Procedures Removed: 6 obsolete surgeries excluded.
• New Additions: 69 advanced procedures added, including:
  • Interventional Radiology
  • Cardiothoracic and Vascular Surgery (CTVS)
  • Cancer treatments
• Expected Beneficiaries in 2024-25: Around 75,000 with projected spending of ₹127.50 crore.

Rate Revision Insights

• Committee Formation: Led by MLA Dr. Srinivas N T with 8 expert doctors and 11 medical professionals.
• Need for Revision: Procedure rates unchanged since 2017-18 were below market rates, discouraging hospital participation.
• Proposed Changes:
  • 15–20% increase in common procedures.
  • 80–100% rise in rare, life-saving procedures.
• Funding Plan:
  • ₹40 crore grant proposed from the government.
  • Remaining cost to be covered via increased enrolments.

Benefits for Rural Communities

• Affordable Healthcare: Lower premiums make it accessible for low-income families.
• Targeted Coverage:
  • Includes emergencies like snake bites, farming injuries, etc.
  • General ward access with optional upgrades.
• Self-Help Groups and Workers Included: Beedi workers, fishermen, weavers in cooperative societies are eligible.

Eligibility Criteria

• Co-op Membership: Minimum 90 days membership required.
• Age Limit: Up to 75 years.
• Income Cap: Monthly income not exceeding ₹30,000.
• Family Inclusion: Spouse, children, parents, nieces/nephews.

Limitations and Exclusions

• Not Covered:
  • Cosmetic/dental procedures (unless injury-related)
  • Dialysis and transplant costs
  • Accident-related injuries
  • Pre-existing conditions