Annexure-B

Protocol guidelines for the empaneled Network Hospitals

recognized under theYeshasvini Scheme.

Yeshasvini Trust is issuing the following protocol guidelines for

implementing Yeshasvini Co-operative Members Health Care Scheme for
treating the Yeshasvini Members in the network hospitals.

Yeshasvini Counter: The NWH shall have Yeshasvini counter, manned by a

staff trained in Yeshasvini protocols for guiding the beneficiaries. The NWH
shall supply the Yeshasvini badges to the concerned staff interacting with
Yeshasvini beneficiaries. Hospital shall display the mobile no. of the
district coordinator in your District and contact numbers of the call
Centre in Yeshasvini counter to enable the beneficiary to have interaction in
case of any problems.

Yeshasvini Board: All Yeshasvini NWH shall display a board as “Yeshasvini”

in Kannada prominently at the reception with documents required for availing
cashless facility under Yeshasvini scheme are to be displayed.

Notification of the coordinator: The NWH must display the contact details
of the Hospital staff earmarked for handling Yeshasvini scheme at the
entrance / reception area. Please furnish the name and contact number of
your hospital coordinator.

Photo Album: All network hospitals are requested to maintain photo album
of Yeshasvini patients with a small case history.

OPD and IPD and OT registers: The NWH shall maintain OPD & IPD & OT
registers.

Publicity: The NWH shall print at least 500 Yeshasvini pamphlets (frequently
asked questions) and distribute among the beneficiaries to bring about
awareness. The NWH also put posters highlighting the advantages of scheme
at prominent places of the hospital & also outside the hospital for visitors to
know about the scheme.

Visitors Book: The NWH shall maintain visitor book in the YeshasviniCounter
,whenever official from Trust / MSP visits the hospital, the NWH is requested
to take their signature in the visitor’s book. The visitor book shall contain the
details s u c h as Name of the Visitor, Date of Visit, Designation and
Signature.

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Visit of Yeshasvini District coordinator: For smooth functioning of the
scheme district coordinators have been appointed in all the districts. District
coordinator visits your hospital regularly and you shall show the relevant
documents of Yeshasvini member whenever it is requested. The district
coordinator can interact with admitted beneficiaries under Yeshasvini scheme.
The network Hospitals shall facilitate the same.

Scheme Period: The scheme period starts every year from 1st January and
ends to 31st December or as notified by the Government of Karnataka from
time to time

Website: Please visit scheme website Sahakara Sindhu.

Also, you may send emails for any queries/clarification/grievances to

[email protected] and [email protected].

Members Covered: Any member of a Co-operative society who has

completed three months’ period, can become the member of the Yeshasvini
Scheme.His family members – husband/wife, father, mother, sons, unmarried
daughters, daughter in law, grand children are covered. Married daughters
and her children who are staying with the above members for any reason and
membership is paid, is eligible for benefit under the scheme. If unmarried
daughters’ contribution is paid and she get married during the current year
she will be covered for the current year only.

Age Limit: No age limit prescribed. Beneficiary is eligible to take treatment

from new born to his/her lifetime.

Screening of Yeshasvini patients: You are requested to screen all patients

while getting admitted and confirm being Yeshasvini Scheme beneficiary by
incorporating new field in your hospital admission form that “Yeshasvini
scheme beneficiary YES or NO” so as to avoid confusion.

Health Camp: Network hospital shall make arrangements for conducting

health camp for beneficiaries residing in and around the area being serviced
by the network hospital. It is proposed to have four such camps in a year to
focus on the General health and awareness/ health hazard etc. prevailing in
the defined geographical area. The report of the same has to be submitted to
MSP through District Coordinator with the feedback forms collected by the
members attending the camp.

OPD: The beneficiaries are entitled for out Patient consultations including
super specialty consultation. Consultation amount is fixed at Rs.200 and is
valid for a period of three months. Out of this, Rs.100/- will be reimbursed
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by the Trust to the hospital and the hospitals shall collect Rs.100/- from the
beneficiary. The number of OPD patients availed should be recorded and
informed to our District Coordinators on weekly / Monthly basis. (Incase your
hospital rates are less than the rates that are mentioned above,we request
you to honors your hospital rates.)
For all OPD cases , a detailed consultation notes with seal and signature of the
treating doctor is mandatory.

Diagnostic Tests at discounted rates: The hospitals are entitled to collect

investigation charges from beneficiaries after extending 25% discount on the
prevailing hospital tariff.

Benefits Extended: The Yeshasvini beneficiary is entitled to avail the benefit

for following ailments on cashless basis:

2128 procedures (totaling basic 1650 procedures with 478 ancillary

procedures (ICU, ICU with ventilator and HDU) ) as attached.
(Package master modification)

Package Rates: Package rates have been fixed for all the
procedures/surgeries under the scheme. This includes all the charges like
Admission Charges/registration charges, Bed Charges, Nursing Charges,
Operation Theatre Charges, Procedure Charges, ICU/CCU Charges,
Anesthesia Charges, Instrument Charges, Cost of OT Consumables and
Medicines, Professional fees of the Surgeon and related routine investigations
pre (15 days) and during the hospitalization. Please raise the bill as per the
agreed tariff and you shall not collect any money towards above-mentioned
items under any circumstances from the beneficiaries. (All Packages Will
Include Drugs, Diagnostics, Consultations, Procedure, Stay for Patient).

Yeshasvini trust will communicate with the hospital in case of any

changes/revisions in the package rates

In case your hospital rates are less than the rates that are mentioned in the
Yeshasvini rate list, we request you to mention your hospital rates in the
preauthorization form).

Note:

• On no account shall any amount be collected from the individual

beneficiaries for covered treatment. The Network Hospitals/Nursing
Homes will provide necessary OT medicines, consumables and
disposable sundries of standard quality and will not get them purchased
through the Yeshasvini Beneficiaries.

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• Post hospitalization charges (after the discharge of the patient) are not
covered under the scheme. Hence expenses towards Diagnostics and
Medicines incurred by the individual Beneficiary after the discharge of
the patient from the Hospital/Nursing Home shall not form a part of this
package and all such expenses will have to be borne by the Beneficiary.

• The package rates mentioned are all inclusive of the implants and
the prosthesis. In case implant / prosthesis are used for the patient
then you can raise the bill as per the format given. & also submit the
Invoice & stickers of the implants & prosthesis used. Incase patient is
willing to go for higher end implants /prosthesis then the difference
charges for the implants/prosthesis shall be collected from the
Beneficiaries. For this it is mandatory to collect a signed consent letter
from the beneficiary expressing his own interest to opt for higher end
implants.

• In case of cataract surgery, the package rate is inclusive of lens

charges. Therefore, you are requested not to collect lens charges
from the patient. Incase patient is willing to go for higher end lens,
then the difference charges for the lens shall be collected from the
beneficiaries. For this it is mandatory to collect a signed consent letter
from the beneficiary expressing his own interest to opt for higher end
lens.

• IOL stickers to be attached during claims submission.

• MRP of the lens to be attached in case of higher lens charges

• Ward Eligibility: All beneficiaries under Yeshasvini Scheme are entitled

only for General Ward Admission. Incase patient is willing to go for
higher end category rooms, then the difference charges (maximum of
15% for sharing ward and 25% for special ward of the package
amount, Please note this facility is not applicable for day care
procedures which do not require hospitalization. ) shall be collected
from the Beneficiaries. For this it is mandatory to collect a signed
consent letter from the beneficiary expressing his own interest to opt
for higher category rooms.

• E-Preauthorization: You are requested to obtain E-Preauth for all

cashless admissions so as to enable us to know the Trust liability
towards network hospitals. Hence, it is mandatory to obtain E-
preauthorization’s. All data entered in the E-Preauth request such as
UHID no., patient name, age, gender, presenting complaints,diagnosis,
etc., should match with the attached supporting documents. Further
approved pre authorizations are valid for one month only from the
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probable date of authorization. Hence please return the preauthorization in
case you have not utilized on time. All approved pre authorizations for
which claims are not submitted within 90 days from the date of discharge
will be considered as null and void.

• The Hospital shouldn’t claim in two different health schemes for the
same beneficiary under the same admission, and trust can take an
action, in case of such of misusages.

Note: The user id & password provided to NWH for the E-Preauth
platform is unique & confidential, hence MSP is not responsible for
any misuse thereafter.

Note: While scanning essential documents to attach to E-Preauth, please do

not forget to save the files with naming particular documents so as to ensure
fast service like, in case you have scanned ID card please save the file by
naming as ID card. In case the file is not saved with particular name it
becomes difficult for us to which attachment has got which document and
further to verify the particular document we have to browse through all the
attachments from which more time will be consumed, and it could end with
delay in service. Hence in case scanned documents attached to E-Preauth
are not saved with proper names such preauthorization will be summarily
delayed.

While scanning the essential documents please select low resolution and small
size without fail.

Please take care of the typing mistakes while filling up the E-Preauth as it
will be difficult to judge the surgery for which you are requesting. Please take
care of typing mistakes & also request NWH to select the proper procedure
code while submitting Preauth Request.
Kindly fill up all the fields properly with right information. All supportive
documents should be scanned in original and sent. Photocopies are not
entertained.

Duly filled and signed First Admission Report/ Initial Intimation report and PA
request form has to be enclosed at the time of Preauth request.

Procedure for extending treatment:

It is the duty of the network hospitals to identify the beneficiaries. Please

identify the beneficiaries properly and obtain preauthorization for every
cashless admission before discharge of the patient. In case of any
discrepancies the network hospital shall be held responsible for such cases. In
this connection please follow below mentioned guidelines.
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ID card and Receipt: The family of the Scheme Members is issued with ID
cards with unique ID nos with facility of QR Code.ID Cards are issued to
principal card holder and details of family members are embedded in the card.
The photos of the enrolled members are fastened in order to identify easily.
The receipts have to be provided on demand, wherever the Hospitals demand
for confirmation.

Identification of the beneficiary:

In case of fresh member enrolled for the current period: The beneficiary
who wants to avail the benefit of the scheme presents Yeshasvini Identity Card
at the Yeshasvini Counter of your hospital you shall insist for original ID card
and do not entertain photocopy of ID Card. Confirm the identity with photo
of the ID card and if it matches the person who comes for treatment can be
considered for benefits under Yeshasvini Scheme. They can avail the
treatment after 15 days of the enrollment.

In case of renewed member: The beneficiary furnishes the original copy

of ID card along with the receipts for being paid the contribution to the
Yeshasvini scheme for the current period. Please verify whether contribution
paid is correct or not. Further identify the beneficiary by comparing
photograph of the beneficiary in the id card. If it tallies provide the benefit
under the scheme after confirming that he has paid for renewal amount by
seeing the receipt. For any doubt, contact local coordinator or project manager
MSP.

ID card verification points: Make sure that ID card is not manipulated. In

case it is manipulated like erasing the beneficiary names and contribution
manipulation etc., please request the patient to furnish the letter from
secretary of the concerned cooperative Society as well as from DRCS for being
manipulated on genuine grounds, otherwise do not forward such E- Preauth.
You shall verify the DRCS and Society letter and in case the ID card is
manipulated on genuine grounds then send E-Preauth attaching ID card and
attach the letter received from DRCS and Society Secretary and make sure
to enclose DRCS and coop secretary letters along with the claim. Otherwise
claim will be rejected and such Preauth will be invalid. Please do not give the
chance for objection on the internet so as to ensure fast service.

After identification of the beneficiary, the NWH coordinator explains about the
facility extended under the scheme and about their eligibility limits and the
standard exclusions as applicable under the scheme.

After verifying the relevant documents produced by the beneficiary to

ascertain the authenticity of the identity, the NWH shall extend outpatient

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consultation i.e., it may be Super specialty, General Specialty and consulting
doctor consultation and further diagnostic tests if necessary, at concessional
rates as fixed under scheme.

If Consultant does not recommend any OPD investigation and advises only
medical line of treatment on OPD basis, such treatment cost shall be borne by
the beneficiary only.

If the Consultant advises the beneficiary for in-patient hospitalization for

Medical line of treatment, the beneficiary is eligible to get cashless treatment.

If the Consultant advices for a Surgery for the ailment covered under the
scheme, the same to be operated under YESHASVINI SCHEME and you shall
strictly follow the guidelines about procedure for extending cashless
treatment.

To extend cashless facility to the scheme beneficiaries Preauthorization is

must and in case bills are raised without obtaining preauthorization such bills
will be rejected summarily. The NWH shall also be held responsible for such
treatment cost wherein it has not taken any action to obtain preauthorization
even though the beneficiary has revealed about being beneficiary of
Yeshasvini scheme.

The Co-coordinator at the NWH shall send the Pre-authorization form / First
Admission Report (FAR) to the MSP using E-Preauth method through internet
for authorization along with scanned copy of the Yeshasvini I.D Card and
relevant documents as it is mentioned in this protocol.

After detailed scrutiny of the documents (Medical & Technical), MSP shall send
the preauthorization to the network hospital.

After receipt of the preauthorization, the NWH shall extend cashless treatment
under Yeshasvini scheme.

The beneficiary gets discharged from the network hospital without paying any
amount towards the treatment covered under the scheme to the network
hospital. The Beneficiary signs on the final bill before getting discharged from
the hospital.

At the time of discharge, the NWH coordinator explains about the balance sum
available in the card, and system generated balance sum copy to be singed
the beneficiary, and the same needs to be uploaded while claiming.

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The NWH in turn shall raise the claim in favor of implementing agency in the
prescribed format issued under this scheme.

After detailed scrutiny of the bills, MSP shall place the bills before the
Yeshasvini Trust & gets the clearance.

The Yeshasvini Trust releases the payment to the hospital within 45 days
from the date of receipt of bill in the TPA office.

Note:

1) In case of emergency, the NWH shall take undertaking letter from the
beneficiary that incase he/she is not covered under Yeshasvini scheme the
cost of the surgery will be met by the beneficiary only. Soon after receipt of
undertaking letter from the beneficiary the network hospital can proceed with
the surgical treatment. The preauthorization for the same shall be sent to MSP
with immediate effect & shall obtain the preauthorization before the discharge
of the patient.

2) In case preauthorization is not obtained or obtained after the discharge of

the patient from the network hospital, implementing agency will not be
responsible for such payment.

3) The approved preauthorization is valid for one month from the date of
issuance & invalid preauthorization shall be sent to implementing agencywith
immediate effect.

Essential documents required for obtaining preauthorization using E-

Preauth method:

1) ID Card and Receipt:

While filling up the E-Preauth in the Member receipt No. field as well as in
the Member ID no. field please mentions the ID no. in both the fields since
ID card acts as receipt also.

While scanning the ID card save the file by giving appropriate name of
particular document ex: in case you have scanned the ID card save
the file as ID card and in case it is not saved with giving appropriate name

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as ID card such Preauth will not be attended and further request you to save
the file with lowest resolution and small size.

Please do not attach the receipt issued from cooperative society.

Please attach the copy of ID card cum receipt issued by Yeshasvini Trust
only.

2) Required investigation reports for professional scrutiny:

The Instructions to Be Incorporated with the List:

Obstetrics and gynecology:

• The benefits under the scheme for deliveries are allowed for only
two live births.
• For LSCS the network hospitals shall appended with claim record
details of OT medicines.
• For Neonatal care of normal new born baby the network hospital
shall give medical justification regarding the necessity for NICU.
• LAVH and vaginal hysterectomy shall be avoided in patients of less
than 40 years of age unless clearly indicated.
• Laparoscopic ovarian drilling which is an invasive procedure must
be preceded by

I. Counseling.
II. Medical management for 6months
III. Hormonal assay
IV. Procedure may preferably be done for more than 24 years age
group indicated.
V. In all cases of Hysterectomy, pre-operative USG, and post-
operative histopathology report are mandatory.
VI. Preauthorization/claim for prolapse /decent uterus shall be
supported by pre op and post op USG respectively.
VII. For Laparoscopic Ovarian Cystectomy the size of the Cyst should
be more than 6cm and the test CA 125 is mandatory.
VIII. Biopsy report of the specimen is mandatory (uterus/Cyst).
IX. Photograph of mesh insertion intraoperative is must.

Guidelines for Genitourinary Procedures:

I. All symptomatic ureteric stones measuring more than 6mm shall

be taken for lithotripsy procedure.
II. Radiological proof of stone in USG/KUB/IVP/CT with clear mapping
of size shall be provided in case of renal/ureteric/vesicle calculi
for approval lithotripsy procedures.

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 III. Plain CT scan is required in case of radiolucent renal/ureteric
calculi which cannot be proved otherwise.
IV. Hospitals shall upload intraoperative video endoscopic recordings
for all endoscopic procedures at the time of submission of claims.
Supporting pre and post-operative investigations need to be
submitted.
V. All postoperative photographs shall show face as well as scar in
the same photograph.

Guidelines for Laparoscopic procedures:

The hospital shall upload photograph depicting the face of the patient and
operative site along with specimen removed with date and time depicted on
the print/image.

Hospitals shall upload intra-operative video recording of entire procedure

starting from the patient on table till the end of procedure clearly depicting
the organ involved in the surgery along with claims attachment.

Endocrinology: For all thyroid cases please attach thyroid function testreport
to E-Preauth to justify the diagnosis. You shall enclose histopathology report
as well as thyroid function test report along with the claim.

Urology cases: For all Urology cases please attach ultrasound report to E-
Preauth to justify the diagnosis. In case stent is used please enclose the
invoice for the stent to process the claim under Yeshasvini scheme without
which claim will not be settled.

Neonatal Services: Packages would include neonates up to age of 28 days

after birth. However, for infants born preterm (<37 weeks), the age limit
extends to postmenstrual age (period after the first day of last menstrual
period) of 44 weeks OR body weight up to 3 kg
- All the packages are inclusive of everything including drugs, diagnostics,
consultations, procedures, treatment modalities that the baby would require
for its management
- In case a baby in a lower cost package develops a complication requiring
higher level of care, the baby should be moved for higher cost package
- For packages 2, 3, 4 and 5, mother's stay in the hospital [postnatal
ward/special ward for such mothers] for breastfeeding, family centered care
and KMC (Kangaroo Mother Care) is mandatory. In packages 2, 3, 4 and 5
mothers should be allotted KMC bed when
the newborn is eligible for Kangaroo mother care. The cost of bare bed is
included. If the mother requires treatment for her own illnesses, it would be
covered under the mother's packages.

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- It is MANDATORY to ensure that the neonate receives vaccination as per
NATIONAL IMMUNIZATION SCHEDULE before discharge
Empanelment classification: Advanced criteria
Procedures under this domain need to have specialized infrastructure and HR
criteria. In-order to be eligible to provide services under this domain, the
provider needs to qualify for advanced criteria as indicated for the
corresponding specialty under the empanelment guidelines
Pre-authorization: Mandatory for Special, Advanced (and needing
surfactant therapy) and Critical Neonatal packages and for progressive
extension of treatment/ hospital stay/ shifting across packages.
Pre-authorization remarks: Prior approval must be taken for progressive
extension of therapeutic treatments (i.e. for extending stay beyond the
prescribed limit/ in cases which might need shifting of packages based on
clinical vitals and need - then the previously blocked package needs to be
unblocked and the total amount of new package needs to be considered to
be debited).
- All clinical test reports, diagnosis, TPR charting, case sheet/ clinical notes
and discharge summary need to be submitted for extension of packages and
during claims submission.

CANCER:

Empanelment classification: Advanced criteria

Procedures under this domain need to have specialized infrastructure and HR
criteria. In-order to be eligible to provide services under this domain, the
provider needs to qualify for advanced criteria as indicated for the
corresponding specialty under the empanelment guidelines provided for
provider network.
Pre-authorization: Mandatory for all packages
Pre-authorization remarks: Prior approval must be taken for all
treatments/ malignancies.
please justify the diagnosis with histopathology report and as it is mentioned
above please save attachment with name of the investigation report and
forward the E-Preauth.
- The type and duration of treatment is different for all cancers. It is very
important to complete the entire treatment which may in some cases last for
up to 3 years. For certain cancers like Chronic Myeloid Leukemia (CML) the
treatment is lifelong.
- Cancer care treatments are advised to go through a clinical treatment
approval process before initiating the best suitable treatment. A clinical
treatment approval process is mandated for cancer care, since it involves a
multi-modal approach covering surgical, chemotherapy and radiation
treatments and appropriate supportive care that could assess to determine
the best course of patient management for such conditions.

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- There should be pre-authorization at each step for cancer care treatments.
It is prescribed that decision regarding appropriate patient care for cancer
care treatments should be taken by a multidisciplinary tumor board for tumors
requiring multimodal treatment (if available within the treating hospital or if
not then it could be sent to the nearest regional cancer center (RCC) for
approval) that should include a highly trained team of Surgical, Radiation and
Medical/ Pediatric Oncologist in order to ensure the most appropriate
treatment for the patient. A detailed Oncology Treatment Plan Approval form
is annexed. This could prove to be very vital for the target group in focus
based on factors other than age alone, such as implications on the financial
cover and to avoid unnecessary treatments. Further the design of the package
and its step-wise approach also reflects the same.

Onco Specialty Surgeries: In case of onco surgeries please justify the

diagnosis with histopathology report and as it is mentioned above please save
attachment with name of the investigation report and forward the E- Preauth.
- Relapse/recurrence may sometimes occur during/ after treatment.
Retreatment is often possible which may be undertaken after evaluation by a
Medical/ Pediatric Oncologist/ tumor board with prior approval and pre
authorization of treatment.
- Chemotherapy is given per weight (body surface area). Clinical treatment
approval/ pre authorization and communication is necessary to ensure each
child receives the recommended dose of medicines. Under or over dosing is
dangerous. So, dosing will differ in young children and older children.- Only in
Specialty care hospitals.

OBG Specialty:

Sl. Surgery Required documents

No. Name
1 LSCS / NVD Ultrasound report and clinical note to justify the
diagnosis. Please attach these reports along with
the claim. Reports are essential to settle the claim.
Attested copy of the Birth register containing the
name of the Mother / Father of the newborn has
to
be attached with the individual claim.
2 Hysterectomy pre-operative USG, and post-
operativehistopathology report are mandatory

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Orthopedic Cases: For all cases basic investigations reports like X-ray shall
be attached with E-Preauth and also enclose the same along with the claim.
Attach MLC certificate along with E-Preauth in case of RTA and you shall
enclose the same along with the claim to ensure fast service. For all orthopedic
cases please make sure to enclose check x-ray report along with the claim.
(x-ray report should capture patient name, age, and date andtime stamp,
and X-rays of affected limb/body region).

In case implant / prosthesis are used for the patient, then you can raise the
bill as per the format given. & also submit the Invoice & stickers, and barcode
of the implants & prosthesis used. Incase patient is willing to go for higher
end implants /prosthesis then the difference charges for implants/prosthesis
shall be collected from the Beneficiaries. For this, it is mandatory to collect a
signed concern letter from the beneficiary expressing his own interest to opt
for higher end implants.

CARDIO THORACIC SURGERY:

Empanelment classification: Advanced criteria
Procedures under this domain need to have specialized infrastructure and HR
criteria. In-order to be eligible to provide services under this domain, the
provider needs to qualify for advanced criteria as indicated for the
corresponding specialty under the empanelment guidelines
Pre-authorization: Mandatory for all packages
Pre-authorization remarks: Specific Pre and Post-op Investigations such as
ECHO, ECG, pre/ post-op X-ray, post-op scar photo, CAG/ CT/ MRI reports
etc. will need to be submitted/ uploaded for pre-authorization/ claims
settlement purposes. The costs for such investigations will form part of the
approved package cost.
- It is also advised to perform cardiac catheterization as part of the treatment
package for congenital heart defects.

Sl. No Surgery Required documents

. Name
1 CABG / Angiogram report is must. Please attach the same
PTCA with E-Preauth and give the name to attachment.
2 OHS For all open-heart surgeries please attach ECHO
report and in case Angiogram is done please attach
the same also. Please enclose the same along with
the claim.
Wherever implants and stents are used please enclose the invoices along
with the claim without which claim will not be settled and also attach
acknowledgement certificate for being received the amount from the
beneficiary towards implants only, otherwise the claim will not be settled.

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Gastro Specialty: In case of onco surgeries please justify the diagnosis with
histopathology report and as it is mentioned above please save attachment
with name of the investigation report and forward the E-Preauth. In case
of any excisions please furnish histopathology report at the time of submission
of claim.

Important General Guidelines: Other than above mentioned specialties, in

all other specialties please justify the diagnosis with investigation reports and
wherever it is diagnosed clinically please enclose clinical report along with the
claim and obtain verification done by District Coordinator before discharge of
the patients.

Please furnish invoice for implants used cases. Attach only those files as it is
requested above and do not attach non-essential documents.

While scanning the documents please save the document by giving

appropriate name of the particular document for ex: while scanning X-Ray
report save it with giving name as X-Ray report and save the document by
selecting lowest resolution and small size option.

Animal bites: Wound photos/doctor notes with completion of 5th dose.

Snake bites: Wound photos/doctor notes with treatment notes.

Agricultural Hazards: Drowning, Electric shock, injuries caused while

operating Agricultural Equipment, Bull gore injury, wound photos, doctor note
with treatment notes.

Claims Submission: All claims must be sent within 90 days from the dateof
discharge of the Beneficiary from the hospital. Where ever Credit bills are not
available you may raise the bill under the letter head of your hospital as “credit
bill” with bill No. and IP No. The claims must be accompanied by check list
ensuring presence of the following documents: -

• Attested Photocopy of the Yeshasvini I.D. Card.

• Photocopy of Aadhar card and Ration Card
• Voter ID/DL
• Credit Final bill – raised in favor of “Yeshasvini Trust with beneficiary
name”. The same amount should be claimed in the final bill provided
as Aneexure-5.
• Original claim form duly signed by beneficiary
• Original discharge summary.
• Original Operation Notes.

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 • In case of Angioplasty procedure, please enclose Angiogram CD and
report.
• All Laboratory/Investigation reports that are attached to E-Preauth to
justify the diagnosis.
• In case of enhancement taken in Preauth, both initial & enhancement
authorization letters have to be attached as part of the claim.
• All preauthorization approval letters have to be duly signed by our
District Coordinator prior to claim submission.
• All documents submitted at the time of preauthorization should be part
of claim submitted.

The Network Hospital will be reimbursed from the Yeshasvini Co-operative

Members Health Care Trust (a Trust formed by the Dept., of Co-operation,
Govt., of Karnataka) as per the standardized and Pre-defined Package Rates.

If a beneficiary avails inpatient treatment at the NWH, which is not covered

under the scheme, it is the responsibility of the NWH to collect the charges for
the medical treatment. No money will be reimbursed to the NWH for inpatient
medical line of treatment.

This arrangement shall be in force till the termination of this arrangement by

the Trust / MSP or the hospital with a prior notice of 30 days. However, MSP
/ Trust reserves the right to terminate this arrangement without any prior
intimation.

Non-compliance to the Yeshasvini Guide lines shall result in forfeiture of the

recognition as Yeshasvini Network Hospital.
Any legal liability arising out of services rendered shall be the sole
responsibility of the Network Hospital.

Exclusions to the Policy:

The Trust shall not be liable to make any payment under this Scheme in
respect of any expenses whatsoever incurred by any members in connection
with or in respect of:

1. Conditions that do not require hospitalization: Outpatient

Diagnostic, Medical and Surgical procedures or treatments unless
necessary for treatment of a disease covered under day care procedures
(as applicable) will not be covered.

2. Except those expenses covered under pre and post hospitalization

expenses, further expenses incurred at Hospital or Nursing Home

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 primarily for evaluation / diagnostic purposes only during the
hospitalized period and expenses on vitamins and tonics etc. unless
forming part of treatment for injury or disease as certified by the
attending physician.

3. Fertility related procedures: Hormone replacement therapy for Sex

change or treatment which results from or is in any way related to sex
change.

4. Vaccination: Vaccination, inoculation or change of life or cosmetic or

of aesthetic treatment of any description, plastic surgery other than as
may be necessitated due to an accident or as a part of any illness.
Circumcision (unless necessary for treatment of a disease not excluded
hereunder or as may be necessitated due to any accident).

5. Suicide: Intentional self-injury/suicide.

6. Persistent Vegetative State.

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