Characteristics and Functions…
1. The Yeshasvini plan covers 1,600 surgeries available only at approved hospitals on cashless basis to beneficiaries. The plan pays the participating hospital a fixed tariff for each of these defined benefits. It is stated that the tariff is 40-50% off the “regular” price of the private hospitals. In addition, Out Patient Diagnosis (OPD) is provided at no cost to beneficiaries and diagnostic tests are at a discounted tariff. Some network hospitals are also providing discounts on medical stays.
2. The plan excludes coverage for normal delivery, prosthesis, implants, joint replacement surgeries, transplants, Chemotherapy, cosmetic surgery, burn cases, joint replacement surgeries, dental surgeries and several other events and items.
3. The maximum benefit available per insured is Rs. 100,000 per procedure or Rs. 200,000 annually, based on the tariff schedule set by the Trust.
4. Tariffs have been set on approximately 150 of the currently 1,600 covered procedures. FHPL sets a tariff, when required, by using the current state government tariff as a guide, asking providers for a quote and finally negotiating the final rate. Once accepted all hospitals in the network are reimbursed at the set tariff.
5. The beneficiary must be admitted to the hospital prior to the end of the plan year to receive service for that year plan.
6. For Year 3 Yeshasvini will add normal delivery to the benefits available at the fixed tariff of Rs. 500 per delivery.
7. The provider network of private hospitals is accredited by FHPL based on minimum criteria such as available infrastructure, quality of work, number of physicians, hours of operation, ambulance service, etc.
