CHIRAYU (Comprehensive Health Insurance Of Antyodaya Units) Haryana (2022): Expanding Access To Affordable Healthcare  – IMPRI Impact And Policy Research Institute

Policy Update
Sneha Kohli

Background

The Comprehensive Health Insurance of Antyodaya Units (CHIRAYU) Scheme of Haryana was launched on November 21, 2022 as an extension of state-specific Ayushman Bharat Yojana by the Department of Health, Haryana Government (Ayushman Bharat, Haryana, n.d.). The rationale behind launching CHIRAYU Haryana was to extend state-level implementation to Ayushman Bharat Pradhan Mantri Jan Arogya Yojana to ensure healthcare development. 

The main objective of the scheme is to reduce out of pocket healthcare expenditure by providing healthcare benefits to all the eligible beneficiaries for indoor treatments & day care procedures through a network of Empanelled Health Care Providers (EHCPs) as defined in Health benefit packages of National Health Authority, GoI after successful receipt of nominal contribution / registration fee of ͅ₹1500 per family per annum. (Government of Haryana, Health Department, 2025)

The eligibility of the beneficiary is based upon eligible families with verified annual income above ₹ 1.80 Lakh and up to ₹ 3.00 Lakh in PPP ID (Parivar Pehchan Patra) of CRID (Citizen Resource Information Department) Haryana. (Government of Haryana, Health Department, 2025) The scheme ensures free medical facilities up to Rs 5 lakh provided to all eligible families through cashless health insurance coverage. 

The key provisions of the scheme as issued in the official Haryana Government Gazette are as follows: (Government of Haryana, Health Department, 2025) 

• The scheme is completely cashless, paperless, transparent, and digital and IT driven which enables free treatment to eligible beneficiaries in all empanelled public & private hospitals as per PMJAY guidelines. 
• No cap on family size and age of entitled members. 
• Around 2,200 treatment procedures covering surgery, medical and day care treatment with cost of medicines and diagnostics included. 
• Treatment cost inclusive of investigations, 3 days prior to hospitalization and 15 days post–hospitalization expenses. 
• All pre-existing diseases are covered under the scheme. 
• Eligible beneficiaries can avail services across India as the scheme has national portability benefits. 
• There is a dedicated grievance redressal mechanism inbuilt in the scheme both at district and State level. 

Functioning 

The CHIRAYU healthcare scheme is modelled under the broad implementation architecture of Ayushman Bharat PM-JAY based on a federal process, with stakeholder inputs taken from all States and UTs through national conclaves, sectoral working groups, intensive led exercises and piloting of key modules.The Scheme is principle based rather than rule based, allowing States enough flexibility in terms of packages, procedures, scheme design, entitlements as well as other guidelines while ensuring that key benefits of portability and fraud detection are provided at a national level. Therefore, states have the option to use an existing Trust/Society or set up a new Trust/Society to implement the Scheme as a State Health Agency. The State is free to implement the Scheme through an insurance company or directly through the Trust/Society/Implementation Support Agency or a mixed approach. (Ayushman Bharat, Haryana, n.d.)

Hence, Haryana has adopted a further decentralized institutional framework establishing State Implementation Unit comprising of Operational Core Team headed by Chief Executive Officer of AB-HHPA (Ayushman Bharat Haryana Health Protection Authority ) with the support of Additional Chief Executive Officer/ Joint Chief Executive Officer along-with Executive Officers and their team members. Further, a District Implementation Unit has also been established at each district consisting of Operational Team headed by Chief Medical Officer of Health Department with the support of District Nodal Officer and District Information Manager along-with PMAM (Pradhan Mantri Arogya Mitra). (Government of Haryana, Health Department, 2025) 

This Scheme pertains to provide health care benefits to the eligible beneficiaries of the State and is 100% financed by the State Government. Since the inception of the scheme, over ₹3,050 crore has been disbursed to hospitals. For the current financial year 2026–27, approximately ₹950 crore has been allocated by the Haryana Government under the CHIRAYU Yojana for providing health coverage to eligible beneficiaries. The allocation forms part of the Health and Family Welfare budget, which has been increased to ₹12,840 crore for 2026–27. (Finance Department, Government of Haryana, 2026) 

The progress of the scheme as marked by Sanket Ghogare (2026) over 28 lakh families in Haryana are covered. 

Performance

Since its launch in November 2022, the CHIRAYU scheme has expanded in terms of beneficiary coverage, treatment utilisation, hospital empanelment and government expenditure. 

Source: Department of Economic and Statistical Affairs, Haryana, Economic Survey of Haryana 2023–24, 2024–25 and 2025–26; Finance Department, Government of Haryana, Haryana Budget 2026–27. 

1. Expansion of access: The rapid increase in CHIRAYU cards and the expansion of the hospital network indicate a substantial widening of access to cashless healthcare services since the scheme’s launch (Government of Haryana, 2023, 2025).
2. Increased utilisation: The processing of 16.9 lakh claims worth ₹2,083 crore by December 2025 demonstrates considerable utilisation of the scheme among Antyodaya families. The additional ₹1.80–3 lakh income category also recorded 36,148 claims, indicating uptake beyond the original beneficiary group (Government of Haryana, 2026).
3. Growing fiscal commitment: The allocation of ₹950 crore in 2026–27 reflects continued government financial support for the scheme. The wider Health and Family Welfare budget also increased by 21% compared with the 2025–26 revised estimate (Finance Department, Government of Haryana, 2026).
4. Implementation concerns: The CAG’s earlier audit of PM-JAY identified issues concerning hospital accountability and recovery of penalties. In Haryana, ₹36.67 lakh in penalties had been imposed on defaulting hospitals, of which ₹19.81 lakh had been recovered and ₹16.85 lakh remained to be recovered. However, these findings relate to 2019–2021 and therefore predate CHIRAYU, so they should be treated as broader implementation lessons rather than direct evidence of current CHIRAYU performance.

Overall, the available evidence indicates strong expansion in coverage and utilisation, accompanied by increasing fiscal support. However, available administrative data are more comprehensive on cards, claims, hospitals and expenditure than on long-term health outcomes, reduction in out-of-pocket expenditure and beneficiary satisfaction.

Impact

The core objectives of CHIRAYU are to improve access to quality secondary and tertiary healthcare for economically vulnerable households and provide financial protection against high medical expenditure. Available evidence indicates progress towards these objectives.

1. Improved access and equity: By providing cashless hospitalisation coverage of up to ₹5 lakh per family annually and targeting Antyodaya and lower-income households, CHIRAYU has reduced financial barriers to accessing secondary and tertiary healthcare. Its subsequent extension to additional income groups has further widened access beyond the original beneficiary population (Press Information Bureau, 2023).
2. Financial protection: Independent evidence from Haryana supports the financial-protection objective underlying CHIRAYU. A case-control study found that PM-JAY beneficiaries incurred 65% lower direct medical expenditure than non-beneficiaries. Catastrophic health expenditure was also substantially lower among beneficiaries, 13.3% compared with 45.9% among non-beneficiaries. However, non-medical expenses such as transportation continued to impose costs on households.
3. Achievement of objectives: Overall, available evidence suggests that CHIRAYU has contributed towards improving financial access and reducing the burden of hospitalisation costs among vulnerable households. However, evidence is stronger for financial protection than for longer-term outcomes such as improvements in health status, quality of care, poverty reduction and beneficiary satisfaction. Further CHIRAYU-specific impact evaluations are therefore required to establish its long-term effects.

Emerging Issues

The CHIRAYU scheme under the broad spectrum of PM-JAY can be critically evaluated with identification of the following emerging issues and challenges with scheme coverage and implementation:

1. Non-medical expenditure remains outside the core coverage: While CHIRAYU covers hospitalisation-related medical expenses, beneficiaries may continue to incur costs for transportation, food, accommodation and wage loss. A Haryana specific study found that PM-JAY beneficiaries had lower direct medical expenditure but continued to face higher non-medical expenditure, with distance and travel time also affecting the overall financial burden (Kumar et al., 2025). However, evidence remains limited on whether beneficiaries meet these residual costs through informal borrowing, microfinance or other coping mechanisms, highlighting a gap in assessing the scheme’s overall financial-protection impact. 
2. Timely settlement of hospital claims: Concerns regarding pending payments to empanelled hospitals emerged in 2025, prompting representations from the Indian Medical Association. The State Health Authority stated that payments were being processed and that additional funds had been sanctioned, while also undertaking surprise inspections of hospitals. This indicates the need to maintain both financial predictability for providers and accountability in claims processing.
3. Claims management and data quality issues: The CAG identified weaknesses in PM-JAY’s information and validation systems, including missing admission, discharge, pre-authorisation and claim-approval dates in 56,702 Haryana cases in the audited period. Although the audit predates CHIRAYU, it highlights the importance of robust data validation and monitoring mechanisms within the PM-JAY architecture.
4. Evidence on long-term health outcomes remains limited: Current evidence is stronger on enrolment, claims and financial expenditure than on indicators such as quality of treatment, health outcomes, beneficiary satisfaction and long-term changes in financial vulnerability. This creates a gap in assessing whether increased utilisation is translating into sustained improvements in health and wellbeing.

Way Forward

The following policy recommendations can be taken into consideration to reduce the issues and challenges and ensure maximum welfare:

1. Financial protection beyond hospitalisation costs: CHIRAYU can explore mechanisms for reducing indirect costs through referral transport, travel assistance and stronger availability of medicines and diagnostics at empanelled facilities, particularly for vulnerable and geographically distant beneficiaries (Kumar et al., 2025).
2. Establish claim-settlement mechanisms: A time-bound claim-settlement system with transparent turnaround-time monitoring can help maintain provider participation while reducing payment-related disputes. Priority mechanisms for smaller hospitals, combined with transparent deductions and an accessible appeal process, can strengthen provider confidence without weakening financial oversight. The existing Haryana system already provides for online claims processing and appeals through a Medical Audit Committee.
3. Strengthen digital monitoring, audit and fraud detection: Real-time validation of beneficiary, admission and claim data should be strengthened alongside regular medical audits, surprise inspections and automated identification of irregular claims. Haryana’s existing framework already provides for online complaint and grievance tracking, anti-fraud guidelines and claims-adjudication mechanisms, which can be further integrated into routine monitoring.
4. Outcome-based monitoring and independent evaluation: The scheme should supplement administrative indicators with periodic measurement of out-of-pocket expenditure, treatment outcomes, quality of care, beneficiary satisfaction, grievance resolution and equity in access. Independent impact evaluations would enable the government to assess not only how many claims are processed, but whether CHIRAYU is achieving its broader objectives of financial protection and improved healthcare access.

Greater convergence between CHIRAYU and other health programmes could further strengthen referral linkages and ensure continuity of care across primary, secondary and tertiary healthcare. Thus, the next phase of CHIRAYU should focus not only on expanding coverage but on strengthening financial protection, provider accountability, digital governance and outcome-based monitoring to ensure that increased access translates into sustained improvements in healthcare outcomes.

References

Ayushman Bharat, Haryana. (n.d.). Haryana Ayushman Bharat implementation overview. Government of Haryana. https://ayushmanbharat.haryana.gov.in/haryana-ayushman-bharat-implementation-overview/

Comptroller and Auditor General of India. (2023). Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (Report No. 11 of 2023). https://cag.gov.in/uploads/download_audit_report/2023/Report-No.-11-of-2023_PA-on-PMJAY_English-PDF-A-064d22bab2b83b5.38721048.pdf

Department of Economic and Statistical Affairs, Haryana. (2025). Economic Survey of Haryana 2024–25. Government of Haryana. https://cdnbbsr.s3waas.gov.in/s32b0f658cbffd284984fb11d90254081f/uploads/2025/03/20250317378593833.pdf

Department of Economic and Statistical Affairs, Haryana. (2026). Economic Survey of Haryana 2025–26. Government of Haryana. https://esaharyana.gov.in/document/economic-survey-of-haryana-2025-26-2

Directorate of Information, Public Relations & Languages, Government of Haryana. (2022, November 22). CHIRAYU Haryana to give new lease of life to 1.25 crore Antyodaya population. Government of Haryana. https://www.prharyana.gov.in/en/taking-yet-another-historic-step-to-ensure-the-benefit-of-health-facilities-to-every-needy-person

Finance Department, Government of Haryana. (2026). Haryana budget 2026–27. Government of Haryana. https://finhry.gov.in/budget-2026-27

Government of Haryana, Health Department. (2025, July 22). Extension of benefits of PMJAY-CHIRAYU scheme to families with certified annual income ranges above ₹1.80 lakh and up to ₹3.00 lakh and certain specified categories of workers (Notification No. 49/22/2025-6HB-II). Haryana Government Gazette (Extraordinary), No. 127-2025/Ext. https://avantiscdnprodstorage.blob.core.windows.net/legalupdatedocs/44869/GOB512-1.PDF

Ghogare, S. (2026, May 15). Haryana Chirayu Ayushman Scheme. Schemes In India. https://schemesinindia.in/schemes/haryana/haryana-chirayu-ayushman-health-scheme

Government of Haryana. (2023). CHIRAYU Scheme (Comprehensive Health Insurance of Antyodaya Units). https://cdnbbsr.s3waas.gov.in/s3169779d3852b32ce8b1a1724dbf5217d/uploads/2023/08/202308252011971615.pdf

Government of Haryana. (n.d.). Benefits of AB-PMJAY. Ayushman Bharat, Haryana. https://ayushmanbharat.haryana.gov.in/benefits-of-ab-pmjay

Government of Haryana, Ayushman Bharat–Haryana Health Protection Authority. (2025, August 18). Hospital payments under Ayushman Bharat Scheme being processed without delay: State Health Authority. Government of Haryana. https://www.prharyana.gov.in/en/press-note-158

Kumar, A. P., Yerram, A., Chugh, Y., Rana, S., Mudgal, D., Prinja, S., & Muraleedharan, V. R. (2025). Impact of India’s publicly funded health insurance scheme on financial risk protection: A case-control study from Haryana state in India. BMJ Open, 15(9), e093304. https://bmjopen.bmj.com/content/15/9/e093304

Press Information Bureau. (2023, November 2). Union Home Minister and Minister of Cooperation, Shri Amit Shah addresses the ‘Antyodaya Mahasammelan’ organized on the occasion of completion of 9 years of the Government of Haryana as the chief guest in Karnal today. Government of India. https://www.pib.gov.in/PressReleasePage.aspx?PRID=1974160&lang=2&reg=48

About the contributor

Sneha Kohli is a third-year B.A. (Hons.) Political Science student at Jesus and Mary College, University of Delhi. She has a keen interest in public policy, governance, and policy research, with prior experience in research projects, policy analysis, and academic writing. She values curiosity, critical thinking, and collaborative learning, and looks forward to contributing to and learning from IMPRI’s research ecosystem. 

Acknowledgements

The author extends sincere gratitude to the IMPRI team for their expert guidance and Amrutha Kolluru and Kaustav Majumdar for their valuable feedback and support. 

Disclaimer

All views expressed in the article belong solely to the author and not necessarily to the organisation. 

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