The Pension Fund Regulatory and Development Authority (PFRDA) has issued operational guidelines for NPS Swasthya under the National Pension System (NPS), 2026. The guidelines specify the withdrawal amount, insurance cover, and conditions for the sustenance of the account in case of insufficient balance.
NPS Swasthya is a health-focused pension product under the National Pension System (NPS), which allows subscribers to build a dedicated corpus for medical expenses. PFRDA introduced it initially as a proof of concept under its regulatory sandbox framework to test how healthcare benefits could be integrated with the NPS architecture. It includes a super top-up health insurance policy.
Though, as per the final framework, the insurance policy is mandatory for enrolment, the NPS Swasthya investment account and insurance policy remain legally and operationally distinct. The two make up the essential components of the scheme.
Any individual eligible to join NPS may enrol in NPS Swasthya.
Contributions and Charges
The minimum initial contribution must cover the first-year premium, including taxes, Rs 200 plus applicable taxes, and Rs 1,000 towards investment in the NPS Swasthya account. Subsequent contributions shall be made with a minimum limit of Rs 10.
The charges applied to NPS Swasthya will be the same as those applicable to NPS under the All Citizen Model, with an additional charge of up to 0.08% per annum of the NPS Swasthya corpus.
Partial Withdrawals
Subscribers are allowed to withdraw up to 25 percent of the total contributions made to the NPS Swasthya account for healthcare expenses, including eligible out-patient and in-patient expenses. There is no limit to the number of times these partial withdrawals can be made, along with zero waiting period.
The amount, however, is settled with the concerned hospital, healthcare provider, or other eligible entity towards the Eligible Healthcare Expenses, instead of going directly to the subscriber.
Insurance Policy
The insurance policy is a family floater which covers the subscriber, spouse, and up to two dependent children. Parents are not included.
The Annual Aggregate Deductible applies to the combined eligible expenses of all covered members in a policy year, not separately to each claim.
The policy provides four such deductibles against the family floater sums insured:
* Rs 10,000 deductible — Rs 1 lakh cover
* Rs 50,000 deductible — Rs 5 lakh cover
* Rs 1 lakh deductible — Rs 10 lakh cover
* Rs 3 lakh deductible — Rs 30 lakh cover
The entry age for subscribers is set from 18 to 70 years. Renewal may continue up to and including age 85 years, subject to premium, policy terms, and applicable law.
The insurance policy has a 30-day waiting period, excluding cases of accidents. Also, for pre-existing diseases, specified diseases, or procedures, the waiting period is 12 months, subject to the final Insurance Policy and applicable insurance law.
Transfer of Funds from Existing NPS Scheme
A subscriber may choose to transfer funds from an existing NPS scheme under the All Citizen Model to the NPS Swasthya account, subject to the amount being limited to meet the applicable deductible under the Insurance Policy.
Closure of Account
PFRDA mentions the following conditions for the closure of the account: normal exit, premature exit, non-availability of funds to renew insurance, and death of the subscriber.
* If eligible inpatient healthcare expenditure in a single instance exceeds the amount permissible through partial withdrawal, the accumulated NPS Swasthya corpus is first used towards that. In case of any remaining balance, the scheme would be merged with an NPS scheme under the All Citizen Model. If there is no existing NPS scheme, the NPS Swasthya scheme will be converted into one.
* If the available balance is insufficient for the renewal premium, the subscriber would be alerted, where practicable, at least 90, 60, and 30 days before renewal. In case the subscriber is unable to pay the premium till the applicable grace period, the account stands closed and merged with an NPS scheme under the All Citizen Model. If there is no existing NPS scheme, the NPS Swasthya scheme will be converted into one.
