NPS Swasthya operational guidelines issued: pension account with a mandatory super top-up health cover, ₹1,000 minimum investment, withdrawals paid straight to hospitals

What PFRDA has issued

By Circular No. PFRDA/2026/49/NPS-SWASTHYA/01 dated 18 September 2026, the Pension Fund Regulatory and Development Authority has issued the “Operational Guidelines for NPS Swasthya under the National Pension System (NPS), 2026”, under section 14 of the PFRDA Act, 2013 read with Regulation 4A of the Exits and Withdrawals Regulations, 2015. The circular comes into force with immediate effect; the Guidelines say they come into force from the date specified by the Authority through a circular.

NPS Swasthya has two parts that stay legally and operationally distinct: an account with an NPS Swasthya investment scheme, and a separate super top-up health insurance policy arranged by the Pension Fund (PF) under a master policy with an IRDAI-registered insurer.

Contributions, charges and investment

Using the money for treatment

• Partial withdrawal: for eligible healthcare expenses, including out-patient and in-patient expenses, up to 25% of the contributions made by the subscriber. There is no limit on the number of withdrawals and no waiting period. The amount is settled with the hospital or healthcare provider and is not paid to the subscriber.
• Premature exit: allowed where eligible in-patient expenditure in a single instance exceeds what partial withdrawal permits. The corpus is first used for that expenditure; any balance moves to an NPS scheme under the All Citizen Model.
• Transfer in: funds may be moved from an existing All Citizen Model scheme, limited to the amount needed to meet the policy deductible.
• If renewal premium cannot be paid: the PF is to alert the subscriber, where practicable, at least 90, 60 and 30 days before renewal. If cover lapses after the grace period, NPS Swasthya is closed and merged into an All Citizen Model scheme.

The standard insurance policy

• Covers subscriber, spouse and up to two dependent children as one family floater; parents are excluded.
• Entry age 18 to 70 years; renewal may continue up to and including 85 years.
• Single private room; ICU at actuals; pre-hospitalisation 30 days and post-hospitalisation 60 days; road ambulance up to ₹2,500 per emergency hospitalisation.
• No co-payment or disease-specific sub-limit.
• Initial waiting period 30 days (except accident); pre-existing disease 12 months; specified disease or procedure 12 months.
• Enrolment is ordinarily on a Good Health Declaration.
• Cover starts not later than T+1 working days from successful enrolment and receipt of the minimum initial contribution.

Who runs it

Pension Funds offer and manage the scheme and remain solely responsible for compliance. They engage a Health Benefit Administrator (HBA) from a panel maintained by the Association of NPS Intermediaries. The insurer cannot be a group or common-control entity of the PF, and the PF cannot take insurance commission. Grievances can be lodged on the Pension Sahayak platform; the insurer is responsible for claim-related grievances under IRDAI regulations.

Existing sandbox subscribers

NPS Swasthya schemes offered under the Regulatory Sandbox are discontinued on implementation of these Guidelines. Their subscribers will get an option to migrate to a scheme under the Guidelines or merge into an All Citizen Model scheme.

What to check before enrolling

The Guidelines require that the sum insured, deductible, exclusions, waiting periods, premium and charges be disclosed before enrolment, with insurance premium shown separately from account charges. Read those disclosures first.