A. General
What is NPS Swasthya?
NPS Swasthya is a specific-purpose pension scheme introduced under Regulation 4A of the PFRDA (Exits and Withdrawals under the National Pension System) Regulations, 2015.
It enables a subscriber to build a retirement corpus while also providing access to specified healthcare-related benefits and a separate super top-up group health insurance policy.
Is NPS Swasthya a health insurance product?
No. NPS Swasthya is a pension scheme under NPS. It also provides access to a separate super top-up health insurance policy. The NPS Swasthya account and the Insurance Policy are legally and operationally distinct. It is governed by the Operational Guidelines for NPS Swasthya under the National Pension System (NPS), 2026.
Is the health insurance policy mandatory for joining NPS Swasthya?
Yes. A subscriber must have the applicable Insurance Policy for enrolment under NPS Swasthya. The Insurance Policy is arranged by the Pension Fund through an insurer registered with IRDAI.
Is NPS Swasthya different from an ordinary NPS account?
Yes. NPS Swasthya is a specific-purpose NPS scheme with provisions for specified healthcare-related withdrawals and a separate super top-up health insurance policy.
Does NPS Swasthya replace a subscriber's existing NPS account?
No. An NPS Swasthya account is separate from other NPS accounts. Closure of an NPS Swasthya account does not by itself affect any other NPS account maintained by the subscriber.
Who can join NPS Swasthya?
Any individual who is eligible to join NPS may enrol under NPS Swasthya, subject to the applicable provisions of the NPS Swasthya Guidelines and applicable insurance requirements.
B. Enrolment and Account Structure
Does a person need to have an existing NPS account to enrol in NPS Swasthya?
No. 
What does an NPS Swasthya account consist of?
NPS Swasthya consists of an NPS Swasthya investment account and a separate super top-up health insurance policy. The two components are legally and operationally distinct.
Who arranges the health insurance policy?
The Pension Fund offering NPS Swasthya arranges the standard super top-up group health insurance policy through an insurer registered with IRDAI.
Who is covered under the standard family health insurance policy?
The standard coverage unit comprises the subscriber, spouse and up to 2 dependent children. 
Can parents be included in the standard NPS Swasthya family-floater policy?
No. Parents are excluded from the standard family-floater coverage under the Insurance Policy.
What is the entry age for the standard Insurance Policy?
The standard Insurance Policy provides for entry from age 18 years up to 70 years, subject to the applicable insurance terms and law.
Up to what age can the Insurance Policy be renewed?
Renewal may continue up to and including age 85 years, subject to the applicable policy terms and insurance law.
C. Contributions, Investment and Charges
What is the minimum initial contribution under NPS Swasthya?
The minimum initial contribution must cover at least the applicable first-year insurance premium, including taxes, ₹200 towards annual maintenance charges plus applicable taxes, and ₹1,000 towards investment in the NPS Swasthya account.
Why is the first-year insurance premium included in the initial contribution?
The first-year insurance premium is required to be paid upfront as part of the minimum initial contribution so that the applicable Insurance Policy can be arranged at the time of enrolment.
What is the minimum subsequent contribution under NPS Swasthya?
The minimum subsequent contribution is ₹10.
Is the insurance premium the same for every subscriber?
No. The premium is determined by the insurer in accordance with the applicable IRDAI framework. Premiums may therefore depend on the applicable insurance terms, including the relevant age category and policy option.
How are contributions under NPS Swasthya invested?
Contributions are invested in accordance with the investment pattern prescribed for the Central Government Scheme under the applicable PFRDA investment guidelines.
Are returns under NPS Swasthya guaranteed?
No. The investment is market-linked. The return on the investment is not guaranteed.
What charges apply to NPS Swasthya?
The charges applicable to NPS under the All Citizen Model apply to NPS Swasthya. In addition, the Pension Fund may levy a charge of up to 0.08% per annum of the AUM of the NPS Swasthya corpus, plus applicable taxes and an annual maintenance charge of ₹200 plus applicable taxes payable to the HBA.
Will insurance premium and NPS Swasthya charges be shown separately?
Yes. The insurance premium and applicable taxes are required to be shown separately from the charges relating to the NPS Swasthya account.
Will the subscriber be informed about applicable charges?
Yes. Applicable charges are required to be disclosed to the subscriber before enrolment and when there is a change in such charges.
D. Existing NPS Account and Transfer
Can a subscriber transfer money from an existing NPS account to NPS Swasthya?
Yes. A subscriber may 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.
Is transfer from an existing NPS account to NPS Swasthya mandatory?
No. The Guidelines provide this as an option for the subscriber, subject to the applicable conditions.
What is the purpose of transferring funds from an existing NPS account to NPS Swasthya?
Such transfer is permitted to meet the applicable deductible under the Insurance Policy, subject to the conditions specified in the Guidelines.
Can the entire balance of an existing All Citizen Model NPS account be transferred to NPS Swasthya?
No. The transfer permitted under the Guidelines is limited to the amount required to meet the applicable deductible under the Insurance Policy.
E. Healthcare Expenses and Partial Withdrawal
For what purpose can a partial withdrawal be made from NPS Swasthya?
A partial withdrawal may be made towards an Eligible Healthcare Expense, including eligible outpatient and inpatient healthcare expenses, subject to the conditions in the NPS Swasthya Guidelines.
What is the maximum amount that can be withdrawn as a partial withdrawal?
The amount of a partial withdrawal cannot exceed 25% of the contributions made by the subscriber to the NPS Swasthya account, subject to the Guidelines.
Is the 25% limit based on the current value of the NPS Swasthya corpus?
No. The 25% limit is linked to the contributions made by the subscriber to the NPS Swasthya account, and not to the current market value of the corpus.
How many partial withdrawals can a subscriber make?
There is no restriction on the number of partial withdrawals, subject to the applicable conditions and limits under the Guidelines.
Is there a minimum waiting period before making the first partial withdrawal?
No. 
Is there a waiting period between two partial withdrawals?
No minimum waiting period is prescribed for subsequent partial withdrawals, subject to the other conditions applicable to partial withdrawal.
Is a partial withdrawal available only for hospitalisation?
No. Partial withdrawal may be made for an Eligible Healthcare Expense, including eligible outpatient and inpatient expenses, subject to the Guidelines.
Is the amount of partial withdrawal paid directly to the subscriber?
No. The permitted amount is settled with the concerned hospital, healthcare provider or other eligible entity towards the Eligible Healthcare Expense, in accordance with the prescribed process.
Does a healthcare expense have to be covered by the Insurance Policy to qualify for withdrawal from NPS Swasthya?
No. An Eligible Healthcare Expense under the Guidelines is a healthcare expense permitted from the NPS Swasthya corpus. Its eligibility is not determined solely by whether the expense is admissible under the Insurance Policy.
Can an expense not paid by the insurer be considered from the NPS Swasthya corpus?
An Eligible Healthcare Expense may be considered for payment from the NPS Swasthya corpus even where it is not paid by the Insurance Policy, subject to the applicable provisions and process under the Guidelines.
Can a subscriber make repeated withdrawals for healthcare expenses?
Yes. There is no restriction on the number of partial withdrawals for eligible healthcare expenses. Each withdrawal remains subject to the applicable conditions and limit under the Guidelines.
F. Health Insurance
What type of health insurance is provided under NPS Swasthya?
The Insurance Policy under NPS Swasthya is a standard super top-up group health insurance policy arranged through an IRDAI-registered insurer.
What is a super top-up health insurance policy?
A super top-up policy provides additional health insurance coverage once the specified annual aggregate deductible is crossed, subject to the terms and conditions of the Insurance Policy.
What is the Annual Aggregate Deductible?
The Annual Aggregate Deductible is the specified amount of admissible healthcare expenses that is considered cumulatively during the policy year before the super top-up insurance coverage becomes applicable, subject to the terms of the Insurance Policy.
Is the deductible applied separately to every claim?
No. The Annual Aggregate Deductible applies cumulatively to admissible healthcare expenses of the covered family members during the policy year, rather than separately to each claim, subject to the Insurance Policy.
What deductible and sum insured options are available under the standard Insurance Policy?
The standard Insurance Policy provides the following combinations:
₹10,000 deductible with ₹1 lakh sum insured;
₹50,000 deductible with ₹5 lakh sum insured;
₹1 lakh deductible with ₹10 lakh sum insured; and
₹3 lakh deductible with ₹30 lakh sum insured.
The applicable option and premium are required to be disclosed before enrolment.
When does insurance coverage start?
The Insurance Policy is required to commence not later than T+1 working day from successful enrolment and receipt of the applicable minimum initial contribution, where T is the date of successful enrolment.
Is insurance coverage automatic once the subscriber makes a contribution?
The Insurance Policy is mandatory for enrolment, and coverage commences in accordance with the Insurance Policy after successful enrolment and receipt of the applicable minimum initial contribution. Coverage remains subject to the terms of the Insurance Policy and applicable insurance law.
What documents should a subscriber receive for the Insurance Policy?
The subscriber should receive the applicable insurance documents, including the Certificate of Insurance and Customer Information Sheet, along with relevant details of the insurer and TPA.
What is the role of the TPA?
The TPA is appointed by the insurer in accordance with applicable insurance law. The TPA may perform functions relating to insurance services and claims as permitted under the applicable insurance framework.
Who governs insurance claims?
Insurance-related matters, including claims, underwriting, waiting periods, exclusions and other policy terms, are governed by applicable insurance law and the terms and conditions of the Insurance Policy.
Can the insurer change the terms of the Insurance Policy for an individual subscriber during the policy period?
Insurance terms are governed by applicable insurance law and the Insurance Policy. Any change in the policy terms is subject to the applicable legal and regulatory requirements.
Does a healthcare withdrawal depend on the insurance claim being approved?
No. Healthcare withdrawal and insurance coverage are separate components. An Eligible Healthcare Expense may be considered from the NPS Swasthya corpus subject to the Guidelines, while the insurance claim is dealt with under the Insurance Policy and applicable insurance law.
G. Insurance Renewal and Continuity
Can the renewal premium be paid from the NPS Swasthya corpus?
Yes. The renewal premium may be funded from the NPS Swasthya corpus in accordance with the Guidelines and the subscriber's mandate.
What happens if there is not enough money in the NPS Swasthya account to pay the renewal premium?
Where the available balance may be insufficient, the Pension Fund shall, where practicable, alert the subscriber at least 90, 60 and 30 days before renewal. If the premium remains unpaid after the applicable grace period and the insurance cover lapses, the NPS Swasthya account shall be treated as closed in accordance with the Guidelines.
What happens after the NPS Swasthya account is closed because the insurance premium was not paid?
The NPS Swasthya scheme shall be closed and merged into an NPS scheme under the All Citizen Model. If the subscriber does not have an existing All Citizen Model NPS scheme, the NPS Swasthya scheme shall be changed into an All Citizen Model NPS scheme.
Will the subscriber be informed before the insurance cover is due for renewal?
Where practicable, the Pension Fund shall alert the subscriber at least 90, 60 and 30 days before renewal where the available balance may be insufficient for payment of the renewal premium. The applicable grace period and consequences of non-payment are also required to be disclosed.
H. Change of NPS Swasthya Scheme
Can a subscriber change from one NPS Swasthya scheme to another?
Yes. A subscriber may change from one NPS Swasthya scheme to another at the time of renewal of the Insurance Policy, in the manner specified by the Authority.
Does changing the NPS Swasthya scheme also mean changing the Pension Fund?
It may. A change of NPS Swasthya scheme may involve a change of Pension Fund and the associated Insurance Policy.
What happens to an insurance claim that is already pending when the subscriber changes the NPS Swasthya scheme?
A change of NPS Swasthya scheme does not affect an admitted, pending or reopened insurance claim or grievance. Insurance-related continuity, migration, portability and waiting-period matters are governed by applicable insurance law and IRDAI requirements.
Does the outgoing insurer remain responsible for a claim arising during its policy period?
Yes. The outgoing insurer remains responsible for claims arising during the relevant policy period, subject to the Insurance Policy and applicable insurance law.
I. Premature Exit and Closure
When can a subscriber opt for premature exit from NPS Swasthya?
A subscriber may opt for premature exit where eligible inpatient healthcare expenditure in a single instance exceeds the amount that can be met through a partial withdrawal under the Guidelines.
What happens to the NPS Swasthya corpus in case of premature exit?
The NPS Swasthya corpus is first used towards the eligible inpatient healthcare expenditure. Any remaining balance is dealt with in accordance with the Guidelines through transfer or merger into an NPS scheme under the All Citizen Model.
What happens if the subscriber already has an All Citizen Model NPS account at the time of premature exit?
Where any balance remains after meeting the eligible inpatient healthcare expenditure, the balance is merged into the subscriber's NPS scheme under the All Citizen Model, in accordance with the Guidelines.
What happens if the subscriber does not have an All Citizen Model NPS account?
The NPS Swasthya scheme is changed into an NPS scheme under the All Citizen Model. Upon such change, the NPS Swasthya account stands closed.
What happens to the Insurance Policy after premature exit?
If an Insurance Policy is already in force, it continues for the remaining policy period, subject to the terms and conditions of the Insurance Policy and applicable insurance law.
In what circumstances can an NPS Swasthya account be closed?
An NPS Swasthya account may be closed on normal exit, premature exit, non-availability of funds for renewal of insurance, or death of the subscriber, as applicable under the Guidelines.
Does closure of an NPS Swasthya account close the subscriber's other NPS accounts?
No. Closure of an NPS Swasthya account does not affect any other NPS account maintained by the subscriber.
J. Normal Exit, Death and Nomination
What provisions apply to normal exit from NPS Swasthya?
The exit provisions applicable to Non-Government subscribers under the PFRDA (Exits and Withdrawals under the National Pension System) Regulations, 2015, apply to NPS Swasthya.
What happens to the NPS Swasthya account on the death of the subscriber?
The account is closed on the death of the subscriber, as applicable under the Guidelines. The exit provisions applicable to Non-Government subscribers under the PFRDA (Exits and Withdrawals under the National Pension System) Regulations, 2015, apply to NPS Swasthya.
What nomination provisions apply to NPS Swasthya?
The nomination provisions applicable to Non-Government subscribers under the PFRDA (Exits and Withdrawals under the National Pension System) Regulations, 2015, apply to NPS Swasthya.
K. Grievance Redressal and Subscriber Protection
Where can a subscriber raise a grievance relating to NPS Swasthya?
A subscriber may lodge a grievance through the Pension Sahayak platform against the concerned stakeholder.
Can a grievance be raised against the HBA?
Yes. The HBA is required to provide first-instance grievance redressal for services provided by it. It is also required to facilitate resolution of other healthcare-related grievances by routing them to the responsible entity, as applicable.
What is the role of the Pension Fund in grievance redressal?
The Pension Fund is required to establish an effective grievance redressal mechanism. Where a grievance relates to services provided by an HBA or insurer engaged under NPS Swasthya, the Pension Fund coordinates with the concerned entity for timely resolution.
Can a subscriber raise an insurance grievance through Pension Sahayak?
Yes. A subscriber may lodge a grievance relating to NPS Swasthya against the insurer through Pension Sahayak. Insurance claims and other insurance matters remain subject to applicable insurance law and the Insurance Policy.
Will subscribers receive information about the terms of NPS Swasthya before enrolment?
Yes. Subscribers are required to receive complete, accurate, clear and timely information about NPS Swasthya before enrolment and throughout the tenure of the account. This includes information on applicable charges, insurance premium, benefits, deductible, exclusions, waiting periods, family coverage, claims and grievance redressal.
What information should be disclosed about the Insurance Policy before enrolment?
The subscriber should be informed about material terms such as the sum insured, annual aggregate deductible, exclusions, waiting periods, premium, renewal terms, underwriting, claims process and grievance redressal.
Will the subscriber be informed if there is a material change in NPS Swasthya?
Yes. Material changes affecting subscribers are required to be communicated as early as practicable and, where possible, before the change takes effect. Changes relating to insurance are subject to applicable insurance law and policy requirements.
What happens if an adverse decision is taken in relation to the subscriber?
Where applicable, an adverse decision should be communicated or displayed with the reason in plain language and with information on the available route for escalation or grievance redressal.
L. Practical Questions
Can a subscriber have another NPS account while holding an NPS Swasthya account?
Yes. An NPS Swasthya account is separate from other NPS accounts. 
Can I pay the deductible partly through my NPS Swasthya account and partly from my own funds?
Yes. The deductible under NPS Swasthya may be met either partly through the amount available under NPS Swasthya and partly from the subscriber’s own funds or entirely from the subscriber’s own funds or entirely from other insurance policy or entirely from NPS Swasthya account.
Does the NPS Swasthya account have to be closed if another NPS account is closed?
No. Closure of another NPS account does not by itself result in closure of the NPS Swasthya account. The NPS Swasthya account is closed only in the circumstances specified under the Guidelines.
Can the insurance policy continue even after the NPS Swasthya account is changed following premature exit?
Where the Insurance Policy is already in force, it continues for the remaining policy period, subject to its terms and conditions and applicable insurance law.
Does the insurance policy cover every medical expense incurred by the subscriber?
No. Insurance coverage is subject to the terms and conditions of the Insurance Policy, including applicable deductibles, exclusions, waiting periods and other policy conditions.
Does an insurance rejection automatically mean that the expense cannot be considered under NPS Swasthya?
No. Eligibility for payment from the NPS Swasthya corpus is determined under the Guidelines. An Eligible Healthcare Expense may be considered even if it is not paid by the Insurance Policy. However, a fraudulent or fabricated request is not eligible for payment from the corpus.
Can one family member's insurance underwriting outcome affect the other family members?
The standard Insurance Policy provides family-floater coverage. Where underwriting requirements apply, the insurer deals with the relevant member in accordance with applicable insurance law and the Insurance Policy. One family member's insurance outcome does not by itself determine the eligibility of all other family members.
Is a fresh medical underwriting required every time the Insurance Policy is renewed?
Fresh underwriting at renewal is not imposed except in cases involving enhancement of the sum insured, subject to applicable insurance law and the Insurance Policy.
Can the premium change at renewal?
Renewal premium is governed by the applicable insurance law and the Insurance Policy. The insurer determines the premium in accordance with the applicable IRDAI framework.
Can the insurance policy be discontinued if the subscriber does not have enough funds for renewal?
Yes. If the renewal premium remains unpaid after the applicable grace period and the insurance cover lapses, the NPS Swasthya account is treated as closed in accordance with the Guidelines.
What happens to the NPS Swasthya account after the insurance cover lapses?
The NPS Swasthya scheme is closed and merged into an NPS scheme under the All Citizen Model. If the subscriber does not have an existing All Citizen Model NPS scheme, the NPS Swasthya scheme is changed into an All Citizen Model NPS scheme.
Does a change of Pension Fund automatically cancel an existing insurance claim?
No. A change of NPS Swasthya scheme shall not affect an admitted, pending or reopened insurance claim or grievance. The applicable continuity and claim provisions are governed by insurance law and the Insurance Policy.
Where can a subscriber find the detailed terms of the Insurance Policy?
The subscriber should refer to the applicable Insurance Policy and the insurance documents provided at enrolment and renewal, including the Certificate of Insurance and Customer Information Sheet. Insurance matters are governed by applicable insurance law and the applicable Insurance Policy.