NPS Swasthya: PFRDA Issues Guidelines for Pension Scheme With Built-In Health Insurance
NPS Swasthya brings health insurance benefits into the pension framework under new PFRDA guidelines.
NPS Swasthya combines pension planning with built-in health insurance, offering subscribers financial and healthcare protection.
NPS Swasthya: At one end of the new NPS Swasthya framework sits a contribution of Rs 10. At the other sits a family health cover of up to Rs 30 lakh. Between them, the Pension Fund Regulatory and Development Authority (PFRDA) has set out how a single National Pension System account will serve two purposes: building a retirement corpus and paying for medical care.
The regulator issued the operational guidelines on September 18, 2026, and they came into force immediately. They apply to PFRDA-registered intermediaries, Health Benefit Administrators (HBAs) and other stakeholders. The guidelines state that the scheme is intended to help subscribers accumulate a dedicated fund for retirement while giving them access to health insurance and related services through the existing NPS architecture.
NPS Swasthya: How the scheme is structured
NPS Swasthya has two components. The first is an NPS Swasthya investment account, into which subscribers make their contributions. The second is a separate super top-up health insurance policy, which is compulsory. A person cannot enrol in the scheme without taking the policy.
Any individual who is eligible to join the National Pension System can enrol. Money paid into the investment account will be invested according to the pattern prescribed for the Central Government Scheme. The framework also allows partial withdrawals for eligible healthcare expenses, subject to conditions set by the regulator.
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NPS Swasthya: Contribution requirements and healthcare withdrawals
The minimum initial contribution is made up of three parts: the first-year premium for the health policy, an annual maintenance charge of Rs 200 payable to the HBA along with applicable taxes, and Rs 1,000 to be invested in the NPS Swasthya account. After enrolment, the minimum subsequent contribution is Rs 10.
Subscribers may withdraw up to 25 percent of their contributions to cover eligible healthcare expenses, and the guidelines do not cap the number of partial withdrawals. The amount is not paid to the subscriber. It is settled directly with the hospital, healthcare provider or other eligible entity to which the expense is owed.
NPS Swasthya: What the health policy covers
The standard policy is a family floater covering the subscriber, the spouse and up to two dependent children. Parents are not included. Subscribers can enter the scheme between the ages of 18 and 70, and the policy can be renewed up to and including age 85, subject to the premium, the policy terms and applicable law.
Buyers can choose from four sum insured options, each paired with an annual aggregate deductible. A sum insured of Rs 1 lakh carries a deductible of Rs 10,000, while Rs 5 lakh carries Rs 50,000. The Rs 10 lakh option has a deductible of Rs 1 lakh, and the Rs 30 lakh option has one of Rs 3 lakh. Under a super top-up policy, the insurer begins paying once total claims in a policy year exceed the deductible.
The policy also provides a single private room for normal hospitalisation and covers ICU charges at actuals. Both benefits are subject to the sum insured and the final policy wording.
