The Pension Fund Regulatory and Development Authority (PFRDA) has issued a 27-page ‘Operational Guidelines for NPS Swasthya under NPS, 2026. It has given detailed information on the minimum contribution for NPS Swasthya, its premium, fees and charges, partial withdrawal rules, how to transfer from an existing NPS scheme, as well as provisions for normal and premature exit.
The guidelines’ circular clarified that different premiums will be charged for age groups of 18-40, above 40 to 60 and above 60 to 70 entry-age groups.
The PFRDA has also explained premium charges for the Rs 10 lakh-Rs 30 lakh health cover under the NPS Swasthya. Here, we take you through key guidelines under the NPS Swasthya circular.
NPS Swasthya: What is the minimum contribution?
To start, you need to pay the first-year insurance premium (with taxes included); a yearly maintenance fee of Rs 200 (plus taxes) that goes to the Health Benefit Administrators HBAs) through PFs to manage the NPS Swasthya scheme; and Rs 1,000 to open your NPS Swasthya account.
After that, you must add at least Rs 10 to your NPS Swasthya account each time you make a contribution.
NPS Swasthya fees and charges
The charges applicable to NPS under the All Citizen Model, will also apply to NPS Swasthya.
In addition, the PF may levy a charge of up to 0.08% per annum on the Assets Under Management (AUM) of your NPS Swasthya corpus (plus taxes) for managing the NPS Swasthya scheme.
An annual maintenance fee of Rs 200 plus taxes, will also be payable to HBAs through PFs for servicing the scheme.
All applicable charges have to be disclosed to the subscriber before enrolment and whenever there is a change in the charges.
No charge other than the one permitted or approved by the authority can be recovered from the subscriber.
NPS Swasthya contributions
The PFRDA, in its circular said that the minimum initial contribution will be the applicable first-year insurance policy premium, includeing taxes.
The annual maintenance charges of Rs 200, plus applicable taxes, payable to HBA through PFs for servicing of the NPS Swasthya scheme; and
A payment of Rs 1,000 for investment in the NPS Swasthya account
The minimum subsequent contribution to NPS Swasthya is Rs 10.
The premium will be remitted to the insurer in line with the prescribed fund-flow
process given in the Standard Operating Procedure (SoP).
NPS Swasthya insurance premium
The circular says that the insurer should decide on the premium based on the IRDAI framework. For scheme comparability, premium should be quoted for entry age cohorts of 18 to 40 years, above 40 to 60 years, and above 60 to 70 years, based on completed age at initial entry.
NPS Swasthya standard insurance policy
According to the circular, subscriber, spouse and up to two dependent children as one family floater are allowed in the NPS Swasthya scheme. Parents are excluded from it.
The subscriber entry age is 18 to 70 years. Entry-age premium cohorts are 18 to 40 years; above 40 to 60 years; above 60 to 70 years.
You can renew NPS Swasthya up to and including the age of 85 years, subject to premium, policy terms and applicable law.
The annual aggregate deductible should apply to cumulative insurance - admissible expenses of all covered family members during the policy year and should not apply separately to each claim, says the circular.
NPS Swasthya partial withdrawal rules
A subscriber can make a partial withdrawal from the NPS Swasthya account for eligible healthcare expenses.
This includes eligible out-patient and in-patient expenses, subject to the applicable guidelines.
The amount withdrawn cannot exceed 25% of the contributions made by the subscriber to the NPS Swasthya account.
There is no restriction on the number of partial withdrawals that a subscriber can make. There is also no minimum waiting period for the first or any subsequent partial withdrawal.
However, the withdrawal amount will not be paid directly to the subscriber.
Instead, the amount will be settled with the concerned hospital, healthcare provider or other eligible entity towards the eligible healthcare expenses. The settlement will be made according to the prescribed fund-flow process.
Can you transfer money from an existing NPS account to NPS Swasthya?
Yes. A subscriber can transfer funds from an existing NPS scheme under the All Citizen Model to the NPS Swasthya account.
However, the amount transferred will be limited to the amount required to meet the applicable deductible under the insurance policy.
Can you change the NPS Swasthya scheme?
A subscriber can change from one NPS Swasthya scheme to another at the time of renewal of the insurance policy.
The change will have to be made in the manner specified by the Authority.
Such a change may also involve a change of Pension Fund (PF) and the associated insurance policy.
When will the NPS Swasthya account be closed?
The NPS Swasthya account will be closed in the following situations:
•Normal exit
•Premature exit
•Non-availability of funds to renew the insurance
•Death of the subscriber
The closure of the NPS Swasthya account will not affect any other NPS account maintained by the subscriber.
NPS Swasthya premature exit rules
A subscriber can opt for premature exit from the NPS Swasthya account when eligible inpatient healthcare expenditure in a single instance exceeds the amount permitted through partial withdrawal.
In such a case, the accumulated NPS Swasthya corpus will first be used towards the eligible in-patient healthcare expenditure.
If there is any balance left after meeting the eligible healthcare expenditure, the NPS Swasthya scheme will be closed and merged into an NPS scheme under the All Citizen Model.
If the subscriber does not have an existing NPS scheme under the All Citizen Model, the NPS Swasthya scheme will be changed into an NPS scheme under the All Citizen Model.
Once this change takes place, the NPS Swasthya account will stand closed.
The insurance policy that is already in force will continue for the remaining policy period, subject to its terms and applicable insurance law.
NPS Swasthya: Account closure rules
An NPS Swasthya account shall be closed upon normal exit, premature exit, non-availability of funds to renew insurance or the death of the subscriber.
The closure of the NPS Swasthya account should not affect any other NPS account maintained by the subscriber, says the circular.
