​NPS Swasthya

Key Highlights: NPS Swasthya

Who is Eligible for NPS Swasthya

• Any Indian citizen who is eligible to open a standard National Pension System (NPS) account can join NPS Swasthya.
• Age Requirements:
  • Entry Age: Individuals who are 18 to 70 years old are eligible to enroll.
  • Renewal Age: The plan can be renewed until 85 years of age.
• Compulsory Insurance Plan: Enrollment involves subscribing to a compulsory super top-up health insurance plan together with the creation of the NPS Swasthya investment account.
• Scope of Family Health Insurance Coverage: The main health insurance plan is designed to be a family floater plan which provides cover to: Subscriber, Spouse, Two dependents, and children(Parents are explicitly excluded from cover).
• Transfer Provision for Existing NPS Members: Existing NPS members under the NPS All Citizens Model are allowed to transfer money from their NPS account into the NPS Swasthya account up to the deductible of the insurance plan.

Coverage and Benefits under NPS Swasthya

• Flexible Withdrawals: It allows you to withdraw up to 25 per cent of your personal contribution in the NPS Swasthya account, which will be used for OPD treatment, which involves outpatient services such as consultations, and IPD treatment that includes admissions to hospitals.
• No Waiting Period and Withdrawal Limit: Unlike other NPS accounts, in the flexible withdrawal option, there is no waiting period before you make your first withdrawal and no limit on the number of withdrawals.
• Funds transferred directly to Hospitals: The funds will not be transferred to your bank account but rather will go directly to the hospital through a Health Benefit Administrator (HBA).
• When you join, you automatically get a family floater insurance policy that covers you, your spouse, and up to 2 children. Parents are not included in this cover. Here, the "deductible" is the amount of your medical bill you cover yourself before the insurance takes over.

1. What the Insurance Covers:

   • Hospital & ICU Stay: Single private room coverage and full ICU expenses with no upper cap.
   • Specialised & Modern Treatments: Covers daycare procedures, AYUSH therapies, domiciliary (at-home) care, and modern medical treatments.
   • Pre & Post-Hospitalisation: Medical expenses covered for 30 days prior to admission and 60 days after discharge.
   • Ambulance Charges: Road ambulance expenses are covered up to ₹2,500.

2. Waiting Periods:

   • Initial Waiting Period: 30 days for general illnesses (accidental injury covered from day 1).
   • Pre-Existing & Specified Conditions: A 12-month waiting period applies to NPS Swasthya.

Important Updates Under Final Guidelines

Note: Present Status of Implementation of NPS Swasthya (Portal not Available for Public) Although the PFRDA has already launched the operational guidelines, the onboarding portal and application registration are not active for Public. 

(Circular No. PFRDA/2026/49/NPS-SWASTHYA/01 issued on September 18, 2026)

1. Removal of Minimum Balance Requirement

   • You no longer need to maintain a minimum corpus of ₹50,000 before making your first medical partial withdrawal.

2. Emergency Exit Option for Heavy Medical Expenses

   • In case your total medical cost exceeds your 25% withdrawal amount limit, you can opt for an emergency early withdrawal. This lets you withdraw your entire pension savings balance towards meeting the bill, with the remaining being credited directly into your NPS All Citizen account.

3. Lapse of Policy and Automatic Conversion of the Account

   • In case you do not make the payment for the renewal of your insurance policy annually by getting reminders (at 90, 60, and 30 days before), your health insurance plan would lapse. After that, your account gets converted into a normal NPS All Citizen account.

4. Strict Rules on Commissions and Data Privacy

   • Pension Fund Managers are strictly prohibited from earning insurance commissions or receiving claim-linked payments.
   • Your medical and health data is fully protected and cannot be shared for marketing or used to force choices toward specific healthcare providers.

Documents Required for NPS Swasthya

• Proof of Identity (KYC)
• Aadhaar Card
• PAN Card
• Alternative proofs of identity (if Aadhaar is not available): Passport, Voter ID, or Driving License

1. Proof of Address

   A adhaar Card/Passport/Voter ID/Utility Bill (less than 3 months old electricity/gas/water bill)

2. Bank Account Details

   Cancelled Cheque (with printed name of the subscriber) or a Bank Statement/Passbook (with the account number, IFSC code & beneficiary name for bank verification.

3. Details of Nominee & Dependent Family (In case of taking up a Health insurance policy)

   ID proof & age proof of Nominee and dependant family members (Spouse & 2 dependent children)

4. Existing NPS Subscribers (in case of transferring money)

   PRAN (Permanent Retirement Account Number) Card or account statement in case of NPS Swasthya by transferring the existing NPS corpus.

How to Apply Step by Step for NPS Swasthya

You can apply for NPS Swasthya through both Online and offline modes.

1. Through Online Mode:

   Step 1: Visit the Official Website. Visit an official NPS website such as Protean eNPS or CAMS NPS.

   Step 2: Verify Your Identity (KYC)Select the option “New Registration” and complete KYC using your Aadhaar, PAN card or DigiLocker through OTP verification.

   Step 3: Select Your Plan Register yourself under the plan NPS Swasthya and choose your investment manager (PFM).

   Step 4: Select Health Insurance Coverage. Select your own health insurance coverage in rupees (₹1 Lakh, ₹5 Lakh, ₹10 Lakh, or ₹30 Lakh) for yourself and family (your spouse and 2 children).

   Step 5: Enter Nominee & Family Details. Enter the basic information and ID proofs of the nominees and your covered family members.

   Step 6: Make payment online through UPI, Debit Card, or Net Banking:

   Health insurance premium, one-time registration fee of ₹200, and your investment amount of at least ₹1,000

   Step 7: Digital Sign and Complete Registration. Complete the registration process digitally with your Aadhaar OTP. You will immediately receive your PRAN and welcome kit.

2. Through Offline Mode

   Step 1: Visit a Bank or NPS Centre

   Visit one of the NPS bank branches or centres (also referred to as Point of Presence).

   Step 2: Fill out the Forms

   Request and complete two forms, both of which are available in paper form:

   • The NPS Swasthya Registration Form
   • Super Top-up Health Insurance Form

   Step 3: Attach Copies of Your Documentation

   Attach the following documents in self-attested format:

   • Identity and Address Proofs
   • PAN card
   • Copy of Bank Account (e.g., DD or passbook)
   • Age Proof (for spouse and children who come under coverage)

   Step 4: Make the First Deposit

   Make the payment for the registration and investment amount in the form of a cheque/ DD.

   Step 5: Receive Your Acknowledgement Receipt

   Get an acknowledgement receipt from the officer. This receipt will help you keep track of the application and registration process.

Support and Contact Information

Other Government Schemes

• Ayushman Bharat PM-JAY is a centrally sponsored scheme that offers coverage of up to ₹5 lakh per family per year for secondary and tertiary care hospitalisation.
• Rashtriya Arogya Nidhi: provides a financial coverage to BPL families of up to ₹15 lakh to ₹20 lakh for life-threatening illnesses
• Central Government Health Scheme (CGHS)is a health insurance plan for government employees, pensioners, Members of Parliament, and eligible dependents.
• Employee State Health Insurance Scheme: provides medical coverage for organised sector employees earning up to ₹21,000 per month.
• Pradhan Mantri Suraksha Bima Yojana (PMSBY) is an accidental death and disability Insurance cover that offers coverage of up to ₹2 lakh.