Pension Fund Regulatory and Development Authority (PFRDA) Releases Operational Guidelines for NPS Swasthya Scheme Combining Pension with Health Cover

Key facts

• The Pension Fund Regulatory and Development Authority (PFRDA) has issued detailed operational guidelines for NPS Swasthya, a retirement pension scheme with health insurance coverage.
• Anyone eligible to join NPS can enrol in NPS Swasthya; individuals aged 18 to 70 can join, with renewal permitted up to 85 years of age.
• The scheme has a dual structure comprising an NPS Swasthya Investment account and a separate mandatory super top-up health insurance policy, offered by pension funds through Irdai-registered insurers under a master policy arrangement.
• The family floater covers the subscriber, spouse, and up to two dependent children, excluding parents, with four deductible tiers: Rs 10,000 for Rs 1 lakh cover, Rs 50,000 for Rs 5 lakh, Rs 1 lakh for Rs 10 lakh, and Rs 3 lakh for Rs 30 lakh sum insured.
• The minimum initial contribution includes the first-year insurance premium, an annual health benefit administrator maintenance charge of Rs 200 plus taxes, and at least Rs 1,000 for investment; subsequent contributions can be as low as Rs 10.
• Subscribers can make partial withdrawals of up to 25 per cent of total contributions for OPD and IPD treatments, with no minimum waiting period, and payments are settled directly with healthcare providers.
• NPS Swasthya fund investments follow the Central Government Scheme investment pattern, and pension funds may levy up to 0.08 per cent per annum as asset management fee.
• Mandated service timelines include cashless pre-authorisation within 1 hour, final discharge authorisation within 3 hours, and platform uptime of at least 99.5 per cent monthly.
• PFRDA prohibits pension funds from receiving insurance commissions, claim-linked payments, or premium shares, and restricts health data from being used for profiling, marketing, or provider steering.