NPS Swasthya combines a retirement investment account with a separate, mandatory super top-up health insurance policy. Under PFRDA’s operational guidelines issued on September 18, 2026, subscribers can use up to 25% of their own Swasthya contributions for eligible healthcare expenses. The withdrawal is paid to the healthcare provider, not to the subscriber. The account and insurance policy are distinct parts of the arrangement, and neither makes Swasthya simply a health insurance plan nor a substitute for reviewing your other cover.
How does NPS Swasthya work?
NPS Swasthya is a voluntary arrangement within India’s National Pension System, regulated by the Pension Fund Regulatory and Development Authority (PFRDA). It is intended to let a subscriber build a dedicated investment corpus for retirement while providing access to a separate super top-up policy and a defined route for eligible healthcare withdrawals.
Enrollment requires both a Swasthya investment account and a separate super top-up insurance policy. The policy is mandatory, but it is legally and operationally distinct from the pension account: insurance claims are governed by the policy wording and applicable insurance rules, while withdrawals from the account follow NPS Swasthya rules.
The current operational framework is the one PFRDA published on September 18, 2026, effective immediately. It supersedes the temporary regulatory-sandbox pilot arrangements; terms from those earlier pilots should not be assumed to apply to a current Swasthya scheme.
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How much can you withdraw for medical expenses?
You may make partial withdrawals for eligible outpatient or inpatient healthcare expenses, up to 25% of your own contributions to the Swasthya account. The cap is not 25% of the total account balance. PFRDA’s September 2026 guidelines set no limit on the number of withdrawals and no minimum waiting period before a first or later withdrawal.
The money is settled with the hospital, healthcare provider or other eligible entity through the prescribed process; it is not paid directly to you. The account withdrawal route is separate from an insurance claim. The guidelines also say eligible healthcare expenses not paid by insurance may be considered from the Swasthya corpus, subject to the applicable withdrawal rules.
Money transferred from another NPS All Citizen Model account into Swasthya is limited to the applicable insurance deductible. Do not treat that transfer limit as an increase to the 25% withdrawal cap on your own Swasthya contributions.
Is NPS Swasthya health insurance?
No. Swasthya is a pension arrangement that requires a separate super top-up policy as a condition of enrollment. A super top-up is supplementary insurance: under the guidelines, it responds when eligible medical expenses aggregated during a policy year cross the deductible. The account and policy have different rules, funding and payment paths.
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The standard design is a family floater for the subscriber, spouse and up to two dependent children. Parents are excluded. The stated subscriber entry-age range is 18 to 70; renewals may continue through age 85, subject to the premium, policy wording and applicable law.
Deductible and sum insured options
PFRDA’s September 2026 standard design lists these deductible and family-floater sum-insured pairings:
| Deductible | Family-floater sum insured |
|---|---|
| ₹10,000 | ₹1 lakh |
| ₹50,000 | ₹5 lakh |
| ₹1 lakh | ₹10 lakh |
| ₹3 lakh | ₹30 lakh |
The deductible is central to how a super top-up works: the policy is designed to respond after eligible expenses cross that threshold. Compare the deductible with the cover you already have and the amount you could pay yourself; a larger sum insured does not remove the deductible.
Waiting periods and policy wording
The standard design states a 30-day initial waiting period, except for accidents as specified in the final policy wording. It also states 12-month waiting periods for pre-existing diseases and specified diseases or procedures. Controlled Type 2 diabetes, hypertension, hyperlipidaemia and asthma that do not trigger enhanced underwriting are stated to be covered after the initial 12-month waiting period. The insurer’s final policy wording and applicable insurance law govern the actual cover, exclusions and claims.
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What is the minimum contribution?
For initial funding, the September 2026 guidelines require enough to cover all three components below. The insurance premium is not a single universal amount fixed by PFRDA: the insurer determines it under the IRDAI framework, with applicable taxes listed separately.
- The first-year insurance premium, including applicable taxes.
- ₹200 in annual HBA maintenance charges, plus applicable taxes. The charge is payable to the HBA through the pension fund.
- At least ₹1,000 invested in the Swasthya account.
The minimum subsequent contribution is ₹10. All charges applicable to the NPS All Citizen Model also apply. In addition, a pension fund may levy up to 0.08% per year of Swasthya assets under management for scheme management, plus applicable taxes. Charges must be disclosed before enrollment and when they change.
How is the Swasthya account invested?
Under the September 2026 framework, contributions follow the investment pattern prescribed for the Central Government Scheme under current PFRDA investment guidelines. Each pension fund maintains a separate scheme account, and PFRDA may change the applicable pattern. The specific fund’s current disclosures are therefore important when comparing options.
Investment returns are not guaranteed by the healthcare withdrawal rules. Swasthya is still an NPS investment account, so its value can change with its investments and charges; a healthcare purpose does not make the corpus equivalent to a bank deposit or an insurance benefit.
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What if a bill exceeds the partial-withdrawal amount?
For a single eligible inpatient expense that exceeds the amount permitted through partial withdrawal, a subscriber can opt for premature exit. The accumulated Swasthya corpus is first used for the eligible expense. Any balance remaining is merged into the subscriber’s NPS All Citizen Model scheme. If the subscriber has no such account, the Swasthya scheme changes into an All Citizen Model scheme.
Normal exit and death are handled under the applicable exit rules for non-government NPS subscribers.
What happens if the insurance premium is not paid at renewal?
If the pension fund considers the Swasthya balance potentially inadequate to renew the policy, it should, where practicable, alert the subscriber 90, 60 and 30 days before renewal. If the premium remains unpaid after the applicable grace period and the insurance cover lapses, the Swasthya account closes and is merged into, or converted to, an All Citizen Model NPS scheme under the prescribed process.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.Does NPS Swasthya replace health insurance?
Do not assume that it does. The arrangement includes a mandatory super top-up policy, but its deductible, covered members, exclusions and waiting periods determine how that policy works. The account’s healthcare withdrawal provision is separate and limited to the applicable rules. Before enrolling, compare the actual policy wording and premium with your existing insurance, household needs and ability to meet the deductible.
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Useful comparison points include the deductible, sum insured, premium and taxes; who is covered; exclusions and waiting periods; renewal terms; the insurer’s provider and claim process; NPS charges and investment pattern; and the 25% limit on partial withdrawals. PFRDA requires pre-enrollment disclosure, but live premiums, insurer identity, policy wording, provider lists and onboarding arrangements may vary. Check the current official disclosures and the final policy before deciding. The cited guidelines do not establish a tax treatment, so no tax deduction or tax-free withdrawal should be assumed from this description.
How the 2026 pilots differ from the current framework
NPS Swasthya began as a limited-duration regulatory-sandbox proof of concept. PFRDA’s January 27, 2026 circular described a test of healthcare-related benefits within the NPS architecture, including outpatient and inpatient expenses. On April 7, PFRDA modified terms for new PoC 2 schemes, including mandatory insurance and a ₹25,000 minimum initial contribution; schemes already operating under the earlier pilot continued on their existing terms. Those pilot conditions are not blanket rules for the September operational framework.
The first pilot included provisions such as a ₹50,000 Swasthya-corpus trigger for the first partial withdrawal and, for eligible subscribers older than 40, a transfer option involving up to 30% of self and/or employee contributions from a Common Scheme Account. Its inpatient-expense exit threshold and settlement route were also specific to that version. PoC 2 had its own premature-exit terms.
One named February 2026 pilot, ICICI PF NPS Swasthya Equity Plus, used Apollo 24|7 and selected Apollo Hospitals network locations for its healthcare path. Its ₹50,000 withdrawal trigger and reported allocation of 70%–100% equity, up to 30% debt and up to 10% money-market exposure described that named pilot, not every Swasthya offering. PFRDA’s September guidelines direct that sandbox schemes be discontinued upon implementation; existing pilot subscribers may migrate under the prescribed process or merge into an All Citizen Model scheme. Availability and migration arrangements should be confirmed with the relevant official provider.
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