Operational Guidelines for NPS Swasthya under the National Pension System

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CIRCULAR

Circular No. PFRDA/2026/49/NPS-SWASTHYA/01 September 18, 2026

To,

• i. Registered intermediaries of PFRDA
• ii. Health Benefit Administrators (‘HBAs’)
• iii. Association of NPS Intermediaries (‘ANPI’)
• iv. All other NPS Stakeholders

Madam / Sir,

Subject: Operational Guidelines for NPS Swasthya under the National Pension System (NPS), 2026

1. In exercise of the powers conferred under Section 14 of the Pension Fund Regulatory and Development Authority Act, 2013 read with Regulation 4A of the Pension Fund Regulatory and Development Authority (Exits and Withdrawals under the National Pension System) Regulations, 2015 and all other enabling provisions, the Pension Fund Regulatory and Development Authority (hereinafter referred to as ‘Authority’) hereby issues the “Operational Guidelines for NPS Swasthya under the National Pension System (NPS), 2026”, attached with this Circular.

2. These Guidelines shall apply to all registered intermediaries of PFRDA, HBAs and ANPI. Every PF shall ensure that HBA and insurer engaged by it for implementation of NPS Swasthya complies with the applicable provisions of these Guidelines.

3. All concerned intermediaries shall take necessary steps to ensure compliance with the provisions of the Guidelines attached to this Circular and shall establish appropriate systems, processes and controls for effective implementation of NPS Swasthya.

4. The Authority may issue clarifications, operational instructions or directions, from time to time, for the effective implementation of these Guidelines.

5. This Circular shall come into force with immediate effect.

6. The circular is made available on the PFRDA website (www.pfrda.org.in) in the Circular section under the regulatory framework.

Yours faithfully,

Sumit Kumar 2026.09.18 16:57:04 +05'30' Chief General Manager

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ई – 500, टावर – ई, पाचवाां तल, वर्ल्ड टरेड सेंटर, नौरोजी नगर, नई दिल्ली – 110 029
िू रभाष: 91 – 11 – 40717900, वेबसाइट: www.pfrda.org.in
E – 500, Tower – E, Fifth Floor, World Trade Center, Nauroji Nagar, New Delhi – 110 029
Phone: 91 – 11 – 40717900, Website: www.pfrda.org.in
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INDEX

CHAPTER I – PRELIMINARY............................................................................................... 4

1. Short title and commencement ...................................................................................... 4
2. Applicability ................................................................................................................... 4
3. Definitions...................................................................................................................... 4
   CHAPTER II – NPS SWASTHYA FRAMEWORK ................................................................. 6
4. Eligibility and Account Structure .................................................................................... 6
5. Contributions ................................................................................................................. 6
6. Investment..................................................................................................................... 6
7. Fees and Charges......................................................................................................... 7
8. Partial Withdrawals........................................................................................................ 7
9. Transfer from an existing NPS Scheme under All Citizen Model.................................... 7
10. Change of NPS Swasthya scheme.............................................................................. 8
11. Closure of NPS Swasthya Account.............................................................................. 8
12. Premature Exit............................................................................................................. 8
13. Normal Exit and Exit due to Death............................................................................... 9
14. Non-availability of funds to renew insurance................................................................ 9
15. Nomination .................................................................................................................. 9
16. Existing NPS Swasthya Subscribers under Regulatory Sandbox................................. 9
    CHAPTER III – PENSION FUND (PF) ................................................................................ 10
17. Governance of NPS Swasthya .................................................................................. 10
18. Responsibilities of PF ................................................................................................ 10
19. Engagement of HBA.................................................................................................. 11
20. Supervision and Oversight of HBA............................................................................. 11
    CHAPTER IV – HEALTH BENEFIT ADMINISTRATOR (HBA)............................................ 12
21. Empanelment of HBA ................................................................................................ 12
22. Eligibility Criteria........................................................................................................ 12
23. Empanelment Process............................................................................................... 13

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24. Engagement Agreement and Service Level Standards.............................................. 14
25. Core Responsibilities of HBA..................................................................................... 15
26. Monitoring, Review and Corrective Action ................................................................. 16
27. Suspension, Termination and Orderly Transition ....................................................... 16
28. Compliance with Directions........................................................................................ 17
    CHAPTER V – INSURANCE POLICY................................................................................. 17
29. Insurance Policy ........................................................................................................ 17
30. Standard Insurance Policy......................................................................................... 18
31. Insurance Premium ................................................................................................... 21
    CHAPTER VI – CENTRAL RECORDKEEPING AGENCY (CRA), TRUSTEE BANK AND POINT OF PRESENCE (PoP) ............................................................................................ 22
32. Responsibilities of CRA ............................................................................................. 22
33. Responsibilities of Trustee Bank................................................................................ 23
34. Responsibilities of Point of Presence......................................................................... 23
    CHAPTER VII – TECHNOLOGY, SUBSCRIBER DISCLOSURE AND GRIEVANCE REDRESSAL ...................................................................................................................... 23
35. Technology and Operational Framework ................................................................... 23
36. Disclosures................................................................................................................ 24
37. Grievance Redressal ................................................................................................. 25
    CHAPTER VIII – REPORTING, COMPLIANCE AND REGULATORY POWERS................ 25
38. Regulatory Reporting................................................................................................. 25
39. Compliance ............................................................................................................... 26
40. Power to Call for Information ..................................................................................... 26
41. Power to Issue Directions and Interpretation ............................................................. 27

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“NPS Swasthya seeks to enable subscribers to build a dedicated corpus for meeting retirement expenses while facilitating access to health insurance and healthcare-related services through the ecosystem established under NPS architecture. The Scheme provides greater flexibility for healthcare-related withdrawals and specified exit options to enable subscribers to meet eligible healthcare expenses in an efficient and timely manner.”

CHAPTER I – PRELIMINARY

1. Short title and commencement

1.1. These Guidelines may be called the “Operational Guidelines for NPS Swasthya under the National Pension System (NPS), 2026”.

1.2. These Guidelines are issued under Regulation 4A of the Pension Fund Regulatory and Development Authority (Exits and Withdrawals under the National Pension System) Regulations, 2015, and shall come into force from the date specified by the Authority through a circular.

2. Applicability

2.1. These Guidelines shall apply to registered intermediaries of PFRDA participating in NPS Swasthya and shall also apply to the Association of NPS Intermediaries (ANPI) and Health Benefit Administrators (HBAs).

2.2. An insurer and its Third Party Administrator (TPA) shall participate in NPS Swasthya for the purpose of super top-up insurance policy in accordance with the applicable insurance law. Their registration, insurance conduct, product terms, premium, underwriting, policy issuance, claims and insurance related grievances shall remain governed by Insurance Regulatory and Development Authority of India (IRDAI).

2.3. Nothing contained in these Guidelines shall be construed as authorising any entity to undertake insurance solicitation, distribution, underwriting, policy issuance, claim adjudication, TPA activity or any other insurance activity without the registration, permission or appointment required under applicable insurance law.

3. Definitions

Unless the context otherwise requires:

3.1. “Act” means the Pension Fund Regulatory and Development Authority Act, 2013.

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3.2. “Eligible Healthcare Expense” means a healthcare expense permitted to be met from the NPS Swasthya corpus under these Guidelines, irrespective of whether the expense is admissible under the Insurance Policy.

3.3. “Health Benefit Administrator” or “HBA” means an entity empanelled by ANPI and engaged by a PF to perform pension-side technology, account-administration, authorization-coordination, recordkeeping, subscriber-interface functions, healthcare technology platform services under NPS Swasthya in accordance with these Guidelines. An HBA is not, by reason of such empanelment, an insurer, TPA or insurance intermediary.

3.4. “Insurer” means an entity registered with the IRDAI and engaged by a PF for NPS Swasthya.

3.5. “Insurance Policy” means a super top-up health insurance policy provided by an insurer engaged by PF under master policy arrangement in respect of NPS Swasthya.

3.6. “NPS Swasthya” means the pension scheme for a specific purpose introduced under Regulation 4A of the Pension Fund Regulatory and Development Authority (Exits and Withdrawals under the National Pension System) Regulations, 2015, to facilitate retirement savings together with such healthcare benefits and insurance policy as may be specified under these Guidelines.

3.7. “NPS Swasthya Corpus” means the net asset value of units outstanding in the NPS Swasthya account of a subscriber.

3.8. “Super Top-up insurance” means a supplementary insurance plan that covers total yearly medical expenses once a deductible threshold is crossed. It considers the total medical costs incurred in a policy year, not just individual claims.

3.9. “Third Party Administrator” or “TPA” means an entity appointed by the insurer in accordance with applicable insurance law.

3.10. Words and expressions used but not defined in these Guidelines shall have the meanings assigned to them under the Act, the regulations framed thereunder and the circulars, guidelines or directions issued by the Authority. Insurance expressions shall, where relevant, have the meanings assigned under applicable insurance law and the Insurance Policy.