NPS Swasthya Pension Scheme: Check Eligibility, Pensioners Benefits, Medical Claim Rules, Fees & Withdrawals

Good news has arrived for pensioners as the Pension Fund Regulatory and Development Authority (PFRDA) rolled out the second proof of concept (PoC) of 'NPS Swasthya' which is aimed at easing pensioners in withdrawing their corpus for medical expenses.

What Is NPS Swasthya Pension Scheme?

The scheme is rolled out as a Proof of Concept ('PoC') on a limited and controlled basis under the Regulatory Sandbox Framework. This was done after examining the feasibility of integrating health-related benefit mechanisms with the existing NPS architecture.

How The Scheme Works?

The scheme is introduced for a specific sector scheme under the NPS, intended exclusively to provide financial support for out-patient and in-patient medical expenses, within the framework of the Multiple Scheme Framework ('MSF').

The scheme works strictly as a Proof of Concept, for a limited duration and shall operate in a controlled environment under the Regulatory Sandbox Framework.

PFRDA has directed that PFs may also collaborate with FinTechs and other such entities for carrying out such PoC. For the purpose of this PoC, provisions of PFRDA (Exits and Withdrawals under NPS) Regulations, 2015 have been relaxed under Regulatory Sandbox Framework.

NPS Swasthya Pension Scheme Eligibility:

The scheme is available for all Indian citizens. However, they must have a common scheme account with NPS. If you do not have an NPS account and want to apply for this pension scheme, then one such account will be opened mandatorily.

PFRDA said, "Any Citizen of India is eligible for joining the NPS Swasthya Pension Scheme. A Common Scheme Account shall mandatorily be opened along with the NPS Swasthya Pension Scheme Account, if not already available."

NPS Swasthya Pension Scheme Fees & Charges:

Fees and charges applicable under the Scheme shall be governed by the MSF and shall be disclosed transparently. Such charges shall include charges payable to the HBA.

NPS Swasthya Pension Scheme Contributions:

Subscribers shall be permitted to contribute any amount to the NPS Swasthya Pension Scheme, in accordance with the extant guidelines applicable to the Non-Government Sector under NPS.

NPS Swasthya Pension Scheme Transfer of Contributions from Common Scheme Account:

Subscribers (excluding subscribers under Government Sector and Government-owned Corporates), aged above 40 (forty) years shall be permitted to transfer up to 30% (thirty percent) of their self and/or employee contributions from the Common Scheme Account to the NPS. Swasthya Pension Scheme Account.

NPS Swasthya Pension Scheme Partial Withdrawals for Medical Expenses:

Subscribers shall be permitted to make partial withdrawals from their NPS Swasthya Pension Scheme Account to meet outpatient or inpatient medical expenses as and when such expenses arise. At any instance, withdrawal shall be permitted up to 25% (twenty-five percent) of the subscriber's own contributions made to the Scheme, in accordance with the provisions of the PFRDA Act, 2013.

There shall be no restriction on the number of partial withdrawals and no minimum waiting period shall apply, provided that the first partial withdrawal shall be permitted only after accumulation of a minimum corpus of ₹50,000 under the Scheme.

NPS Swasthya Pension Scheme Premature Exit for Critical Medical Treatment:

In case of inpatient medical treatment where medical expenses in a single instance exceed 70% (seventy percent) of the total corpus available in the subscriber's NPS Swasthya Pension Scheme Account, the subscriber shall be permitted to undertake a premature exit with 100% (one hundred percent) lump sum, irrespective of the corpus size, solely for meeting such medical expenses.

NPS Swasthya Pension Scheme Settlement of Claims:

Amounts withdrawn or exited shall be remitted directly to the concerned HBA/TPA, as applicable, based on valid claims and supporting invoices. Any surplus amount remaining after settlement of medical expenses shall be transferred to the subscriber's Common Scheme Account.

NPS Swasthya Pension Scheme Exit in Other Cases:

In all other cases, exit provisions applicable to All Citizens under NPS, including normal and premature exit, shall apply upon transfer of the accumulated amount from the NPS Swasthya Pension Scheme Account to the Common Scheme Account.