Pension Fund Regulatory and Development Authority (PFRDA) has launched the NPS Swasthya Pension Scheme.
The pension body has said that NPS Swasthya Pension Scheme shall be introduced as 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.
The Scheme shall be a contributory pension scheme, governed by the provisions of section 12(1)(a) and section 20 of the PFRDA Act and shall be offered to citizens of India on a voluntary basis.
From eligibility, charges to medical claim rules –11 key points of NPS Swasthya Pension Scheme Explained
1. Eligibility: 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.
2. Fees and 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.
3. 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.
4. Investment of contributions: Contributions under the Scheme shall be invested by the PFs in accordance with the investment guidelines prescribed under the MSF.
5. 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.
6. 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.
7. 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.
8. 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.
9. 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.
10. Grievance Redressal Mechanism: PFs, in association with the HBA/TPA, shall establish a robust grievance redressal mechanism to ensure timely and effective resolution of subscriber grievances. The responsibility for grievance resolution shall vest with the PF. CRAs shall provide necessary subscriber-level information to facilitate efficient servicing and grievance handling.
11. Data Sharing and Consent: Subscriber-level data required for claim processing shall be shared with the HBA/TPA or hospital, as applicable. In compliance with the Digital Personal Data Protection Act 2023 and rules framed thereunder, explicit digital consent shall be obtained from the subscriber by the PF or CRA at the time of activation of the NPS Swasthya Pension Scheme.
