NPS Swasthya under the National Pension System (NPS), 2026 – Operational Guidelines :Pension Fund Regulatory And Development Authority Circular dated 18-09-2026
पेंशन निधि विनियामक और विकास प्राधिकरण
PENSION FUND REGULATORY AND DEVELOPMENT AUTHORITY
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
- 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.
- 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.
- 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.
- The Authority may issue clarifications, operational instructions or directions, from time to time, for the effective implementation of these Guidelines.
- This Circular shall come into force with immediate effect.
- The circular is made available on the PFRDA website (www.pfrda.org.in) in the Circular section under the regulatory framework.
Yours faithfully,
Digitally Sd/-
Sumit Kumar
Chief General Manager
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 |
| 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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