NPS Swasthya: ₹1 lakh to ₹30 lakh — Check health insurance cover, deductibles the scheme likely provides

The Pension Fund Regulatory and Development Authority’s new health-focused pension product, the NPS Swasthya, is expected to launch in October, as per reports. Speaking to reporters at an event in Mumbai on Thursday, 10 September, PFRDA Chairman Sivasubramanian Ramann had also told reporters the authority is likely to launch the product within 30 days — sometime in October.

He said that guidelines could be expected before the formal launch, as testing under proof of concept (PoC) received encouraging response. “We are working on it (NPS Swasthya). The PoC worked very well… a very encouraging response that has led us to finalise the product,” he stated.

Ramann added that the Central Recordkeeping Agencies (CRAs) are working on the technology required for the product and the formal launch could be expected “hopefully in about 30 days’ time”, i.e. mid-October.

Last week Outlook Money cited sources to report that NPS Swasthya is due for formal launch on 1 October.

What is NPS Swasthya? Policy explained

Developed in the PFRDA’s regulatory sandbox framework, the PoC tested how healthcare benefits could be integrated with the National Pension System (NPS) architecture.

Explaining how the product would work, Ramann said payment mechanism for the proposed product would work directly between the pension account, insurer and hospital. “What is important in the NPS Swasthya is my ability to pay money to the hospital directly. So, from the pension account, money will release and go directly to the hospital. Then the health benefit administrator, through the insurance company, will release the top-up insurance, which will go to the hospital,” he explained.

• The minimum initial contribution has three components:

– First-year health insurance premium, including applicable taxes.

– ₹200 annual maintenance charge, plus applicable taxes.

– At least ₹1,000 towards the NPS Swasthya investment account. The minimum subsequent contribution is ₹10.

The insurance premium is not a fixed amount under the guidelines. It will be determined by the insurer based on the applicable insurance framework and the subscriber’s age group.

What health insurance cover does NPS Swasthya provide?

The standard super top-up policy will offer family-floater coverage with four deductible and sum-insured combinations:

• ₹10,000 deductible (what you pay annually towards the policy) – ₹1 lakh cover (for eligible expenses)
• ₹50,000 deductible – ₹5 lakh cover
• ₹1 lakh deductible – ₹10 lakh cover
• ₹3 lakh deductible – ₹30 lakh cover

Healthcare expenses to be covered by the scheme include inpatient hospitalisation, eligible day-care procedures, domiciliary hospitalisation, AYUSH treatment, prescribed modern treatments, and organ-donor medical expenses, subject to the final policy terms.

Disclaimer: This is purely for educational and informational purposes and should not be construed as investment advice. Please visit the official website for the latest updates.