Who Can Join?
The NPS Swasthya Pension Scheme is open to every citizen of India, offering a proactive approach to managing future medical costs. To participate, individuals
must establish a Common Scheme Account if they don't already possess one. This foundational account is a prerequisite for enrolling in the Swasthya Pension Scheme. The Pension Fund Regulatory and Development Authority (PFRDA) has introduced this as a specialized offering under the National Pension System (NPS) umbrella, specifically designed to assist with both outpatient and inpatient medical expenditures. It operates within the broader Multiple Scheme Framework (MSF).
Costs and Contributions
Understanding the financial aspects is key. The fees and charges associated with the NPS Swasthya Pension Scheme are dictated by the MSF guidelines and are presented transparently to subscribers. These include various operational costs, such as those payable to the healthcare benefit administrator (HBA). Subscribers have the flexibility to contribute any amount they wish to their Swasthya Pension Scheme account, adhering to the existing regulations applicable to the non-government sector within the NPS framework. This allows for a personalized contribution strategy based on individual financial planning and anticipated medical needs.
Investing Your Funds
Once contributions are made to the NPS Swasthya Pension Scheme, these funds are meticulously managed and invested by the Pension Funds (PFs). This investment process strictly follows the established investment guidelines set forth under the Multiple Scheme Framework (MSF). For individuals over the age of 40, there's a provision to transfer a portion of their existing contributions from their Common Scheme Account to their NPS Swasthya Pension Scheme Account. This transfer is permitted up to 30% of their self-contributions and/or employee contributions, providing an opportunity to bolster their medical expense fund.
Accessing Funds: Partial Withdrawals
A significant benefit of the NPS Swasthya Pension Scheme is the ability to access funds for medical needs. Subscribers can make partial withdrawals from their scheme account to cover both outpatient and inpatient medical expenses as they arise. Each withdrawal is capped at 25% of the subscriber's own contributions made to the scheme, following the PFRDA Act, 2013 provisions. There are no limits on the number of partial withdrawals allowed, nor is there a mandatory waiting period. However, the very first withdrawal requires a minimum accumulated corpus of ₹50,000 in the scheme.
Critical Illness Exit
In dire medical circumstances, the scheme offers a critical exit option. If a subscriber requires inpatient medical treatment where the expenses in a single instance surpass 70% of their total accumulated corpus within the NPS Swasthya Pension Scheme Account, they can opt for a premature exit. This allows for a 100% lump-sum withdrawal of the entire corpus, regardless of its size, specifically to meet these substantial medical costs. This provision ensures that critical health emergencies do not become insurmountable financial burdens.
Claim Settlement Process
The process for settling claims from the NPS Swasthya Pension Scheme is designed for efficiency. Funds withdrawn or funds from an exit are directly transferred to the relevant healthcare benefit administrator (HBA) or third-party administrator (TPA), based on validated claims and submitted invoices. Should there be any remaining funds after all medical expenses have been settled, this surplus amount is then transferred back to the subscriber's Common Scheme Account. This ensures that all funds are accounted for and managed appropriately.
Normal Exit and Grievances
For situations other than specific medical needs, the general exit provisions applicable to all NPS citizens apply. This includes both normal and premature exits, with the accumulated amount from the NPS Swasthya Pension Scheme Account being transferred to the Common Scheme Account. Furthermore, to address any subscriber concerns, Pension Funds, in collaboration with HBAs/TPAs, are mandated to establish a comprehensive grievance redressal mechanism. The Pension Funds hold the ultimate responsibility for resolving these issues, with Central Recordkeeping Agencies (CRAs) providing essential subscriber data to facilitate this.
Data Privacy and Consent
Protecting subscriber data is paramount. Essential subscriber information required for processing claims will be shared with the HBA/TPA or hospital as necessary. Crucially, in adherence to the Digital Personal Data Protection Act 2023, explicit digital consent will be secured from each subscriber. This consent will be obtained by the Pension Fund or CRA at the point when the NPS Swasthya Pension Scheme is activated, ensuring transparency and compliance with data protection regulations.
