Aditya Birla Health Insurance (ABHI) has detailed the premiums, coverage and terms of its NPS Swasthya Top-Up Benefit, a group health insurance policy for NPS Swasthya subscribers offered through Axis Bank.
Annual premiums, including GST, range from ₹1,732 to ₹29,743, depending on the age of the insured members, family size and sum insured.
The policy is part of the NPS Swasthya framework governed by operational guidelines issued by the Pension Fund Regulatory and Development Authority (PFRDA).
Here is a look at the costs, coverage, withdrawal rules and conditions subscribers should know.
What is NPS Swasthya?
The framework combines a dedicated National Pension System (NPS) investment account with a separate super top-up health insurance policy. It lets subscribers build a retirement corpus, hold health insurance and use part of the corpus for eligible healthcare expenses. The two components remain legally and operationally separate, and the insurance is governed by applicable insurance laws and regulations.
What does it cost to join?
The minimum initial contribution has three components:
the first-year insurance premium, including taxes; ₹200 plus taxes as the annual maintenance charge payable to the Health Benefit Administrator (HBA); and at least ₹1,000 invested in the NPS Swasthya account.
The minimum subsequent contribution is ₹10. Contributions are invested according to the pattern prescribed for the Central Government Scheme.
Also read: Nine months on, NPS can invest in private funds, but only 1% of its money, says report
The account attracts the charges applicable to the NPS All Citizen Model. A pension fund may also levy up to 0.08% a year of the corpus, plus taxes. Charges must be disclosed before enrolment and whenever they change.
How do withdrawals work?
Subscribers can make partial withdrawals for eligible healthcare expenses, including specified outpatient and inpatient costs. The amount cannot exceed 25% of contributions to the account.
There is no limit on the number of withdrawals and no minimum waiting period for the first or any later one.
The money is not paid to the subscriber. It is settled with the hospital, healthcare provider or other eligible entity. Subscribers can also move money from an existing All Citizen Model account into NPS Swasthya, but only to the extent needed to meet the insurance deductible.
What does the ABHI plan cover?
The family-floater policy covers the subscriber, spouse and up to two dependent children. Parents are not covered. Subscriber and spouse must be aged 18 to 70, and children 91 days to 25 years. Plan options range from one adult to two adults and two children.
Also read: NPS Diwas 2026: Why NPS is no longer just a tax-saving product
There are four combinations of annual aggregate deductible and sum insured:
| Annual aggregate deductible | Family-floater sum insured |
| ₹10,000 | ₹1 lakh |
| ₹50,000 | ₹5 lakh |
| ₹1 lakh | ₹10 lakh |
| ₹3 lakh | ₹30 lakh |
The deductible applies cumulatively to expenses of all covered family members in the policy year, not to each claim.
Covered items include a single private room, ICU at actuals, day-care procedures, domiciliary hospitalisation and AYUSH treatment. The plan also covers modern treatments, mental illness and HIV. Pre-hospitalisation cover is for 30 days and post-hospitalisation for 60 days. Road ambulance costs are covered up to ₹2,500 in an emergency.
The plan also offers five GP tele-consultations a year and a Wellness Saver Card with up to 60% off on pharmacy and nutraceutical products.
How are premiums set?
The cheapest option in the brochure is ₹1,732 a year, for a single adult aged 18–40 with ₹30 lakh cover. The costliest is ₹29,743, for two adults and two children aged 61–70 with ₹5 lakh cover. A single adult aged 61–70 pays between ₹4,953 and ₹12,876, depending on the option.
In every family type and age band, the ₹30 lakh option has the lowest premium and the ₹5 lakh option the highest. Premiums are revised annually.
Waiting periods and health declaration
A 30-day initial waiting period applies, except for accidents as provided in the final policy. Pre-existing diseases and specified diseases or procedures carry a 12-month wait. Controlled Type 2 diabetes, hypertension, hyperlipidaemia and asthma are covered after the initial waiting period, provided they do not trigger enhanced underwriting.
A Good Health Declaration (GHD) is mandatory for all members, and the policy is issued subject to a clean declaration. If a proposal is declined, the subscriber must be told the specific reason. A decline for one member does not by itself disqualify the others. A 30-day free-look period applies, and the policy is valid only for Indian citizens.
Renewal and exit
The policy must start no later than T+1 working days after enrolment and receipt of the minimum initial contribution. Subscribers can switch NPS Swasthya schemes at renewal, which may change both the pension fund and the insurer. A change of insurer initiated by a pension fund must be made without a break in cover.
If the corpus may fall short of the renewal premium, the pension fund must, where practicable, alert the subscriber 90, 60 and 30 days before renewal. If cover lapses after the grace period, the account is closed and the balance moved to the All Citizen Model account.
Premature exit is also allowed where a single eligible inpatient expense exceeds what the partial-withdrawal limit permits. The corpus can first be used towards that expense, and the rest moved to the All Citizen Model account.
Also read: NPS Swasthya guidelines out: Health cover, withdrawals and charges explained
NOTE TO READERS
Disclaimer: This article is for informational purposes only and should not be construed as investment advice. Readers should consult certified experts before making any investment decisions.