{"id":2202,"title":"ADDITION OF NON-MEDICAL EXPENSES COVER (RIDER) AND WAIVER OF ROOM CAPPING : PROPOSAL FORM","purpose":"proposal","insurer":{"slug":"bajaj-general-insurance","name":"Bajaj General Insurance Limited"},"source_pdf":"https://www.bajajgeneralinsurance.com/download-documents/health-insurance/Non-Medical-Expenses-Rider/Non-Medical-Expenses-Cover_Proposal-Form.pdf","sha256":"5930cdde739f879f0a5e26605aab5696171a4391184d6a14958cd2231d8d7797","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is for proposing the addition of Non-Medical Expenses Cover (Rider) and Waiver of Room Capping to an existing health insurance policy. It is filled by the proposer (policyholder).","notes":["Answer all questions in BLOCK letters","Liability of the Company starts only after acceptance of this form and payment of premium","Form is basis of subsequent policy issued","Non-medical expenses cover applicable for Sum Insured 5 Lacs and above","Waiver of Room Capping applicable only to Health Guard Policy with Sum Insured 5 Lac and 7.5 Lac","If opted, covers apply to all family members meeting Sum Insured eligibility","Keep policy contact details updated for faster service","Use original renewal notice as attachment"],"title":"ADDITION OF NON-MEDICAL EXPENSES COVER (RIDER) AND WAIVER OF ROOM CAPPING : PROPOSAL FORM","submit":{"to":"","how":"","address":""},"purpose":"proposal","sections":[{"title":"Proposer Details","fields":[{"help":"List your existing policy names","type":"text","label":"Existing Policy/icies:","options":[],"required":null,"pdf_field":""},{"help":"Provide your existing policy numbers","type":"text","label":"Existing Policy Number(s):","options":[],"required":null,"pdf_field":""},{"help":"Fill columns: Full Name (Title, First Name, Middle Name, Surname), Policy No. 1, Policy No. 2, Policy No. 3, Member Name, Relationship with Proposer, Please specify the illness details with symptoms, Non-medical Expenses cover opted (Yes/No), Treatment details with treating Doctor details, Waiver of Room Capping (Yes/No), Date first treated, Any Pre-existing disease/disability (Yes/No), Current Status of the Illness/Diseases/Injury","type":"table","label":"Member Wise details: Please provide details in the below table if you have any existing disease/disability","options":[],"required":null,"pdf_field":""},{"help":"Enter the place where you are filling the form","type":"text","label":"Place:","options":[],"required":null,"pdf_field":""},{"help":"Enter the date of filling the form","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""},{"help":"Enter your telephone number","type":"phone","label":"Tel.","options":[],"required":null,"pdf_field":""},{"help":"Enter your mobile number","type":"phone","label":"Mobile","options":[],"required":null,"pdf_field":""},{"help":"Enter your email address","type":"email","label":"Email","options":[],"required":null,"pdf_field":""},{"help":"Select Yes or No","type":"choice","label":"Is your  name mentioned above as per your Aadhaar Card? :","options":["YES","NO"],"required":null,"pdf_field":""},{"help":"Write your name exactly as per Aadhaar Card if different","type":"text","label":"If No, Please mention the Name as per Aadhaar Card","options":[],"required":null,"pdf_field":""},{"help":"Sign the form","type":"signature","label":"Signature of Proposer","options":[],"required":null,"pdf_field":""}],"filled_by":"proposer"},{"title":"Declarations – Physical Proposal Form","fields":[{"help":"Select Yes or No and provide details if Yes","type":"choice","label":"Are you or any of the proposal applicants a PEP* or a close relative of PEP*? If yes, please share the details","options":["Yes","No"],"required":null,"pdf_field":""},{"help":"Consent for KYC verification","type":"yes-no","label":"I/we hereby give my/our consent to the Company to verify and obtain my/our identity/address proof through CERSAI records or National Securities Depository Limited Portal for the purpose of undertaking KYC verification.","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Confirm source of premium payment","type":"yes-no","label":"I/we hereby declare and confirm that the premium has been paid out of legally acquired sources of income and the subsequent premiums if any, will continue to be paid out of legally declared and assessed source of income.","options":["Yes","No"],"required":true,"pdf_field":""},{"help":"Consent to share personal information","type":"yes-no","label":"I/We hereby give voluntary consent to Bajaj General/Company to share my/our personal information and data provided in this proposal form with its group companies or any other person in connection with the Insurance Policy or otherwise, including for providing products and services of group companies that may be of interest to me/us, to be used in accordance with their respective privacy policies and subject to appropriate measures being in place to safeguard my/our personal information.","options":["Yes","No"],"required":null,"pdf_field":""}],"filled_by":"proposer"}],"deadlines":[],"applies_to":"Non-medical expenses cover can be opted with any product with Base Sum Insured 5 Lac and above; Waiver of Room Capping can be opted with Health Guard Policy only with Base Sum Insured 5 Lac and 7.5 Lac","attachments":["renewal notice"],"declarations":["Consent to KYC verification through CERSAI or NSDL portal","Declaration that premium is paid from legally acquired sources","Consent to share personal information with group companies and others as per privacy policies"],"dropped_labels":0},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"customer-care","channel":"email","value":"careforyou@bajajgeneral.com","label":"Customer Service Email","level":null,"hours":null,"applies_to":"all","source_url":"https://www.bajajgeneralinsurance.com/forms/form-online-grievance.html","quote":"in a new tab\nBajaj General Insurance Limited\nTollfree: For sales :\n1800-209-0144\nFor service :\n1800-209-5858\nEmail id:\ncareforyou@bajajgeneral.com\nFor senior citizens:\nseniorcitizen@bajajgeneral.com\nFor senior citizens:\n1800-209-5858\nFax no:\n020-30512246\nRegistered","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"1800-209-5858","label":"Service Toll Free Number","level":null,"hours":null,"applies_to":"all","source_url":"https://www.bajajgeneralinsurance.com/forms/form-online-grievance.html","quote":"Careers\nBecome\n                                An Agent\nAwards\nUpdate KYC\nMY ABHA\nBuy Policy:\n1800-209-0144\n| Service:\n1800-209-5858\nService Chat:\n+91 75074 25858\nInsure\nHealth Insurance\nIndividual Health Insurance\nFamily Health Insurance\nInternational","fetched_at":"2026-10-20"},{"purpose":"customer-care","channel":"phone","value":"1800-209-0144","label":"Sales Toll Free Number","level":null,"hours":null,"applies_to":"all","source_url":"https://www.bajajgeneralinsurance.com/forms/form-online-grievance.html","quote":"nsurance\nSupport\nAbout Us\nCareers\nBecome\n                                An Agent\nAwards\nUpdate KYC\nMY ABHA\nBuy Policy:\n1800-209-0144\n| Service:\n1800-209-5858\nService Chat:\n+91 75074 25858\nInsure\nHealth Insurance\nIndividual Health Insurance\nFamily Healt","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"1800-209-5858","label":"Customer Service Toll Free Number","level":1,"hours":null,"applies_to":"all","source_url":"https://www.bajajgeneralinsurance.com/about-us/customer-service.html","quote":"ted servicing team to help you meet your service needs.\nCustomer Service - We're Here to Help\nDial our Toll Free Number\n1800-209-5858\nEmail us on\ncareforyou@bajajgeneral.com\nToll free No. Intermediary\n1800-209-7073\nBOING BOT\nConnect with us on BOING Cha","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"email","value":"ggro@bajajgeneral.com","label":"Grievance Redressal Officer Email Mr. Jerome Vincent","level":2,"hours":null,"applies_to":"all","source_url":"https://www.bajajgeneralinsurance.com/about-us/customer-service.html","quote":"fied with the response given to you by our team, you may write to our Grievance Redressal Officer Mr. Jerome Vincent at\nggro@bajajgeneral.com\nLevel 3\nHead Customer Service\nif you are still not satisfied with the solutions provided, or have some feedback for us,","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"phone","value":"1800-209-7073","label":"Toll free No. Intermediary","level":null,"hours":null,"applies_to":"all","source_url":"https://www.bajajgeneralinsurance.com/about-us/customer-service.html","quote":"Here to Help\nDial our Toll Free Number\n1800-209-5858\nEmail us on\ncareforyou@bajajgeneral.com\nToll free No. Intermediary\n1800-209-7073\nBOING BOT\nConnect with us on BOING Chatbot\nConnect with us on WhatsApp +91 7507425858\nFor Support\nBajaj General App\nPle","fetched_at":"2026-10-20"},{"purpose":"grievance","channel":"whatsapp","value":"+91 7507425858","label":"BOING WhatsApp Chatbot","level":null,"hours":"24x7","applies_to":"all","source_url":"https://www.bajajgeneralinsurance.com/about-us/customer-service.html","quote":"ral.com\nToll free No. Intermediary\n1800-209-7073\nBOING BOT\nConnect with us on BOING Chatbot\nConnect with us on WhatsApp +91 7507425858\nFor Support\nBajaj General App\nPlease scan and download\nMissed Call Facility\nMissed Call - 80809 45060 Short code - SMS","fetched_at":"2026-10-20"}],"how_to_use":"Ask the user for each field in order, in plain words; never invent an answer. Labels are as printed. If fillable_pdf is true, pdf_fields gives the PDF's own field names so the file can be filled directly. The printed form decides if anything differs.","url":"https://indiainsurances.com/forms/bajaj-general-insurance/2202-addition-of-non-medical-expenses-cover-rider-and-waiver-of-room-capping-proposal"}