Electronic Proposal Form – Health

Agent Portal:

Agents can login to the system using their user Id and password. In the Home screen there will be three
icons corresponding to the three electronic proposal forms named as – Individual Health E-Proposal
Form, Family Medicare E-Proposal Form, Arogya Sanjeevani E-proposal Form.

Agent portal Login and Home Screen:

Next the agent can initiate any of the 3 e-proposal forms by clicking on the respective icon. The
proposal form will be opened in a new window.

E-Proposal Form Opened in a new window – First screen – the instruction pop up

At first, there will be an instruction popup stating all the required documents and information that the
user needs to be ready with while filling up this proposal form.

At the top of the form there are some important instructions and some useful links for the user.
Some useful links for User:

Now the Agent will select who is going to fill the proposal form. There are two options: Customer and
Intermediary.

“Please select who will fill up the proposal form” - Agent selects option “Customer”
It implies that customer will fill up the proposal form.

Agent only initiates it, fills up the very basic information like: Proposer Name, Proposer mobile
number and email address, intermediary declaration. And then the agent can send the proposal form as
a link/URL to the customer for his/her action, by clicking the “Send To Customer” button.

Proposer Details Section

Declaration from Intermediary Section:

After clicking the “Send To Customer” button, one transaction id will be generated against this
proposal form and the proposal form will be sent as a URL/link to the email address of the proposer so
that the proposer can proceed with filling up the form.

Transaction ID generated:

The proposer will receive the following email containing the URL of the proposal form initiated by the
agent.
Email to the proposer:

On browsing this link, the proposal form will open at the customer end containing only the name of the
proposer, mobile number and email address, that is filled by the agent before sending it to the proposer.
These 3 fields and the intermediary section will be non-editable at customer end.
E-Proposal form opened at the proposer's end:

Proposer Name, Mobile and Email auto populated and disabled:

Declaration from Intermediary auto populated and disabled:

Now the proposer can proceed to fill up this form sequentially section wise.
“Please select who will fill up the proposal form” - Agent selects option “Intermediary”

It implies that the agent will fill up the proposal form on behalf of the customer. And then the agent will
send the completely filled in proposal form to the customer as a link/URL to the proposer's email
address, by clicking the “Send To Customer” button. One transaction id will be generated against this
proposal form.
Transaction ID generated:

The proposer will receive the following email containing the URL of the proposal form initiated and
completely filled by the agent.

Email to the proposer:

On browsing the URL from the above email, the filled in proposal form will be opened in non editable
mode at the proposer end. Proposer can verify all the information filled in by the agent.

Filled in proposal form opened at proposer's end in non-editable mode:

If any modification is required, proposer has to inform the agent. The agent will again initiate the
respective proposal form, fetch the details using the previously generated transaction Id, modify the
details as required by the proposer and again send the URL to proposer's email address.
Different Sections of the electronic proposal form:

Section I: Proposer Details

This section includes the basic information of the proposer.

Section II: Nomination

This section contains information of the nominee of the proposer.

Section III: Coverage Details

This sections contains information regarding policy period, TPA name, Coverage type (Individual
Basis/ Floater Basis) in case of Family Medicare and Arogya Sanjeevani policy etc.
Section IV: Insured Person Details

This section will take the number of insured persons and their respective details.

Maximum 6 insured persons is allowed only. Otherwise the following validation will come.

Validation when number of insured person > 6 :

After giving the number of insured persons, this section will take information insured wise.
Section V: Existing/Previous Insurance Policy Details

This section first asks the user if any of the insured person have any previous/existing health insurance
policy from any insurer (including UIIC) – two options are there -”YES” or “No”

If the user selects “YES”, then it will take information of the previous insurance policy insured wise.

Previous insurance details table:

And if the user selects “No”, then the above table will not appear.

Section VI: Medical Information

This section will ask the user if anyone of the insured person has any pre-existing disease. If the user
selects “No”, then all the questions will be populated with answer as “No” and all the drop downs will
remain disabled.

Medical history table:

And If the user selects “YES”, then all the drop downs will be enabled and user has to give answer
(YES/NO) to each of the medical history related question.
If the user selects “YES” to any of the medical history question, then one pop up will appear and it will
take the details for that specific illness.
Illness details pop-up:

Now the user has to provide information on the habits of the insured persons.

Habit details table:

If “YES” is selected for any of the habits, then the respective weekly consumed quantity needs to be
given as input.

Now the user needs to selects if pre policy checkup reports will be submitted for any of the insured
persons.
Pre-policy checkup reports table:
Section VII: Payment and Bank Account Details

In this section user can check the premium amount by clicking the “Check Premium” button.

Premium payment mode if “Cheque” is selected, then user has to give cheque date and cheque number
also.
Section VIII: Declaration

This section have 5 declaration statements. User has to check all the declarations before proceeding.
Other information will be auto populated.
Section IX: Vernacular Declaration

This section will only appear if the agent is filling up the proposal form on behalf of the proposer. If
proposer is filling the form by himself, then this section will not be there.

The information in this section will get auto populated based on inputs taken in previous sections
Section X: Declaration from Intermediary

This section is necessarily to be filled by the agent before sending it to the proposer.

Section XI: Statutory Warning

Section XIII: Checklist

In this section user has to upload the documents. 4 documents are mandatory (ID proof, Residence
proof, Age proof and PAN details). If anyone of the insured persons have previous insurance policy
then that document is also mandatory. If anyone of the insured person has any pre existing disease then
pre policy check up reports are also mandatory.

Annexure A – Pre-existing Disease

Those insured persons who have any pre-existing diseases, Annexure A needs to be filled mandatory.

On clicking on the button named as per the insured person, Annexure A form will open as a pop up
Annexure A Popup:
Annexure B – Health Check up Report

In this section user will upload Annexure B form filled by the physician. This will only come, if the
respective insured person has any pre-existing disease.

On clicking on the button named as per the insured person, Annexure B form will open as a pop up.

Annexure-B popup:

Annexure C:

This section is for portability form. As of now this section will be blank.
Saving the proposal:

Once the proposer verifies all the details (in case form is filled by the agent and then sent to the
proposer) or the proposer finishes filling up the form (in case the form is to be filled by the proposer),
he/she can proceed to save the proposal through OTP authentication by clicking the “Save Proposal”
button.
OTP Authentication screen:

The proposal will be saved and will go for DO underwriter approval.

From the proposal saved screen user can view the filled in proposal form in PDF format by clicking the
“Print Proposal” button.
Proposal Saved Screen:
Proposal Form PDF generated:

After saving proposal, one mail will be sent to the proposer's email address stating that the proposal has
been saved successfully. This email will contain one URL for generating the proposal form PDF in
future also.

Proposal saved mail to customer containing the URL to generate PDF:

On browsing the URL, the following page will appear.

On clicking the “Print Proposal” button, the proposal form pdf can be generated again.
Save as Draft (Intermediate Save/ Temporary Save):

While filling up the complete proposal form sequentially, the agent or the proposer can temporarily
save the data by clicking the “Save as Draft” button.

When agent is filling up the form for the proposer, one transaction Id will be generated after saving the
data temporarily.
At a later time agent can re-initiate the respective proposal form and fetch the temporarily save data
using the transaction Id and continue from where he left.
When the proposer is filling up the form, after saving the data temporarily, he/she can just browse the
same URL (received in the email) at a later time and continue from where he/she left.

Note:
The proposal form needs to be filled sequentially section wise, if any mandatory field is left blank in
any section, error pop up will come when the user tries to move to the next section.
Approval from GC:

DO underwriter can login to GC. Under approval workbench, he/she will be able to see the proposal
saved (through the e-proposal Form)

From here the DO underwriter can approve or reject the proposal.

Also DO underwriter can view all the documents – Insured signatures, photos, ID proof, address proof
of the proposer, the proposal form pdf etc, using the “view proposal form” link given there.

Premium Collection and Policy Generation:

The agent can login to the agent portal. Under “Accounting Activities” select “Pending for premium
collection – through cheque” in case payment option is selected as “cheque” while saving the proposal
form.
Pending for premium collection – through cheque:
Cheque date and cheque number will be pre populated as given while filling the proposal form. Agent
has to give other details and proceed. Policy will be generated.

Under “Accounting Activities” select “Pending for premium collection – through payment gateway” in
case payment option is selected as “payment gateway” while saving the proposal form.

Pending for premium collection – through payment gateway:

This payment link will be sent to customer. Customer can proceed with payment and policy will be
generated.

Customer Portal:

The e-proposal forms can be initiated from customer portal also. Customer can login to the portal using
the registered mobile number and OTP. Under Electronic Proposal Form – Health group, FMP or
Arogya sanjeevani proposal form can be initiated.
Now the customer can proceed to fill up the proposal form section wise and finally save the proposal
through OTP authentication as shown before.
Note:

If anyone of the insured person has any pre existing disease then the proposer will not be allowed to
save proposal from customer portal. Following error will come.

After saving the proposal, the customer can proceed for payment and policy generation by clicking the
“Make Payment” button. After successful payment policy will be generated. (No approval)