Relating to pet insurance and pet wellness programs

This bill relates to pet insurance policies and wellness programs. The bill applies to pet insurance policies (policies) that are delivered, issued for delivery, renewed, sold, solicited, negotiated, or offered in this state. Prior to entering into a contract for pet insurance, an insurer shall disclose to a person whether the policy excludes coverage due to a preexisting condition, a hereditary disorder, a congenital anomaly or disorder, a chronic condition, or any other exclusions. Prior to entering into a contract for pet insurance, an insurer shall also disclose to a person any waiting period required by the policy and any limitation on coverage during a waiting period. In addition, the insurer must disclose whether the pet insurer reduces coverage or increases premiums based on the policyholder’s claim history, the age of the covered pet, or a change in the geographic location of the policyholder, and whether the underwriting company differs from the brand name used to market and sell the pet insurance product. “Chronic condition”, “congenital anomaly or disorder”, “hereditary disorder”, “insurer”, “pet insurance”, “preexisting condition”, and “waiting period” are defined in the bill. Under the bill, unless a pet insurance policyholder has filed a claim under a policy, the policyholder shall maintain the right to examine and return the policy to the insurer within 15 days of receipt, and to have the policyholder’s premium refunded if the policyholder is not satisfied for any reason. A policy shall contain a notice that includes specific instructions to complete a return, and any refund issued to a policyholder shall be paid within 30 days after the insurer receives the returned policy. The bill requires an insurer to clearly disclose prior to issuance of a policy, and on the insurer’s internet site, a summary description of the basis or formula on which the insurer determines claim payments under the policy. An insurer shall also disclose within a policy, and on the insurer’s internet site, a benefit schedule if the insurer uses a benefit schedule to determine claim payments under a policy, and a usual and customary fee limitation provision if the insurer determines claim payments under a policy based on usual and customary fees or any other reimbursement limitation based on prevailing veterinary service provider charges. The bill requires an insurer to clearly disclose whether a medical examination by a veterinarian is required for coverage under a policy, the required aspects of the examination, and whether documentation from the examination may result in a preexisting condition exclusion. A pet insurer shall include a summary of all disclosures required by the bill in a separate document that is provided to all policyholders upon issuance of a policy, and that may be accessed on the main page of the insurer’s internet site. At the time a pet insurance policy is delivered or issued for delivery, an insurer shall provide a written disclosure to the policyholder that contains the mailing address, telephone number, and internet site of the department of insurance and financial services, the address and customer service telephone number of the insurer or of the agent or broker of record, and, if the policy is issued or delivered by an agent or broker, a statement advising the policyholder to contact the agent or broker for assistance. Under the bill, an insurer may issue a policy that excludes coverage on the basis of a preexisting condition provided that the insurer complies with the disclosure requirements. The bill prohibits an insurer from issuing a policy that imposes a waiting period that exceeds 30 calendar days for illnesses or orthopedic conditions not resulting from an accident, or any waiting period for accidents. If an insurer issues a pet insurance policy that imposes a waiting period, the insurer shall include a provision in the pet insurance policy allowing for waiver of the waiting period upon completion of a medical examination pursuant to the requirements in the bill. The bill prohibits an insurer from requiring a veterinary examination of a pet covered under a policy as a condition for the renewal of the policy. The bill requires any prescriptive, wellness, or noninsurance benefits included in a policy to comply with all state insurance laws. The bill prohibits an insurer from requiring a person to participate, or not to participate, in a wellness program as a prerequisite to purchasing a policy. “Wellness program” is defined in the bill. The bill prohibits an insurer from marketing a wellness program as pet insurance, or marketing a wellness program during the sale, solicitation, or negotiation of pet insurance. A wellness program sold by an insurer shall keep the costs associated with the wellness program separate and identifiable from any policy sold by the insurer, the terms and conditions for the wellness program shall be separate from any policy sold by the insurer, the products or coverages available through the wellness program shall not duplicate products or coverages available through a policy, and the advertising of the wellness program shall not be misleading as to the nature of the wellness program. An insurer that engages in the sale of a wellness program shall clearly disclose to a person prior to purchasing the wellness program a statement that a wellness program is not an insurance policy, the mailing address, telephone number, and internet site of the department of insurance and financial services, the address and customer service telephone number of the insurer or of the agent or broker of record, and a disclosure that coverages included in the pet insurance contract that are described as wellness shall be considered insurance. The bill prohibits an insurance producer from selling, soliciting, or negotiating a pet insurance product until after the insurance producer is licensed as an insurance producer and has completed training as required by the bill. “Insurance producer” is defined in the bill. An insurer shall require that insurance producers are trained according to the requirements detailed in the bill, and require that they have also been trained on the coverages and conditions of the insurer’s policies. The commissioner of insurance may adopt rules to administer the bill.