(a) A pet insurer transacting pet insurance shall disclose all of the following to consumers:
(1) If the policy excludes coverage due to any of the following:
a. A preexisting condition.
b. A hereditary disorder.
c. A congenital anomaly or disorder.
d. A chronic condition.
(2) If the policy includes an exclusion other than those in paragraph (a)(1) of this section, the following statement: “Other exclusions may apply. Please refer to the exclusions section of the policy for more information.”
(3) A policy provision that limits coverage through a waiting period or affiliation period, or a deductible, coinsurance, or an annual or lifetime policy limit.
(4) If the pet insurer reduces coverage or increases premiums based on the insured’s claim history, the age of the covered pet, or a change in the geographic location of the insured.
(5) If the underwriting company differs from the brand name used to market and sell the product.
(b)Right to examine and return policy. —(1) Unless the insured has filed a claim under a pet insurance policy, a pet insurance applicant has the right to examine and return the policy, certificate, or rider to the company or an agent or insurance producer of the company within 30 days of its receipt and to have the premium refunded if, after examination of the policy, certificate, or rider, the applicant is not satisfied for any reason.
(2) A pet insurance policy, certificate, or rider must have a notice prominently printed on or attached to the first page and include specific instruction to accomplish a return. The following free look statement or language substantially similar must be included:
“You have 30 days from the day you receive this policy, certificate, or rider to review it and return it to the company if you decide not to keep it. You do not have to tell the company why you are returning it. If you decide not to keep it, simply return it to the company at its administrative office or you may return it to the agent or insurance producer that you bought it from as long as you have not filed a claim. You must return it within 30 days of the day you first received it. The company will refund the full amount of any premium paid within 30 days after it receives the returned policy, certificate, or rider. The premium refund will be sent directly to the person who paid it. The policy, certificate or rider will be void as if it had never been issued.”
(c) A pet insurer shall clearly disclose a summary description of the basis or formula on which the pet insurer determines a claim payment under a pet insurance policy within the policy, prior to policy issuance and through a clear and conspicuous link on the main page of the pet insurer or pet insurer’s program administrator’s website.
(d) A pet insurer that uses a benefit schedule to determine claim payment under a pet insurance policy shall do all of the following:
(1) Clearly disclose the applicable benefit scheduled in the policy.
(2) Disclose each benefit schedule that the pet insurer used under its pet insurance policy through a clear and conspicuous link on the main page of the pet insurer or pet insurer’s program administrator’s website.
(e) A pet insurer that determines a claim payment under a pet insurance policy based on usual and customary fees, or another reimbursement limitation based on prevailing veterinary service provider charges, shall do all of the following:
(1) Include a usual and customary fee limitation provision in the policy that clearly describes the pet insurer’s basis for determining usual and customary fees and how that basis is applied in calculating a claim payment.
(2) Disclose the pet insurer’s basis for determining usual and customary fees through a clear and conspicuous link on the main page of the pet insurer or pet insurer’s program administrator’s website.
(f) If a medical examination by a licensed veterinarian is required to effectuate coverage, the pet insurer shall clearly and conspicuously disclose the required aspects of the examination prior to purchase and disclose that examination documentation may result in a preexisting condition exclusion.
(g) A waiting period, and a requirement applicable to a waiting period, must be clearly and prominently disclosed to consumers prior to the policy purchase.
(h) A pet insurer shall include a summary of each policy provision required under subsections (a) through (g) of this section, inclusive, in a separate document titled “Insurer Disclosure of Important Policy Provisions.”
(i) A pet insurer shall post the “Insurer Disclosure of Important Policy Provisions” document required under subsection (h) of this section through a clear and conspicuous link on the main page of the pet insurer or pet insurer’s program administrator’s website.
(j) In connection with the issuance of a new pet insurance policy, the pet insurer shall provide the consumer with a copy of the “Insurer Disclosure of Important Policy Provisions” document required under subsection (h) of this section in at least 12-point type when the pet insurer delivers the policy.
(k) At the time a pet insurance policy is issued or delivered to a policyholder, the pet insurer shall include a written disclosure with all of the following information, printed in 12-point boldface type:
(1) The Department of Insurance’s mailing address, toll-free telephone number, and website address.
(2) The address and customer service telephone number of the pet insurer or the agent or broker of record.
(3) If the policy was issued or delivered by an agent or broker, a statement advising the policyholder to contact the agent or broker for assistance.
(l) The disclosure required under this section is in addition to another disclosure requirement required by law or regulation.