§ 22:1372 — Disclosures

§1372. Disclosures
A. A pet insurer transacting pet insurance shall make all of the following disclosures
to consumers:
(1) Whether 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 any exclusions other than those in Paragraph (1) of this
Subsection, the following statement shall be included in the policy: "Other exclusions may
apply. Please refer to the exclusions section of the policy for more information."
(3) Whether any policy provision limits coverage through a waiting or affiliation
period, a deductible, coinsurance, or an annual or lifetime policy limit.
(4) Whether 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) Whether the underwriting company differs from the brand name used to market
and sell the product.
B.(1) Unless the insured has filed a claim under the pet insurance policy, a pet
insurance applicant shall have the right to examine and return the policy, certificate, or
endorsement to the company or an agent or insurance producer of the company within fifteen
days of receipt and the right to have the premium refunded if, after examination of the policy,
certificate, or endorsement, the applicant is not satisfied for any reason.
(2) A pet insurer shall include the following statement or substantially similar
language on the first page of a policy, certificate, or endorsement, or attached thereto, with
specific instructions for a policyholder to return the policy, certificate, or endorsement:
"You have fifteen days from the day you receive this policy, certificate, or
endorsement to review it and return it to the company if you decide not to keep it. You are
not required 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, if you have not filed a claim. You must return
it within fifteen days of the day you first received it, if you do not want to keep it. The
company shall refund the full amount of any premium paid within thirty days after it receives
the returned policy, certificate, or endorsement. The premium refund shall be sent directly
to the person who paid it. If returned within fifteen days of the day first received, the policy,
certificate, or endorsement will be void as if it had never been issued."
C. A pet insurer shall disclose a summary description of the basis or formula utilized
to determine claim payments under the pet insurance policy prior to policy issuance and
through a link on the pet insurer's website main page or the pet insurer's program
administrator's website main page.
D. A pet insurer that uses a benefit schedule to determine claim payments under a
pet insurance policy shall do both of the following:
(1) Disclose the applicable benefit schedule in the policy.
(2) Disclose all benefit schedules used by the pet insurer under its pet insurance
policies through a link on the pet insurer's website main page or the pet insurer's program
administrator's website main page.
E. A pet insurer that determines claim payments under a pet insurance policy based
on usual and customary fees, or any other reimbursement limitation based on prevailing
veterinary service provider charges, shall do both of the following:
(1) Include a usual and customary fee limitation provision in the policy that describes
the pet insurer's methodology for determining usual and customary fees and an explanation
as to how the methodology is applied in calculating claim payments.
(2) Disclose the pet insurer's methodology for determining usual and customary fees
through a link on the pet insurer's website main page or the pet insurer's program
administrator's website main page.
F. If a medical examination by a licensed veterinarian is required to effectuate
coverage, the pet insurer shall disclose the required aspects of the examination prior to
purchase and disclose that examination documentation may result in a preexisting condition
exclusion.
G. The pet insurer shall disclose to consumers the waiting periods and applicable
requirements prior to a consumer's purchase of a policy.
H. The pet insurer shall include in pet insurance policies a summary of all
disclosures required in Subsections A through G of this Section in a separate document titled
"Insurer Disclosure of Important Policy Provisions."
I. The pet insurer shall provide a copy of the "Insurer Disclosure of Important Policy
Provisions" document provided for in Subsection H of this Section through a link on the pet
insurer's website main page or the pet insurer's program administrator's website main page.
J. Upon issuance or delivery of a new pet insurance policy, the pet insurer shall
provide the policyholder with a copy of the "Insurer Disclosure of Important Policy
Provisions" document provided for in Subsection H of this Section in at least twelve-point
type.
K. Upon issuance or delivery of a pet insurance policy to a policyholder, the pet
insurer shall include a written disclosure with the following information, printed in
twelve-point boldface type:
(1) The department'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) A statement advising the policyholder to contact the broker or agent for
assistance if the policy was issued or delivered by an agent or broker.
L. The disclosures required pursuant to this Section shall be in addition to any other
disclosures required by law, rule, or regulation.

Legislative History

Acts 2023, No. 94, §1, eff. Jan. 1, 2024.