§ 44-6505 — Disclosures, requirements; rights of applicant

Nebraska § 44-6505

• Jurisdiction: Nebraska
• Ch. 44: Insurance

Text

(1) A pet insurer transacting pet insurance shall disclose to consumers:
(a) If the policy excludes coverage due to:
(i) A preexisting condition;
(ii) A hereditary condition;
(iii) A congenital anomaly or disorder; or
(iv) A chronic condition;
(b) If the policy includes any other exclusions and if so, the pet insurer shall include a statement substantially similar to the following:
Other exclusions may apply. Please refer to the exclusions section of the policy for more information;
(c) Any policy provision that limits coverage through a waiting or affiliation period, a deductible, coinsurance, or an annual or lifetime policy limit;
(d) 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; and
(e) If the underwriting company differs from the brand name used to market and sell the product.
(2)(a) Unless the insured has filed a claim under the pet insurance policy, a pet insurance applicant has the right to examine and return the policy, certificate, or rider to the pet insurer or insurance producer within thirty days from its date of receipt and to have the premium refunded if, after examination of the policy, certificate, or rider, the applicant is not satisfied for any reason.
(b) A pet insurance policy, certificate, or rider shall have a notice prominently printed on the first page or attached thereto, including specific instructions to accomplish a return, and shall include a statement substantially similar to the following:
You have up to thirty days from the day you receive this policy, certificate, or rider to review it and return it to the pet insurer if you decide not to keep it. You do not have to tell the pet insurer why you are returning it. If you decide not to keep it, simply return it to the pet insurer at the insurer's administrative office or you may return it to the insurance producer that you bought it from as long as you have not filed a claim. You must return it within thirty days after the day you first received it. The pet insurer will refund the full amount of any premium paid within thirty days after the pet insurer 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.
(3) A pet insurer shall clearly disclose a summary description of the basis or formula on which the pet insurer determines claim payments 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 website of the pet insurer or pet insurer's program administrator.
(4) A pet insurer that uses a benefit schedule to determine claim payment under a pet insurance policy shall:
(a) Clearly disclose the applicable benefit schedule in the policy; and
(b) Disclose all benefit schedules used by the pet insurer under its pet insurance policies through a clear and conspicuous link on the main page of the website of the pet insurer or pet insurer's program administrator.
(5) 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 expenses, shall:
(a) 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 claim payments; and
(b) Disclose the pet insurer's basis for determining usual and customary fees through a clear and conspicuous link on the main page of the website of the pet insurer or pet insurer's program administrator.
(6) If any medical examination by a 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.
(7) Waiting periods and the requirements applicable to them shall be clearly and prominently disclosed to consumers prior to policy purchase.
(8)(a) The pet insurer shall include a summary of all policy provisions required in subsections (1) through (7) of this section in a separate document titled Insurer Disclosure of Important Policy Provisions.
(b) The pet insurer shall:
(i) Provide the consumer with a copy of the Insurer Disclosure of Important Policy Provisions document in at least twelve-point bold type; and
(ii) Post the Insurer Disclosure of Important Policy Provisions document through a clear and conspicuous link on the main page of the website of the pet insurer or pet insurer's program administrator.
(9) At the time a pet insurance policy is issued or delivered to a policyholder, the pet insurer shall include a written disclosure with the following information printed in twelve-point bold type:
(a) The mailing address, toll-free telephone number, and website of the Department of Insurance;
(b) The mailing address and customer service telephone number of the pet insurer or insurance producer of record; and
(c) If the policy was issued or delivered by an insurance producer, a statement advising the policyholder to contact the insurance producer for assistance.
(10) The disclosures required by this section shall be in addition to any other disclosure requirements required by law or rule and regulation.

Legislative History

Source: Laws 2023, LB296, § 5.