§ 7154. Disclosures
(a) A pet insurer transacting pet insurance shall disclose 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; or
(D) a chronic condition.
(2) If the policy includes any other exclusions, the following statement: “Other exclusions
may apply. Please refer to the exclusions section of the policy for more information.”
(3) Any policy provision that 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) If 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, pet insurance
applicants shall have 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
following 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) Pet insurance policies, certificates, and riders shall have a notice prominently printed
on the first page or attached thereto including specific instructions to accomplish
a return. The following free-look statement, or substantially similar language, shall
be included:
You have 30 days following 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, provided you have not filed a
claim. You must return it within 30 days following the day you first received it.
The company will refund the full amount of any premium paid within 30 days following
the day 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.
(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 either the pet insurer or the pet insurer’s program administrator.
(4) A pet insurer that uses a benefit schedule to determine claim payment under a pet
insurance policy shall do the following:
(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 either the
pet insurer or the 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 service provider charges, shall do the following:
(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 either the pet insurer
or the pet insurer’s program administrator.
(6) If any 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.
(7) Waiting periods and the requirements applicable to them must be clearly and prominently
disclosed to consumers prior to the policy purchase.
(8) The pet insurer shall include a summary of all policy provisions required in subdivisions
(1)–(7) of this subsection in a separate document entitled “Insurer Disclosure of
Important Policy Provisions.”
(9) The pet insurer shall post the “Insurer Disclosure of Important Policy Provisions”
document required in subdivision (8) of this subsection through a clear and conspicuous
link on the main page of the website of either the pet insurer or the pet insurer’s
program administrator.
(10) 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 pursuant to subdivision (8) of this subsection in at least 12-point
type when it delivers the policy.
(11) 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 12-point boldface type:
(A) the Department of Financial Regulation’s mailing address, toll-free telephone number,
and website address;
(B) the address and customer service telephone number of the pet insurer or the agent
or broker of record; and
(C) if the policy was issued or delivered by an agent or broker, a statement advising
the policyholder to contact the broker or agent for assistance.
(12) The disclosures required in this section shall be in addition to any other disclosure
requirements required by law or rule. (Added 2023, No. 110 (Adj. Sess.), § 28, eff. July 1, 2025.)