STATE OF NEW YORK
________________________________________________________________________
8276
2023-2024 Regular Sessions
IN ASSEMBLY
November 27, 2023
___________
Introduced by M. of A. HUNTER -- read once and referred to the Committee
on Insurance
AN ACT to amend the insurance law, in relation to providing for the
issuance of pet insurance
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Paragraph 34 of subsection (a) of section 1113 of the
2 insurance law, as renumbered by chapter 359 of the laws of 2021, is
3 renumbered paragraph 35 and a new paragraph 34 is added to read as
4 follows:
5 (34) "Pet insurance" shall have the same meaning as defined by subdi-
6 vision (a) of section three thousand four hundred sixty-two of this
7 chapter.
8 § 2. The insurance law is amended by adding a new section 3462 to read
9 as follows:
10 § 3462. Pet insurance. (a) As used in this section, the following
11 terms shall have the following meanings:
12 (1) "Chronic condition" means a condition that can be treated or
13 managed, but not cured.
14 (2) "Congenital anomaly or disorder" means a condition that is present
15 from birth, whether inherited or caused by the environment, which may
16 cause or contribute to illness or disease.
17 (3) "Hereditary disorder" means an abnormality that is genetically
18 transmitted from parent to offspring and may cause illness or disease.
19 (4) "Orthopedic" refers to conditions affecting the bones, skeletal
20 muscle, cartilage, tendons, ligaments, and joints. It includes, but is
21 not limited to, elbow dysplasia, hip dysplasia, intervertebral disc
22 degeneration, patellar luxation, and ruptured cranial cruciate liga-
23 ments. It does not include cancers or metabolic, hemopoietic, or auto-
24 immune diseases.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD13446-02-3
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1 (5) "Pet insurance" means a property insurance policy that provides
2 coverage for accidents and illnesses of pets.
3 (6) "Preexisting condition" means any condition for which any of the
4 following are true prior to the effective date of a pet insurance policy
5 or during any waiting period:
6 (A) A veterinarian provided medical advice;
7 (B) The pet received previous treatment; or
8 (C) Based on information from verifiable sources, the pet had signs or
9 symptoms directly related to the condition for which a claim is being
10 made.
11 A condition for which coverage is afforded on a policy shall not be
12 considered a preexisting condition on any renewal of the policy.
13 (7) "Renewal" means to issue and deliver at the end of an insurance
14 policy period a policy which supersedes a policy previously issued and
15 delivered by the same insurer or affiliated insurer and which provides
16 types and limits of coverage substantially similar to those contained in
17 the policy being superseded.
18 (8) "Veterinarian" means an individual who holds a valid license to
19 practice veterinary medicine under article one hundred thirty-five of
20 the education law.
21 (9) "Veterinary expenses" means the costs associated with medical
22 advice, diagnosis, care, or treatment provided by a veterinarian,
23 including, but not limited to, the cost of drugs prescribed by a veteri-
24 narian.
25 (10) "Waiting period" means the period of time specified in a pet
26 insurance policy that is required to transpire before some or all of the
27 coverage in the policy can begin. Waiting periods shall not be applied
28 to renewals of existing coverage.
29 (11) "Wellness program" means a subscription or reimbursement-based
30 program that is separate from an insurance policy that provides goods
31 and services to promote the general health, safety, or wellbeing of the
32 pet. If any wellness program requires an agreement or other transaction
33 whereby an insurer is obligated to confer a benefit of pecuniary value
34 upon another party, dependent upon the happening of a fortuitous event
35 in which the insured or beneficiary has, or is expected to have at the
36 time of such happening, a material interest which will be adversely
37 affected by the happening of such event, it is transacting in the busi-
38 ness of insurance and is subject to the provisions of this chapter. This
39 definition is not intended to classify a contract directly between a
40 service provider and a pet owner that only involves the two parties as
41 being the business of insurance, unless other indications of insurance
42 also exist.
43 (b) If an insurer uses any of the terms in subsection (a) of this
44 section in a policy of pet insurance, the insurer shall use the defi-
45 nition of each of those terms as set forth in such subsection and
46 include the definition of the terms in the policy. The insurer shall
47 also make the definitions available through a clear and conspicuous link
48 on the main page of the insurer or insurer's program administrator's
49 website. Nothing in this section shall in any way prohibit or limit the
50 types of exclusions insurers may use in their policies or require insur-
51 ers to have any of the limitations or exclusions defined in this
52 section.
53 (c) (1) An insurer transacting pet insurance shall disclose the
54 following to consumers:
55 (A) If the policy excludes coverage due to any of the following:
56 (i) A preexisting condition;
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1 (ii) A hereditary disorder;
2 (iii) A congenital anomaly or disorder; or
3 (iv) A chronic condition.
4 (B) If the policy includes any other exclusions, the following state-
5 ment: "Other exclusions may apply. Please refer to the exclusions
6 section of the policy for more information."
7 (C) Any policy provision that limits coverage through a waiting or
8 affiliation period, a deductible, coinsurance, or an annual or lifetime
9 policy limit.
10 (D) Whether the insurer reduces coverage or increases premiums based
11 on the insured's claim history, the age of the covered pet or a change
12 in the geographic location of the insured.
13 (E) If the underwriting company differs from the brand name used to
14 market and sell the product.
15 (2) (A) Unless the insured has filed a claim under the pet insurance
16 policy, pet insurance applicants shall have the right to examine and
17 return the policy, certificate or rider to the company or an
18 agent/insurance producer of the company within thirty days of its
19 receipt and to have the premium refunded if, after examination of the
20 policy, certificate or rider, the applicant is not satisfied for any
21 reason.
22 (B) Pet insurance policies, certificates and riders shall have a
23 notice prominently printed on the first page or attached thereto includ-
24 ing specific instructions to accomplish a return. The following free
25 look statement or language substantially similar shall be included:
26 "You have 30 days from the day you receive this policy, certificate or
27 rider to review it and return it to the company if you decide not to
28 keep it. You do not have to tell the company why you are returning it.
29 If you decide not to keep it, simply return it to the company at its
30 administrative office or you may return it to the agent/insurance
31 producer that you bought it from as long as you have not filed a claim.
32 You must return it within 30 days of the day you first received it. The
33 company will refund the full amount of any premium paid within 30 days
34 after it receives the returned policy, certificate, or rider. The premi-
35 um refund will be sent directly to the person who paid it. The policy,
36 certificate or rider will be void as if it had never been issued."
37 (3) An insurer shall clearly disclose a summary description of the
38 basis or formula on which the insurer determines claim payments under a
39 pet insurance policy within the policy, prior to policy issuance and
40 through a clear and conspicuous link on the main page of the insurer or
41 insurer's program administrator's website.
42 (4) An insurer that uses a benefit schedule to determine claim payment
43 under a pet insurance policy shall do both of the following:
44 (A) Clearly disclose the applicable benefit schedule in the policy.
45 (B) Disclose all benefit schedules used by the insurer under its pet
46 insurance policies through a clear and conspicuous link on the main page
47 of the insurer or insurer's program administrator's website.
48 (5) An insurer that determines claim payments under a pet insurance
49 policy based on usual and customary fees, or any other reimbursement
50 limitation based on prevailing veterinary service provider charges,
51 shall do both of the following:
52 (A) Include a usual and customary fee limitation provision in the
53 policy that clearly describes the insurer's basis for determining usual
54 and customary fees and how that basis is applied in calculating claim
55 payments.
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1 (B) Disclose the insurer's basis for determining usual and customary
2 fees through a clear and conspicuous link on the main page of the insur-
3 er or insurer's program administrator's website.
4 (6) If any medical examination by a licensed veterinarian is required
5 to effectuate coverage, the insurer shall clearly and conspicuously
6 disclose the required aspects of the examination prior to purchase and
7 disclose that examination documentation may result in a preexisting
8 condition exclusion.
9 (7) Waiting periods and the requirements applicable to them shall be
10 clearly and prominently disclosed to consumers prior to the policy
11 purchase.
12 (8) The insurer shall include a summary of all policy provisions
13 required in paragraphs one through seven of this subsection, inclusive,
14 in a separate document titled "Insurer Disclosure of Important Policy
15 Provisions."
16 (9) The insurer shall post the "Insurer Disclosure of Important Policy
17 Provisions" document required in paragraph eight of this subsection
18 through a clear and conspicuous link on the main page of the insurer or
19 insurer's program administrator's website.
20 (10) In connection with the issuance of a new pet insurance policy,
21 the insurer shall provide the consumer with a copy of the "Insurer
22 Disclosure of Important Policy Provisions" document required pursuant to
23 paragraph eight of this subsection in at least twelve-point type when it
24 delivers the policy.
25 (11) At the time a pet insurance policy is issued or delivered to a
26 policyholder, the insurer shall include a written disclosure with the
27 following information, printed in twelve-point boldface type:
28 (A) The department's mailing address, toll-free telephone number and
29 website address.
30 (B) The address and customer service telephone number of the insurer
31 or the agent or broker of record.
32 (C) If the policy was issued or delivered by an agent or broker, a
33 statement advising the policyholder to contact the broker or agent for
34 assistance.
35 (12) The disclosures required in this section shall be in addition to
36 any other disclosure requirements required by law or regulation.
37 (d) (1) An insurer may issue policies that exclude coverage on the
38 basis of one or more preexisting conditions with appropriate disclosure
39 to the consumer. The insurer has the burden of proving that the preex-
40 isting condition exclusion applies to the condition for which a claim is
41 being made.
42 (2) (A) An insurer may issue policies that impose waiting periods upon
43 effectuation of the policy that do not exceed thirty days for illnesses
44 or orthopedic conditions not resulting from an accident. Waiting periods
45 for accidents are prohibited.
46 (B) A pet insurer utilizing a waiting period permitted in subparagraph
47 (A) of this paragraph shall include a provision in its contract that
48 allows the waiting periods to be waived upon completion of a medical
49 examination. Insurers may require the examination to be conducted by a
50 licensed veterinarian after the purchase of the policy.
51 (C) A medical examination under subparagraph (B) of this paragraph
52 shall be paid for by the policyholder, unless the policy specifies that
53 the insurer will pay for the examination.
54 (D) An insurer may specify elements to be included as part of the
55 examination and require documentation thereof, provided the specifica-
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1 tions do not unreasonably restrict a consumer's ability to waive the
2 waiting periods prescribed in subparagraph (B) of this paragraph.
3 (E) Waiting periods, and the requirements applicable to them, shall be
4 clearly and prominently disclosed to consumers prior to the policy
5 purchase.
6 (3) An insurer shall not require a veterinary examination of the
7 covered pet for the insured to have their policy renewed.
8 (4) If an insurer includes any prescriptive, wellness, or non-insu-
9 rance benefits in the policy form, then it is made part of the policy
10 contract and shall follow all applicable laws and regulations under this
11 chapter.
12 (5) An insured's eligibility to purchase a pet insurance policy shall
13 not be based on participation, or lack of participation, in a separate
14 wellness program.
15 (e) (1) No insurer or insurance producer shall market a wellness
16 program as pet insurance.
17 (2) If a wellness program is sold by an insurer or insurance producer:
18 (A) The purchase of the wellness program shall not be a requirement to
19 the purchase of pet insurance.
20 (B) The costs of the wellness program shall be separate and identifi-
21 able from any pet insurance policy sold by an insurer or insurance
22 producer.
23 (C) The terms and conditions for the wellness program shall be sepa-
24 rate from any pet insurance policy sold by an insurer or insurance
25 producer.
26 (D) The products or coverages available through the wellness program
27 shall not duplicate products or coverages available through the pet
28 insurance policy; and
29 (E) The advertising of the wellness program shall not be misleading
30 and shall comply with the provisions of paragraph two of subsection (c)
31 of this section.
32 (F) An insurer or insurance producer shall clearly disclose the
33 following to consumers, printed in twelve-point boldface type:
34 (i) That wellness programs are not insurance.
35 (ii) The address and customer service telephone number of the pet
36 insurer or producer or broker of record.
37 (iii) The department's mailing address, toll-free telephone number,
38 and website address.
39 (3) Coverages included in a pet insurance policy contract described as
40 "wellness" benefits are insurance.
41 (f) (1) An insurance producer shall not sell, solicit, or negotiate a
42 pet insurance product until after the producer is appropriately licensed
43 and has completed the required training identified in paragraph three of
44 this subsection.
45 (2) Insurers shall ensure that its producers are trained under para-
46 graph three of this subsection and that its producers have been appro-
47 priately trained on the coverages and conditions of its pet insurance
48 products.
49 (3) The training required under this subsection shall include informa-
50 tion on the following topics:
51 (A) preexisting conditions and waiting periods;
52 (B) the differences between pet insurance and noninsurance wellness
53 programs;
54 (C) hereditary disorders, congenital anomalies or disorders and chron-
55 ic conditions and how pet insurance policies interact with those condi-
56 tions or disorders; and
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1 (D) rating, underwriting, renewal and other related administrative
2 topics.
3 (4) The satisfaction of the training requirements of another state
4 that are substantially similar to the provisions of paragraph three of
5 this subsection as determined by the superintendent shall be deemed to
6 satisfy the training requirements of this subsection.
7 (g) The superintendent shall promulgate any rules and regulations
8 necessary for the implementation of this section.
9 (h) All other applicable provisions of this chapter shall continue to
10 apply to pet insurance except that the specific provisions of this
11 section shall supersede any general provision of law that would other-
12 wise be applicable to pet insurance.
13 § 3. This act shall take effect on the one hundred eightieth day after
14 it shall have become a law and shall apply to all policies entered into,
15 renewed, modified or amended on or after such effective date. Effective
16 immediately, the addition, amendment and/or repeal of any rule or regu-
17 lation necessary for the implementation of this act on its effective
18 date are authorized to be made and completed on or before such effective
19 date.
