Pennsylvania § 4705 - Policy disclosures.

§ 4705. Policy disclosures.

(a) Information.--A pet insurer shall clearly and conspicuously disclose, in accordance with subsection (b), the following information to an insured or a prospective insured in a pet insurance policy:

(1) Whether the pet insurance policy excludes coverage due to any of the following:

(i) A preexisting condition.

(ii) A hereditary disorder.

(iii) A congenital anomaly or disorder.

(iv) A chronic condition.

(2) If the pet insurance 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 limitation of coverage through a waiting period or affiliation period.

(4) Any deductible or coinsurance.

(5) The annual or lifetime policy limit of the pet insurance policy, if any.

(6) Whether the pet insurer will reduce coverage or increase premiums based on the insured's claim history, the age of the covered pet or a change in the geographic location of the insured.

(7) The name of the underwriting company if it differs from the brand name used to market and sell the product.

(8) A summary description of the basis or formula on which the pet insurer determines claim payments under the pet insurance policy.

(9) If a pet insurer uses a benefit schedule to determine claim payment under the pet insurance policy:

(i) The applicable benefit schedule in the pet insurance policy.

(ii) All benefit schedules used by the pet insurer under its pet insurance policies.

(10) If a pet insurer 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:

(i) The usual and customary fee limitation provision in the pet insurance 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.

(ii) The pet insurer's basis for determining usual and customary fees.

(11) If any medical examination by a veterinarian is required to effectuate coverage, the required aspects of the examination and a statement that the examination documentation may result in a preexisting condition exclusion.

(12) Clear and prominent disclosure of waiting periods, if any, and requirements applicable to them.

(b) Methods of disclosure.--

(1) A pet insurer shall prepare a separate document in at least 12-point type that contains the information specified under subsection (a) and in section 4704 (relating to right to examine and return pet insurance policy), which shall be titled "Insurer Disclosure of Important Policy Provisions." The following apply:

(i) The pet insurer shall post the document through a clear and conspicuous link on the main page of the publicly accessible Internet website of the pet insurer or pet insurer's program administrator.

(ii) The pet insurer shall provide the insured a copy of the document upon issuance or delivery of the pet insurance policy.

(2) A pet insurer shall disclose the information required under subsection (a)(8), (9) and (10) in the language of the pet insurance policy itself.

(3) A pet insurer shall disclose the information required under subsection (a)(8), (11) and (12) prior to the issuance of the pet insurance policy.

(4) The information specified under subsection (a)(8), (9) and (10) shall be posted through a clear and conspicuous link on the main page of the publicly accessible Internet website of the pet insurer or pet insurer's program administrator.

(c) Additional information.--At the time that a pet insurance policy is issued or delivered to an insured, the pet insurer shall include a written disclosure with the following information, printed in 12-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) If the pet insurance policy was issued or delivered by an agent or broker, a statement advising the insured to contact the broker or agent for assistance.

(d) Other requirements.--The disclosures required in this section shall be in addition to any other disclosure requirements required by law or regulation.

Cross References. Section 4705 is referred to in section 4706 of this title.