Chapter 422 |
2025 -- S 0649 SUBSTITUTE A Enacted 07/02/2025 |
A N A C T |
RELATING TO INSURANCE -- PET INSURANCE ACT |
Introduced By: Senators Bissaillon, Raptakis, Britto, and Dimitri |
Date Introduced: March 07, 2025 |
It is enacted by the General Assembly as follows: |
SECTION 1. Title 27 of the General Laws entitled "INSURANCE" is hereby amended by |
adding thereto the following chapter: |
CHAPTER 83 |
PET INSURANCE ACT |
27-83-1. Scope and purpose. |
(a) The purpose of this chapter is to promote the public welfare by creating a |
comprehensive legal framework within which pet insurance may be sold in this state. |
(b) The requirements of this chapter shall apply to pet insurance policies that are issued to |
any resident of this state and are sold, solicited, negotiated, or offered in this state, and policies or |
certificates that are delivered or issued for delivery in this state. |
(c) All other applicable provisions of this state’s insurance laws shall continue to apply to |
pet insurance except that the specific provisions of this chapter shall supersede any general |
provisions of law that would otherwise be applicable to pet insurance. |
27-83-2. Definitions. |
(a) If a pet insurer uses any of the terms in this chapter in a policy of pet insurance, the pet |
insurer shall use the definition of each of those terms as set forth herein and include the definition |
of the term(s) in the policy. The pet insurer shall also make the definition available through a clear |
and conspicuous link on the main page of the pet insurer or pet insurer’s program administrator’s |
website. |
(b) Nothing in this chapter shall in any way prohibit or limit the types of exclusions pet |
insurers may use in their policies or require pet insurers to have any of the limitations or exclusions |
defined below. |
(c) For purposes of this chapter: |
(1) “Chronic condition” means a condition that can be treated or managed, but not cured. |
(2) “Congenital anomaly or disorder” means a condition that is present from birth, whether |
inherited or caused by the environment, which may cause or contribute to illness or disease. |
(3) “Hereditary disorder” means an abnormality that is genetically transmitted from parent |
to offspring and may cause illness or disease. |
(4) “Orthopedic” refers to conditions affecting the bones, skeletal muscle, cartilage, |
tendons, ligaments, and joints. It includes, but is not limited to, elbow dysplasia, hip dysplasia, |
intervertebral disc degeneration, patellar luxation, and ruptured cranial cruciate ligaments. It does |
not include cancers or metabolic, hemopoietic, or autoimmune diseases. |
(5) “Pet insurance” means a property insurance policy that provides coverage for accidents |
and illnesses of pets. |
(6) “Preexisting condition” means any condition for which any of the following are true |
prior to the effective date of a pet insurance policy or during any waiting period: |
(i) A veterinarian provided medical advice; |
(ii) The pet received previous treatment; or |
(iii) Based on information from verifiable sources, the pet had signs or symptoms directly |
related to the condition for which a claim is being made. |
(iv) A condition for which coverage is afforded on a policy cannot be considered a |
preexisting condition on any renewal of the policy. |
(7) “Renewal” means to issue and deliver at the end of an insurance policy period a policy |
which supersedes a policy previously issued and delivered by the same pet insurer or affiliated pet |
insurer and which provides types and limits of coverage substantially similar to those contained in |
the policy being superseded. |
(8) “Veterinarian” means an individual who holds a valid license to practice veterinary |
medicine from the appropriate licensing entity in the jurisdiction in which the individual practices. |
(9) “Veterinary expenses” means the costs associated with medical advice, diagnosis, care, |
or treatment provided by a veterinarian, including, but not limited to, the cost of drugs prescribed |
by a veterinarian. |
(10) “Waiting period” means the period of time specified in a pet insurance policy that is |
required to transpire before some or all of the coverage in the policy can begin. Waiting periods |
may not be applied to renewals of existing coverage. |
(11) “Wellness program” means a subscription or reimbursement-based program that is |
separate from an insurance policy that provides goods and services to promote the general health, |
safety, or wellbeing of the pet. If any wellness program: |
(i) Pays or indemnifies another as to loss from certain contingencies called "risks," |
including through reinsurance; |
(ii) Pays or grants a specified amount or determinable benefit to another in connection with |
ascertainable risk contingencies; or |
(iii) Acts as a surety, it is transacting in the business of insurance and is subject to the |
insurance code, as defined in § 27-54.1-1. This definition is not intended to classify a contract |
directly between a service provider and a pet owner that only involves the two (2) parties as being |
“the business of insurance,” unless other indications of insurance also exist. |
27-83-4. 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: |
(i) A preexisting condition; |
(ii) A hereditary disorder; |
(iii) A congenital anomaly or disorder; or |
(iv) 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; and |
(5) If the underwriting company differs from the brand name used to market and sell the |
product. |
(b) Right to examine and return the policy. |
(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/insurance producer of the company within fifteen (15) days of 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 language substantially similar shall be included: |
“You have fifteen (15) days from 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/insurance producer that you bought it |
from as long as you have not filed a claim. You must return it within fifteen (15) days of the day |
you first received it. The company will refund the full amount of any premium paid within thirty |
(30) days after 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.” |
(c) 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 pet |
insurer’s or pet insurer’s program administrator’s website. |
(d) A pet insurer that uses a benefit schedule to determine claim payment under a pet |
insurance policy shall do both of the following: |
(1) Clearly disclose the applicable benefit schedule in the policy; and |
(2) 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 pet insurer’s or pet insurer’s program |
administrator’s website. |
(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 clearly |
describes the pet insurer’s basis for determining usual and customary fees and how that basis is |
applied in calculating claim payments; and |
(2) Disclose the pet insurer’s basis for determining usual and customary fees through a |
clear and conspicuous link on the main page of the pet insurer’s or pet insurer’s program |
administrator’s website. |
(f) 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. |
(g) Waiting periods, and the requirements applicable to them, shall be clearly and |
prominently disclosed to consumers prior to the policy purchase. |
(h) The pet insurer shall include a summary of all policy provisions required in subsections |
(a) through (g) of this section, inclusive, in a separate document titled “Insurer Disclosure of |
Important Policy Provisions.” |
(i) The pet insurer shall post the “Insurer Disclosure of Important Policy Provisions” |
document required in subsection (h) of this section through a clear and conspicuous link on the |
main page of the pet insurer’s or pet insurer’s program administrator’s website. |
(j) 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 subsection (h) of this section in at least twelve-point (12) type when |
the policy is delivered. |
(k) 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 (12) |
boldface type: |
(1) The address and customer service telephone number of the pet insurer or the agent or |
broker of record. |
(2) 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. |
(l) The disclosures required in this section shall be in addition to any other disclosures |
required by law or regulation. |
27-83-5. Policy conditions. |
(a) A pet insurer may issue policies that exclude coverage on the basis of one or more |
preexisting conditions with appropriate disclosure to the consumer. The pet insurer has the burden |
of proving that the preexisting condition exclusion applies to the condition for which a claim is |
being made. |
(b) A pet insurer may issue policies that impose waiting periods upon effectuation of the |
policy that do not exceed thirty (30) days for illnesses or orthopedic conditions not resulting from |
an accident. Waiting periods for accidents are prohibited; provided, however, an insurer shall issue |
coverage to be effective at 12:01 a.m. on the second calendar day after the purchase, subject only |
to the following exceptions: |
(1) If an insurer elects to conduct individualized underwriting on a specific pet, then |
coverage shall be effective by 12:01 a.m. on the second calendar day after the insurer has |
determined such pet is eligible for coverage; |
(2) An insurer may delay coverage from becoming effective to establish a method for the |
consumer or group administrator to pay the premium; |
(3) For pet insurance coverage acquired by an individual through an employer or |
organization, the coverage effective date of such pet insurance may be delayed to align with the |
eligibility and effective date requirements of the employer's organization's benefit plan; or |
(4) If a policy does not include a waiting period for an illness or orthopedic condition, an |
insurer may set a policy effectuation date that is up to fifteen (15) calendar days after purchase, as |
long as such policy effectuation date is clearly disclosed and no premium is earned before the policy |
becomes effective. |
(c)(1) A pet insurer utilizing a waiting period permitted in subsection (b) of this section |
shall include a provision in its contract that allows the waiting periods to be waived upon |
completion of a medical examination. Pet insurers may require the examination to be conducted by |
a licensed veterinarian after the purchase of the policy. |
(i) A medical examination under this subsection shall be paid for by the policyholder, |
unless the policy specifies that the pet insurer will pay for the examination. |
(ii) A pet insurer can specify elements to be included as part of the examination and require |
documentation thereof; provided that, the specifications do not unreasonably restrict a consumer’s |
ability to waive the waiting periods in subsection (b) of this section. |
(2) Waiting periods, and the requirements applicable to them, shall be clearly and |
prominently disclosed to consumers prior to the policy purchase. |
(3) If a policy does not include a waiting period for an illness or orthopedic condition, an |
insurer may set a policy effectuation date that is up to fifteen (15) days after purchase, as long as |
such policy effectuation date is clearly disclosed and no premium is earned before the policy |
becomes effective. |
(d) A pet insurer shall not require a veterinary examination of the covered pet for the |
insured to have their policy renewed. |
(e) If a pet insurer includes any prescriptive, wellness, or non-insurance benefits in the |
policy form, then it is made part of the policy contract and shall follow all applicable laws and |
regulations in the insurance code. |
(f) An insured’s eligibility to purchase a pet insurance policy shall not be based on |
participation, or lack of participation, in a separate wellness program. |
27-83-6. Sales practices for wellness programs. |
(a) A pet insurer and/or producer shall not do the following: |
(1) Market a wellness program as pet insurance; or |
(2) Market a wellness program during the sale, solicitation, or negotiation of pet insurance. |
(b) If a wellness program is sold by a pet insurer and/or producer: |
(1) The purchase of the wellness program shall not be a requirement to the purchase of pet |
insurance; |
(2) The costs of the wellness program shall be separate and identifiable from any pet |
insurance policy sold by a pet insurer and/or producer; |
(3) The terms and conditions for the wellness program shall be separate from any pet |
insurance policy sold by a pet insurer and/or producer; |
(4) The products or coverages available through the wellness program shall not duplicate |
products or coverages available through the pet insurance policy; |
(5) The advertising of the wellness program shall not be misleading and shall be in |
accordance with subsection (b) of this section; and |
(6) A pet insurer and/or producer shall clearly disclose the following to consumers, printed |
in twelve-point (12) boldface type: |
(i) That wellness programs are not insurance. |
(ii) The address and customer service telephone number of the pet insurer or producer or |
broker of record. |
(c) Coverages included in the pet insurance policy contract described as “wellness” benefits |
are insurance. |
27-83-7. Insurance producer training. |
(a) An insurance producer shall not sell, solicit, or negotiate a pet insurance product until |
after the producer is appropriately licensed and has completed the required training identified in |
subsection (c) of this section. |
(b) Insurers shall ensure that its producers are trained under subsection (c) of this section |
and that its producers have been appropriately trained on the coverages and conditions of its pet |
insurance products. |
(c) The training required under this subsection shall include information on the following |
topics: |
(1) Preexisting conditions and waiting periods; |
(2) The differences between pet insurance and noninsurance wellness programs; |
(3) Hereditary disorders, congenital anomalies or disorders, and chronic conditions and |
how pet insurance policies interact with those conditions or disorders; and |
(4) Rating, underwriting, renewal, and other related administrative topics. |
(d) The satisfaction of the training requirements of another state that are substantially |
similar to the provisions of subsection (c) of this section shall be deemed to satisfy the training |
requirements in this state. |
27-83-8. Violations. |
Violations of this chapter shall be subject to penalties pursuant to § 42-14-16. |
SECTION 2. This act shall take effect on January 1, 2026. |
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LC000616/SUB A |
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