2023 -- S 0697 SUBSTITUTE A  | |
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LC002296/SUB A  | |
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STATE OF RHODE ISLAND  | |
IN GENERAL ASSEMBLY  | |
JANUARY SESSION, A.D. 2023  | |
____________  | |
A N A C T  | |
RELATING TO INSURANCE -- PRODUCER LICENSING ACT  | |
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Introduced By: Senator V. Susan Sosnowski  | |
Date Introduced: March 22, 2023  | |
Referred To: Senate Commerce  | |
(Dept. of Business Regulation)  | |
It is enacted by the General Assembly as follows:  | |
1  | SECTION 1. Sections 27-2.4-2 and 27-2.4-16 of the General Laws in Chapter 27-2.4  | 
2  | entitled "Producer Licensing Act" are hereby amended to read as follows:  | 
3  | 27-2.4-2. Definitions.  | 
4  | The following definitions apply to this chapter:  | 
5  | (1) "Business entity” means a corporation, association, partnership, limited liability  | 
6  | company, limited liability partnership, or other legal entity;  | 
7  | (2) "Contracted producer report” means the annual report that all insurers contracting with  | 
8  | insurance producers must provide to the department on or by March 1 listing each insurance  | 
9  | producer to whom the insurer paid one hundred dollars ($100) or more in commissions for the  | 
10  | preceding calendar year of January 1 to December 31. The department shall prescribe the form and  | 
11  | manner of reporting.  | 
12  | (3) "Department” means the department of business regulation;  | 
13  | (4) "Home state” means any state or territory of the United States, or the District of  | 
14  | Columbia, in which an insurance producer maintains his or her principal place of residence or  | 
15  | principal place of business and is licensed to act as an insurance producer;  | 
16  | (5) "Insurance” means any of the lines of authority set forth in this title;  | 
17  | (6) "Insurance commissioner” means the director of the department of business regulation  | 
18  | or his or her designee;  | 
19  | (7) "Insurance producer” means a person required to be licensed under the laws of this state  | 
  | |
1  | to sell, solicit or negotiate insurance;  | 
2  | (8) "Insurer” means: (i) any person, reciprocal exchange, interinsurer, Lloyds insurer,  | 
3  | fraternal benefit society, and any other legal entity engaged in the business of insurance, including  | 
4  | insurance producers; (ii) notwithstanding §§ 27-19-2, 27-20-2, 27-20.1-2, 27-20.2-2, 27-20.3-2,  | 
5  | and 27-41-22, all of whom shall be engaged in the business of insurance for the purpose of this  | 
6  | chapter, nonprofit hospital and/or medical service corporation, a nonprofit dental service  | 
7  | corporation, a nonprofit optometric service corporation, a nonprofit legal service corporation, a  | 
8  | health maintenance organization as defined in chapter 41 of this title or as defined in chapter 62 of  | 
9  | title 42, or any other entity providing a plan of health benefits subject to state insurance regulation;  | 
10  | and (iii) an organization that for consideration assumes certain risks for an insured. Insurer  | 
11  | organizations may include corporations, stock companies, mutual companies, risk retention groups,  | 
12  | reciprocals, captives, Lloyds associations, and government residual plans.  | 
13  | (9) "License” means a document issued by this state's insurance commissioner authorizing  | 
14  | a person to act as an insurance producer for the lines of authority specified in the document. The  | 
15  | license itself does not create any authority, actual, apparent or inherent, in the holder to represent  | 
16  | or commit an insurance carrier;  | 
17  | (10) "Limited line credit insurance” includes credit life, credit disability, credit property,  | 
18  | credit unemployment, involuntary unemployment, mortgage life, mortgage guaranty, mortgage  | 
19  | disability, guaranteed automobile protection (gap) insurance, and any other form of insurance  | 
20  | offered in connection with an extension of credit that is limited to partially or wholly extinguishing  | 
21  | that credit obligation that the insurance commissioner determines should be designated a form of  | 
22  | limited line credit insurance;  | 
23  | (11) "Limited line credit insurance producer” means a person who sells, solicits or  | 
24  | negotiates one or more forms of limited line credit insurance coverage to individuals through a  | 
25  | master, corporate, group or individual policy;  | 
26  | (12) "Limited lines insurance” means those lines of insurance that the insurance  | 
27  | commissioner deems necessary to recognize for purposes of complying with subsection 27-2.4-  | 
28  | 10(e);  | 
29  | (13) "Limited lines producer” means a person authorized by the insurance commissioner  | 
30  | to sell, solicit or negotiate limited lines insurance;  | 
31  | (14) "NAIC” means National Association of Insurance Commissioners;  | 
32  | (15) "Negotiate” means the act of conferring directly with or offering advice directly to a  | 
33  | purchaser or prospective purchaser of a particular contract of insurance concerning any of the  | 
34  | substantive benefits, terms or conditions of the contract, provided that the person engaged in that  | 
  | LC002296/SUB A - Page 2 of 14  | 
1  | act either sells insurance or obtains insurance from insurers for purchasers;  | 
2  | (16) "Person” means an individual;  | 
3  | (17) "Resident” means a person who either resides in Rhode Island or maintains an office  | 
4  | in Rhode Island where the business of producing insurance is transacted and designates Rhode  | 
5  | Island as the residence for purposes of licensure;  | 
6  | (18) "Sell” means to exchange a contract of insurance by any means, for money or its  | 
7  | equivalent, on behalf of an insurance company;  | 
8  | (19) "Solicit” means attempting to sell insurance or asking or urging a person to apply for  | 
9  | a particular kind of insurance from a particular company;  | 
10  | (20) "Terminate” means the cancellation of the relationship between an insurance producer  | 
11  | and the insurer or the termination of an insurance producer's authority to transact insurance;  | 
12  | (21) "Uniform application” means the current version of the NAIC uniform application for  | 
13  | resident and nonresident insurance producer licensing.  | 
14  | 27-2.4-16. Notification to insurance commissioner of termination.  | 
15  | (a) Termination for cause. An insurer or authorized representative of the insurer that  | 
16  | terminates the appointment, employment contract or other insurance business relationship with an  | 
17  | insurance producer shall notify the insurance commissioner within thirty (30) days following the  | 
18  | effective date of the termination, using a format prescribed by the insurance commissioner, if the  | 
19  | reason for termination is one of the reasons set forth in § 27-2.4-14 or the insurer has knowledge  | 
20  | the insurance producer was found by a court, government body, or self-regulatory organization  | 
21  | authorized by law to have engaged in any of the activities in § 27-2.4-14. Upon the written request  | 
22  | of the insurance commissioner, the insurer shall provide additional information, documents, records  | 
23  | or other data pertaining to the termination or activity of the insurance producer.  | 
24  | (b) Termination without cause. An insurer or authorized representative of the insurer that  | 
25  | terminates the appointment, employment, or contract with a producer for any reason not set forth  | 
26  | in § 27-2.4-14, shall notify the insurance commissioner within thirty (30) days following the  | 
27  | effective date of the termination, using a format prescribed by the insurance commissioner. Upon  | 
28  | written request of the insurance commissioner, the insurer shall provide additional information,  | 
29  | documents, records or other data pertaining to the termination.  | 
30  | (b)(c) Ongoing notification requirement. The insurer or the authorized representative of  | 
31  | the insurer shall promptly notify the insurance commissioner in a format acceptable to the insurance  | 
32  | commissioner if, upon further review or investigation, the insurer discovers additional information  | 
33  | that would have been reportable to the insurance commissioner in accordance with subsection (a)  | 
34  | of this section had the insurer then known of its existence.  | 
  | LC002296/SUB A - Page 3 of 14  | 
1  | (c)(d) Copy of notification to be provided to the insurance producer.  | 
2  | (1) Within fifteen (15) days after making the notification required by subsections (a) and  | 
3  | (b)(c) of this section, the insurer shall mail a copy of the notification to the insurance producer at  | 
4  | his or her last known address. If the insurance producer is terminated for cause for any of the  | 
5  | reasons listed in § 27-2.4-14, the insurer shall provide a copy of the notification to the insurance  | 
6  | producer at his or her last known address by certified mail, return receipt requested, postage prepaid  | 
7  | or by overnight delivery using a nationally recognized carrier.  | 
8  | (2) Within thirty (30) days after the insurance producer has received the original or  | 
9  | additional notification, the insurance producer may file written comments concerning the substance  | 
10  | of the notification with the insurance commissioner. The insurance producer shall, by the same  | 
11  | means, simultaneously send a copy of the comments to the reporting insurer, and the comments  | 
12  | shall become a part of the insurance commissioner's file and accompany every copy of a report  | 
13  | distributed or disclosed for any reason about the insurance producer as permitted under subsection  | 
14  | (e)(f) of this section.  | 
15  | (d)(e) Immunities.  | 
16  | (1) In the absence of actual malice, an insurer, the authorized representative of the insurer,  | 
17  | an insurance producer, the insurance commissioner, or an organization of which the insurance  | 
18  | commissioner is a member and that compiles the information and makes it available to other  | 
19  | insurance commissioners or regulatory or law enforcement agencies shall not be subject to civil  | 
20  | liability, except as provided in this section, and a civil cause of action of any nature shall not arise  | 
21  | against these entities or their respective agents or employees, except as provided in this section, as  | 
22  | a result of any statement or information required by or provided pursuant to this section or any  | 
23  | information relating to any statement that may be requested in writing by the insurance  | 
24  | commissioner, from an insurer or insurance producer; or a statement by a terminating insurer or  | 
25  | insurance producer to an insurer or insurance producer limited solely and exclusively to whether a  | 
26  | termination for cause under subsection (a) of this section was reported to the insurance  | 
27  | commissioner, provided that the propriety of any termination for cause under subsection (a) of this  | 
28  | section is certified in writing by an officer or authorized representative of the insurer or insurance  | 
29  | producer terminating the relationship.  | 
30  | (2) In any action brought against a person that may have immunity under this chapter for  | 
31  | making any statement required by this section or providing any information relating to any  | 
32  | statement that may be requested by the insurance commissioner, the party bringing the action shall  | 
33  | plead specifically in any allegation that subdivision (d)(e)(1) of this section does not apply because  | 
34  | the person making the statement or providing the information did so with actual malice.  | 
  | LC002296/SUB A - Page 4 of 14  | 
1  | (3) This chapter shall not abrogate or modify any existing statutory or common law  | 
2  | privileges or immunities.  | 
3  | (e)(f) Confidentiality.  | 
4  | (1) Any documents, materials or other information in the control or possession of the  | 
5  | department that is furnished by an insurer, insurance producer or an employee or agent of the  | 
6  | insurer or insurance producer acting on behalf of the insurer or insurance producer, or obtained by  | 
7  | the insurance commissioner in an investigation pursuant to this section, shall be confidential by law  | 
8  | and privileged, shall not be subject to chapter 2 of title 38, shall not be subject to subpoena, and  | 
9  | shall not be subject to discovery or admissible in evidence in any private civil action. The insurance  | 
10  | commissioner is authorized to use the documents, materials or other information in the furtherance  | 
11  | of any regulatory or legal action brought as a part of the insurance commissioner's duties.  | 
12  | (2) Neither the insurance commissioner nor any person who received documents, materials  | 
13  | or other information while acting under the authority of the insurance commissioner shall be  | 
14  | permitted or required to testify in any private civil action concerning any confidential documents,  | 
15  | materials, or information subject to this chapter.  | 
16  | (3) In order to assist in the performance of the insurance commissioner's duties under this  | 
17  | chapter, the insurance commissioner:  | 
18  | (i) May share documents, materials or other information, including the confidential and  | 
19  | privileged documents, materials or information subject to this chapter, with other state, federal, and  | 
20  | international regulatory agencies, with the NAIC, its affiliates or subsidiaries, and with state,  | 
21  | federal, and international law enforcement authorities, provided that the recipient agrees to  | 
22  | maintain the confidentiality and privileged status of the document, material or other information;  | 
23  | (ii) May receive documents, materials or information, including confidential and privileged  | 
24  | documents, materials or information, from the NAIC, its affiliates or subsidiaries and from  | 
25  | regulatory and law enforcement officials of other foreign or domestic jurisdictions, and shall  | 
26  | maintain as confidential or privileged any document, material or information received with notice  | 
27  | or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the  | 
28  | source of the document, material or information;  | 
29  | (iii) May enter into agreements governing sharing and use of information consistent with  | 
30  | this subsection;  | 
31  | (iv) No waiver of any applicable privilege or claim of confidentiality in the documents,  | 
32  | materials, or information shall occur as a result of disclosure to the commissioner under this section  | 
33  | or as a result of sharing as authorized in this chapter;  | 
34  | (v) Nothing in this chapter shall prohibit the insurance commissioner from releasing final,  | 
  | LC002296/SUB A - Page 5 of 14  | 
1  | adjudicated actions including for cause terminations that are open to public inspection pursuant to  | 
2  | chapter 2 of title 38 to a database or other clearinghouse service maintained by the NAIC, its  | 
3  | affiliates or subsidiaries; and  | 
4  | (vi) If the department releases to an unauthorized third party any documents, materials or  | 
5  | other information provided to the department pursuant to this section, then the department shall be  | 
6  | subject to a fine not to exceed one thousand dollars ($1,000) after a hearing on this violation brought  | 
7  | in the Superior Court.  | 
8  | (f)(g) Penalties for failing to report. An insurer, the authorized representative of the  | 
9  | insurer, or insurance producer that fails to report as required under the provisions of this section or  | 
10  | that is found to have reported with actual malice by a court of competent jurisdiction may, after  | 
11  | notice and hearing, have its license or certificate of authority suspended or revoked and may be  | 
12  | fined in accordance with § 42-14-16.  | 
13  | SECTION 2. Section 27-13.1-7 of the General Laws in Chapter 27-13.1 entitled  | 
14  | "Examinations" is hereby amended to read as follows:  | 
15  | 27-13.1-7. Cost of examinations.  | 
16  | (a) The total cost of the examinations shall be borne by the examined companies and shall  | 
17  | include the following expenses:  | 
18  | (1) One hundred fifty percent (150%) of the total salaries and benefits paid to the examining  | 
19  | personnel of the banking and insurance division engaged in those examinations less any salary  | 
20  | reimbursements;  | 
21  | (2) All reasonable technology costs related to the examination process. Technology costs  | 
22  | shall include the actual cost of software and hardware utilized in the examination process and the  | 
23  | cost of training examination insurance personnel in the proper use of the software or hardware;  | 
24  | (3) All necessary and reasonable education and training costs incurred by the state to  | 
25  | maintain the proficiency and competence of the examining insurance personnel. All these costs  | 
26  | shall be incurred in accordance with appropriate state of Rhode Island regulations, guidelines and  | 
27  | procedures.  | 
28  | (b) Expenses incurred pursuant to subsections (a)(2) and (a)(3) of this section shall be  | 
29  | allocated equally to each company domiciled in Rhode Island no more frequently than annually  | 
30  | and shall not exceed an annual average assessment of three thousand five hundred dollars ($3,500)  | 
31  | five thousand dollars ($5,000) per company for any given three (3) calendar year period. All  | 
32  | revenues collected pursuant to this section shall be deposited as general revenues. That assessment  | 
33  | shall be in addition to any taxes and fees payable to the state.  | 
34  | SECTION 3. Chapter 27-2.4 of the General Laws entitled "Producer Licensing Act" is  | 
  | LC002296/SUB A - Page 6 of 14  | 
1  | hereby amended by adding thereto the following section:  | 
2  | 27-2.4-14.1. Appointments.  | 
3  | (a) An insurance producer shall not act as an agent of an insurer unless the insurance  | 
4  | producer becomes an appointed agent of that insurer. An insurance producer who is not acting as  | 
5  | an agent of an insurer is not required to become appointed.  | 
6  | (b) To appoint a producer as its agent, the appointing insurer shall file, in a format approved  | 
7  | by the insurance commissioner, a notice of appointment within fifteen (15) days from the date the  | 
8  | first insurance application is submitted. An insurer may also elect to appoint a producer to all or  | 
9  | some insurers within the insurer's holding company system or group by the filing of a single  | 
10  | appointment request.  | 
11  | (c) An insurer shall pay an appointment fee, in the amount and method of payment set forth  | 
12  | in a regulation promulgated for that purpose, for each insurance producer appointed by the insurer.  | 
13  | (d) An insurer shall remit, in a manner prescribed by the insurance commissioner, a renewal  | 
14  | appointment fee in the amount set forth in a regulation promulgated for that purpose.  | 
15  | SECTION 4. Chapter 27-9 of the General Laws entitled "Casualty Insurance Rating" is  | 
16  | hereby amended by adding thereto the following section:  | 
17  | 27-9-57. Unfair discrimination.  | 
18  | (a) No individual or entity subject to this chapter shall, because of race, color, creed,  | 
19  | national origin, or disability:  | 
20  | (1) Make any distinction or discrimination between persons as to the premiums or rates  | 
21  | charged for insurance policies.  | 
22  | (2) Demand or require a greater premium from any persons than it requires at that time  | 
23  | from others in similar cases.  | 
24  | (3) Insert in the policy any condition, or make any stipulation, whereby the insured binds  | 
25  | themselves, or their heirs, executors, administrators, or assigns, to accept any sum or service less  | 
26  | than the full value or amount of such policy in case of a claim thereon except such conditions and  | 
27  | stipulations as are imposed upon others in similar cases; and any such stipulation or condition so  | 
28  | made or inserted shall be void.  | 
29  | SECTION 5. Title 27 of the General Laws entitled "INSURANCE" is hereby amended by  | 
30  | adding thereto the following chapter:  | 
31  | CHAPTER 82  | 
32  | PET INSURANCE ACT  | 
33  | 27-82-1. Short Title.  | 
34  | This act shall be known and may be cited as the "Pet Insurance Act."  | 
  | LC002296/SUB A - Page 7 of 14  | 
1  | 27-82-2. Scope and Purpose.  | 
2  | (a) The purpose of this act is to promote the public welfare by creating a comprehensive  | 
3  | legal framework within which pet insurance may be sold in this state.  | 
4  | (b) The requirements of this act shall apply to pet insurance policies that are issued to any  | 
5  | resident of this state and are sold, solicited, negotiated, or offered in this state, and policies or  | 
6  | certificates that are delivered or issued for delivery in this state.  | 
7  | (c) All other applicable provisions of this state's insurance laws shall continue to apply to  | 
8  | pet insurance except that the specific provisions of this act shall supersede any general provisions  | 
9  | of law that would otherwise be applicable to pet insurance.  | 
10  | 27-82-3. Definitions.  | 
11  | (a) If a pet insurer uses any of the terms in this chapter in a policy of pet insurance, the pet  | 
12  | insurer shall use the definition of each of those terms as set forth herein and include the definition  | 
13  | of the term(s) in the policy. The pet insurer shall also make the definition available through a clear  | 
14  | and conspicuous link on the main page of the pet insurer or pet insurer's program administrator's  | 
15  | website.  | 
16  | (b) Nothing in this chapter shall in any way prohibit or limit the types of exclusions pet  | 
17  | insurers may use in their policies or require pet insurers to have any of the limitations or exclusions  | 
18  | defined below.  | 
19  | (c) As used in this chapter:  | 
20  | (1) "Chronic condition" means a condition that can be treated or managed, but not cured.  | 
21  | (2) "Congenital anomaly or disorder" means a condition that is present from birth, whether  | 
22  | inherited or caused by the environment, which may cause or contribute to illness or disease.  | 
23  | (3) "Hereditary disorder" means an abnormality that is genetically transmitted from parent  | 
24  | to offspring and may cause illness or disease.  | 
25  | (4) "Orthopedic" refers to conditions affecting the bones, skeletal muscle, cartilage,  | 
26  | tendons, ligaments, and joints. It includes, but is not limited to, elbow dysplasia, hip dysplasia,  | 
27  | intervertebral disc degeneration, patellar luxation, and ruptured cranial cruciate ligaments. It does  | 
28  | not include cancers or metabolic, hemopoietic, or autoimmune diseases.  | 
29  | (5) "Pet insurance" means a property insurance policy that provides coverage for accidents  | 
30  | and illnesses of pets.  | 
31  | (6) "Preexisting condition" means any condition for which any of the following are true  | 
32  | prior to the effective date of a pet insurance policy or during any waiting period:  | 
33  | (i) A veterinarian provided medical advice;  | 
34  | (ii) The pet received previous treatment; or  | 
  | LC002296/SUB A - Page 8 of 14  | 
1  | (iii) Based on information from verifiable sources, the pet had signs or symptoms directly  | 
2  | related to the condition for which a claim is being made.  | 
3  | (iv) A condition for which coverage is afforded on a policy cannot be considered a  | 
4  | preexisting condition on any renewal of the policy.  | 
5  | (7) "Renewal" means to issue and deliver at the end of an insurance policy period a policy  | 
6  | which supersedes a policy previously issued and delivered by the same pet insurer or affiliated pet  | 
7  | insurer and which provides types and limits of coverage substantially similar to those contained in  | 
8  | the policy being superseded.  | 
9  | (8) "Veterinarian" means an individual who holds a valid license to practice veterinary  | 
10  | medicine from the appropriate licensing entity in the jurisdiction in which he or she practices.  | 
11  | (9) "Veterinary expenses" means the costs associated with medical advice, diagnosis, care,  | 
12  | or treatment provided by a veterinarian, including, but not limited to, the cost of drugs prescribed  | 
13  | by a veterinarian.  | 
14  | (10) "Waiting period" means the period of time specified in a pet insurance policy that is  | 
15  | required to transpire before some or all of the coverage in the policy can begin. Waiting periods  | 
16  | may not be applied to renewals of existing coverage.  | 
17  | (11) "Wellness program" means a subscription or reimbursement-based program that is  | 
18  | separate from an insurance policy that provides goods and services to promote the general health,  | 
19  | safety, or wellbeing of the pet. If any wellness program:  | 
20  | (i) Pays or indemnifies another as to loss from certain contingencies called "risks,"  | 
21  | including through reinsurance;  | 
22  | (ii) Pays or grants a specified amount or determinable benefit to another in connection with  | 
23  | ascertainable risk contingencies; or  | 
24  | (iii) Acts as a surety, it is transacting in the business of insurance and is subject to the  | 
25  | insurance code, as defined in § 27-54.1-1. This definition is not intended to classify a contract  | 
26  | directly between a service provider and a pet owner that only involves the two (2) parties as being  | 
27  | "the business of insurance," unless other indications of insurance also exist.  | 
28  | 27-82-4. Disclosures.  | 
29  | (a) A pet insurer transacting pet insurance shall disclose the following to consumers:  | 
30  | (1) If the policy excludes coverage due to any of the following:  | 
31  | (i) A preexisting condition;  | 
32  | (ii) A hereditary disorder;  | 
33  | (iii) A congenital anomaly or disorder; or  | 
34  | (iv) A chronic condition.  | 
  | LC002296/SUB A - Page 9 of 14  | 
1  | (2) If the policy includes any other exclusions, the following statement: "Other exclusions  | 
2  | may apply. Please refer to the exclusions section of the policy for more information."  | 
3  | (3) Any policy provision that limits coverage through a waiting or affiliation period, a  | 
4  | deductible, coinsurance, or an annual or lifetime policy limit.  | 
5  | (4) Whether the pet insurer reduces coverage or increases premiums based on the insured's  | 
6  | claim history, the age of the covered pet or a change in the geographic location of the insured.  | 
7  | (5) If the underwriting company differs from the brand name used to market and sell the  | 
8  | product.  | 
9  | (b) Right to examine and return the policy.  | 
10  | (1) Unless the insured has filed a claim under the pet insurance policy, pet insurance  | 
11  | applicants shall have the right to examine and return the policy, certificate or rider to the company  | 
12  | or an agent/insurance producer of the company within fifteen (15) days of its receipt and to have  | 
13  | the premium refunded if, after examination of the policy, certificate or rider, the applicant is not  | 
14  | satisfied for any reason.  | 
15  | (2) Pet insurance policies, certificates and riders shall have a notice prominently printed on  | 
16  | the first page or attached thereto including specific instructions to accomplish a return. The  | 
17  | following free look statement or language substantially similar shall be included:  | 
18  | "You have fifteen (15) days from the day you receive this policy, certificate, or rider to  | 
19  | review it, and return it to the company if you decide not to keep it. You do not have to tell the  | 
20  | company why you are returning it. If you decide not to keep it, simply return it to the company at  | 
21  | its administrative office, or you may return it to the agent/insurance producer that you bought it  | 
22  | from as long as you have not filed a claim. You must return it within fifteen (15) days of the day  | 
23  | you first received it. The company will refund the full amount of any premium paid within thirty  | 
24  | (30) days after it receives the returned policy, certificate, or rider. The premium refund will be sent  | 
25  | directly to the person who paid it. The policy, certificate, or rider will be void as if it had never  | 
26  | been issued."  | 
27  | (c) A pet insurer shall clearly disclose a summary description of the basis or formula on  | 
28  | which the pet insurer determines claim payments under a pet insurance policy within the policy,  | 
29  | prior to policy issuance, and through a clear and conspicuous link on the main page of the pet  | 
30  | insurer's or pet insurer's program administrator's website.  | 
31  | (d) A pet insurer that uses a benefit schedule to determine claim payment under a pet  | 
32  | insurance policy shall do both of the following:  | 
33  | (1) Clearly disclose the applicable benefit schedule in the policy.  | 
34  | (2) Disclose all benefit schedules used by the pet insurer under its pet insurance policies  | 
  | LC002296/SUB A - Page 10 of 14  | 
1  | through a clear and conspicuous link on the main page of the pet insurer's or pet insurer's program  | 
2  | administrator's website.  | 
3  | (e) A pet insurer that determines claim payments under a pet insurance policy based on  | 
4  | usual and customary fees, or any other reimbursement limitation based on prevailing veterinary  | 
5  | service provider charges, shall do both of the following:  | 
6  | (1) Include a usual and customary fee limitation provision in the policy that clearly  | 
7  | describes the pet insurer's basis for determining usual and customary fees and how that basis is  | 
8  | applied in calculating claim payments.  | 
9  | (2) Disclose the pet insurer's basis for determining usual and customary fees through a clear  | 
10  | and conspicuous link on the main page of the pet insurer's or pet insurer's program administrator's  | 
11  | website.  | 
12  | (f) If any medical examination by a licensed veterinarian is required to effectuate coverage,  | 
13  | the pet insurer shall clearly and conspicuously disclose the required aspects of the examination  | 
14  | prior to purchase and disclose that examination documentation may result in a preexisting condition  | 
15  | exclusion.  | 
16  | (g) Waiting periods and the requirements applicable to them, must be clearly and  | 
17  | prominently disclosed to consumers prior to the policy purchase.  | 
18  | (h) The pet insurer shall include a summary of all policy provisions required in subsections  | 
19  | (a) through (g) of this section, inclusive, in a separate document titled "insurer disclosure of  | 
20  | important policy provisions."  | 
21  | (i) The pet insurer shall post the "insurer disclosure of important policy provisions"  | 
22  | document required in subsection (h) of this section through a clear and conspicuous link on the  | 
23  | main page of the pet insurer's or pet insurer's program administrator's website.  | 
24  | (j) In connection with the issuance of a new pet insurance policy, the pet insurer shall  | 
25  | provide the consumer with a copy of the "insurer disclosure of important policy provisions"  | 
26  | document required pursuant to subsection (h) of this section in at least twelve-point (12-point) type  | 
27  | when the policy is delivered.  | 
28  | (k) At the time a pet insurance policy is issued or delivered to a policyholder, the pet insurer  | 
29  | shall include a written disclosure with the following information, printed in twelve-point (12-point)  | 
30  | boldface type:  | 
31  | (1) The address and customer service telephone number of the pet insurer or the agent or  | 
32  | broker of record.  | 
33  | (2) If the policy was issued or delivered by an agent or broker, a statement advising the  | 
34  | policyholder to contact the broker or agent for assistance.  | 
  | LC002296/SUB A - Page 11 of 14  | 
1  | (l) The disclosures required in this section shall be in addition to any other disclosures  | 
2  | required by law or regulation.  | 
3  | 27-82-5. Policy Conditions.  | 
4  | (a) A pet insurer may issue policies that exclude coverage on the basis of one or more  | 
5  | preexisting conditions with appropriate disclosure to the consumer. The pet insurer has the burden  | 
6  | of proving that the preexisting condition exclusion applies to the condition for which a claim is  | 
7  | being made.  | 
8  | (b) A pet insurer may issue policies that impose waiting periods upon effectuation of the  | 
9  | policy that do not exceed thirty (30) days for illnesses or orthopedic conditions not resulting from  | 
10  | an accident. Waiting periods for accidents are prohibited. However, an insurer may issue coverage  | 
11  | to be effective at 12:01 a.m. on the second calendar day after the purchase, subject only to the  | 
12  | following exceptions.  | 
13  | (1) If an insurer elects to conduct individualized underwriting on a specific pet, then  | 
14  | coverage must be effective by 12:01 a.m. on the second calendar day after the insurer has  | 
15  | determined such pet is eligible for coverage.  | 
16  | (2) An insurer may delay coverage from becoming effective to establish a method for the  | 
17  | consumer or group administrator to pay the premium.  | 
18  | (3) For pet insurance coverage acquired by an individual through an employer or  | 
19  | organization, the coverage effective date of such pet insurance may be delayed to align with the  | 
20  | eligibility and effective date requirements of the employer's or organization's benefit plan.  | 
21  | (4) A pet insurer utilizing a waiting period permitted in subsection (b) of this section shall  | 
22  | include a provision in its contract that allows the waiting periods to be waived upon completion of  | 
23  | a medical examination. Pet insurers may require the examination to be conducted by a licensed  | 
24  | veterinarian after the purchase of the policy.  | 
25  | (i) A medical examination under subsection (b)(1) of this section shall be paid for by the  | 
26  | policyholder, unless the policy specifies that the pet insurer will pay for the examination.  | 
27  | (ii) A pet insurer can specify elements to be included as part of the examination and require  | 
28  | documentation thereof; provided, the specifications do not unreasonably restrict a consumer's  | 
29  | ability to waive the waiting periods in subsection (b) of this section.  | 
30  | (5) Waiting periods, and the requirements applicable to them, must be clearly and  | 
31  | prominently disclosed to consumers prior to the policy purchase.  | 
32  | (6) If a policy does not include a waiting period for an illness or orthopedic condition, an  | 
33  | insurer may set a policy effectuation date that is up to fifteen (15) calendar days after purchase, so  | 
34  | long as such policy effectuation date is clearly disclosed and no premium is charged before the  | 
  | LC002296/SUB A - Page 12 of 14  | 
1  | policy becomes effective.  | 
2  | (c) A pet insurer must not require a veterinary examination of the covered pet for the  | 
3  | insured to have their policy renewed.  | 
4  | (d) If a pet insurer includes any prescriptive, wellness, or non-insurance benefits in the  | 
5  | policy form, then it is made part of the policy contract and must follow all applicable laws and  | 
6  | regulations in the insurance code.  | 
7  | (e) An insured's eligibility to purchase a pet insurance policy must not be based on  | 
8  | participation, or lack of participation, in a separate wellness program.  | 
9  | 27-82-6. Sales practices for wellness programs.  | 
10  | (a) A pet insurer and/or producer shall not do the following:  | 
11  | (1) Market a wellness program as pet insurance;  | 
12  | (2) Market a wellness program during the sale, solicitation, or negotiation of pet insurance.  | 
13  | (b) If a wellness program is sold by a pet insurer and/or producer:  | 
14  | (1) The purchase of the wellness program shall not be a requirement to the purchase of pet  | 
15  | insurance.  | 
16  | (2) The costs of the wellness program shall be separate and identifiable from any pet  | 
17  | insurance policy sold by a pet insurer and/or producer.  | 
18  | (3) The terms and conditions for the wellness program shall be separate from any pet  | 
19  | insurance policy sold by a pet insurer and/or producer.  | 
20  | (4) The products or coverages available through the wellness program shall not duplicate  | 
21  | products or coverages available through the pet insurance policy;  | 
22  | (5) The advertising of the wellness program shall not be misleading and shall be in  | 
23  | accordance with subsection (b) of this section; and  | 
24  | (6) A pet insurer and/or producer shall clearly disclose the following to consumers, printed  | 
25  | in twelve-point (12-point) boldface type:  | 
26  | (i) That wellness programs are not insurance.  | 
27  | (ii) The address and customer service telephone number of the pet insurer or producer or  | 
28  | broker of record.  | 
29  | (c) Coverages included in the pet insurance policy contract described as "wellness" benefits  | 
30  | are insurance.  | 
31  | 27-82-7. Insurance producer training.  | 
32  | (a) An insurance producer shall not sell, solicit, or negotiate a pet insurance product until  | 
33  | after the producer is appropriately licensed and has completed the required training identified in  | 
34  | subsection (c) of this section.  | 
  | LC002296/SUB A - Page 13 of 14  | 
1  | (b) Insurers shall ensure that its producers are trained under subsection (c) of this section  | 
2  | and that its producers have been appropriately trained on the coverages and conditions of its pet  | 
3  | insurance products.  | 
4  | (c) The training required under this subsection shall include information on the following  | 
5  | topics:  | 
6  | (1) Preexisting conditions and waiting periods;  | 
7  | (2) The differences between pet insurance and noninsurance wellness programs;  | 
8  | (3) Hereditary disorders, congenital anomalies or disorders and chronic conditions and how  | 
9  | pet insurance policies interact with those conditions or disorders; and  | 
10  | (4) Rating, underwriting, renewal, and other related administrative topics.  | 
11  | (d) The satisfaction of the training requirements of another state that are substantially  | 
12  | similar to the provisions of subsection (c) of this section shall be deemed to satisfy the training  | 
13  | requirements in this state.  | 
14  | 27-82-8. Violations.  | 
15  | Violations of this chapter shall be subject to penalties pursuant to § 42-14-16.  | 
16  | SECTION 6. This act shall take effect on January 1, 2024.  | 
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LC002296/SUB A  | |
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  | LC002296/SUB A - Page 14 of 14  | 
EXPLANATION  | |
BY THE LEGISLATIVE COUNCIL  | |
OF  | |
A N A C T  | |
RELATING TO INSURANCE -- PRODUCER LICENSING ACT  | |
***  | |
1  | This act would amend the statutory provisions regarding insurance producer appointments  | 
2  | to provide for an efficient electronic process clarify language relating to insurance claims adjusters,  | 
3  | add elements to unfair discrimination prohibitions and establishes the provisions of the pet  | 
4  | insurance act.  | 
5  | This act would take effect on January 1, 2024.  | 
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LC002296/SUB A  | |
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  | LC002296/SUB A - Page 15 of 14  |