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 | |
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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 |
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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 |
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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. |
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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. |
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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, |
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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 |
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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." |
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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 |
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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. |
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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 |
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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. |
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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 |