Bill Text: NY A02357 | 2017-2018 | General Assembly | Amended
Bill Title: Regulates the issuance of insurance policies covering veterinary expenses.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2018-07-10 - print number 2357b [A02357 Detail]
Download: New_York-2017-A02357-Amended.html
STATE OF NEW YORK ________________________________________________________________________ 2357--B 2017-2018 Regular Sessions IN ASSEMBLY January 18, 2017 ___________ Introduced by M. of A. L. ROSENTHAL -- read once and referred to the Committee on Insurance -- recommitted to the Committee on Insurance in accordance with Assembly Rule 3, sec. 2 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said commit- tee -- again reported from said committee with amendments, ordered reprinted as amended and recommitted to said committee AN ACT to amend the insurance law, in relation to pet insurance The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. The insurance law is amended by adding a new article 42-A 2 to read as follows: 3 ARTICLE 42-A 4 PET INSURANCE 5 Section 4250. Definitions. 6 4251. Applicability. 7 4252. Coverage disclosures and requirements. 8 4253. Penalties. 9 4254. Violations. 10 4255. Rules and regulations. 11 § 4250. Definitions. For purposes of this article, the following defi- 12 nitions shall apply: 13 (a) "Chronic condition" shall mean a condition that can be treated or 14 managed, even if not cured. 15 (b) "Congenital anomaly or disorder" shall mean a condition that is 16 present from birth, whether inherited or caused by the environment, 17 which, to a reasonable medical certainty, has been determined to cause 18 or otherwise contribute to illness or disease. 19 (c) "Hereditary disorder" shall mean an abnormality that is genet- 20 ically transmitted from parent to offspring which, to a reasonable 21 medical certainty, has been determined to cause illness or disease. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD05415-06-8A. 2357--B 2 1 (d) "Pet insurance" shall mean insurance, whether provided under an 2 individual or group insurance policy that provides coverage for veteri- 3 nary expenses. 4 (e) "Preexisting condition" shall mean any condition, whether curable 5 or incurable, which existed or presented on or before the pet insurance 6 policy effective date, whether or not a veterinarian provided a medical 7 diagnosis or for which the pet received treatment. 8 (f) "Veterinarian" shall mean an individual who holds a valid license 9 to practice veterinary medicine from an appropriate licensing entity in 10 the jurisdiction in which he or she practices. 11 (g) "Veterinary expenses" shall mean the costs associated with medical 12 advice, diagnosis, care, treatment or alternative therapies, provided by 13 a veterinarian, including, but not limited to, the cost of drugs 14 prescribed by a veterinarian. 15 (h) "Waiting period" shall mean the period of time specified in a 16 policy of pet insurance before coverage begins under such policy. 17 (i) "Rescue animal" shall include but not be limited to any animal 18 that is (a) adopted from a shelter, (b) adopted from a rescue organiza- 19 tion with foster care, or (c) a stray animal or abandoned animal not 20 from a shelter or rescue organization, including animals surrendered to 21 a veterinarian. 22 § 4251. Applicability. A policy of pet insurance that is marketed, 23 issued, amended, renewed, or delivered, whether or not in New York, to a 24 New York resident, on and after July first, two thousand nineteen, 25 regardless of the situs of the contract or group policyholder, or the 26 jurisdiction in which the contract was issued or delivered, is subject 27 to this article. 28 § 4252. Coverage disclosures and requirements. (a) No policy of pet 29 insurance may be issued if such policy excludes any of the following: a 30 pre-existing condition; a congenital anomaly or disorder; a hereditary 31 disorder; or a chronic condition. 32 (b) (1) Exclusions from coverage other than those set forth in 33 subsection (a) of this section are permissible if prominently disclosed 34 following the statement: "Exclusions may apply. Please refer to the 35 exclusions section of the policy for more information." 36 (2) If any policy of pet insurance provides a limit on coverage 37 through a waiting period, a deductible, co-insurance or an annual or 38 lifetime policy limit, the following shall apply: 39 (i) the waiting period for accident coverage shall not exceed one day 40 after purchase or payment of the initial premium. Except as provided in 41 the preceding sentence (relating to accident coverage), there shall be 42 no waiting period; 43 (ii) the deductible, if any, shall be an annual deductible; and 44 (iii) the waiting period, deductible, co-insurance requirements and/or 45 annual or lifetime limits, if any, shall be prominently disclosed. Such 46 disclosure shall appear or be summarized on the first page of such poli- 47 cy or shall be referred to on the first page in a manner that clearly 48 indicates where such provisions appear in such policy. 49 (3) If such policy includes any other exclusion, the following state- 50 ment shall be included in bold font large enough to be easily visible: 51 "Other exclusions may apply. Please refer to the exclusions section of 52 the policy for more information." 53 (4) Review of denied claims shall be handled by a veterinarian and 54 determinations shall be made based on a standard of reasonable medical 55 certainty. In the event a claim has been denied following an initial orA. 2357--B 3 1 first level review, a secondary review shall be handled by an unaffil- 2 iated, independent veterinarian. 3 (c) (1) Coverage under a policy of pet insurance shall be continuous 4 so long as premiums are paid, regardless of any change of ownership of 5 the covered animal. 6 (2) Each policy of pet insurance shall be transferable and be assigna- 7 ble to a new owner of a covered animal. 8 (3) Renewal of a policy of pet insurance shall not be denied based on 9 claims history or age of the covered animal. 10 (4) Premiums shall not be increased based on claims history. 11 (5) Premium increases shall be approved by the superintendent and such 12 approval shall be made available to the public at least sixty days prior 13 to the effective date of such increase. 14 (d) If a pet insurer uses any of the definitional terms of this arti- 15 cle in a policy of pet insurance, the insurer shall use the definitions 16 of those terms as set forth in this article and include the definition 17 of the term in the policy. The pet insurer shall also make the defi- 18 nition available through a link on the main page of the insurer's inter- 19 net website. 20 (e) A pet insurer shall clearly disclose a summary description of the 21 basis or formula on which the insurer determines claim payments under a 22 pet insurance policy within the policy and through a link on the main 23 page of the insurer's internet website. 24 (f) A pet insurer that uses a benefit schedule to determine claim 25 payments under a pet insurance policy shall do both of the following: 26 (1) clearly disclose the applicable benefit schedule in the policy; 27 and 28 (2) disclose all benefit schedules used by the insurer under its pet 29 insurance policies through a link on the main page of the insurer's 30 internet website. 31 (g) A pet insurer that determines claim payments under a pet insurance 32 policy based on usual and customary fees, or any other reimbursement 33 limitation based on prevailing veterinary service provider charges, 34 shall do both of the following: 35 (1) include a usual and customary fee limitation provision in the 36 policy that clearly describes the insurer's basis for determining usual 37 and customary fees and how that basis is applied in calculating claim 38 payments; and 39 (2) disclose the insurer's basis for determining usual and customary 40 fees through a link on the main page of the insurer's internet website. 41 (3) any pet insurer that issues a policy subject to this article shall 42 be prohibited from imposing any limitations on such type of legal reme- 43 dies that policyholders may seek to pursue for resolution of disputes 44 relating to such policy, including denials of coverage at any stage. No 45 pet insurance company may limit or attempt to limit resolution of 46 disputes by policyholders to binding arbitration, so as to preclude a 47 policyholder from seeking remedies in courts of law. 48 (h) The insurer shall create a summary of all policy provisions 49 required in this section into a separate document titled "Insurer 50 Disclosure of Important Policy Provisions." 51 (i) The insurer shall post the "Insurer Disclosure of Important Policy 52 Provisions" document required in this section through a link on the main 53 page of the insurer's internet website. 54 (j) (1) In connection with the issuance of a new pet insurance policy, 55 the insurer shall provide the consumer with a copy of the "InsurerA. 2357--B 4 1 Disclosure of Important Policy Provisions" document required pursuant to 2 this section in at least twelve point type when it delivers the policy. 3 (2) In addition, the pet insurance policy shall have clearly printed 4 thereon or attached thereto a notice stating that, after receipt of the 5 policy by the owner, the policy may be returned by the insured for 6 cancellation by delivering it or mailing it to the insurer or to the 7 agent through whom it was purchased. 8 (i) The period of time set forth by the insurer for return of the 9 policy shall be clearly stated on the notice, and this free look period 10 shall be not less than thirty days. The insured may return the policy 11 to the insurer or the agent through whom the policy was purchased at any 12 time during the free look period specified in the notice. 13 (ii) The delivery or mailing of the policy by the insured pursuant to 14 this section shall void the policy from the beginning, and the parties 15 shall be in the same position as if a policy or contract had not been 16 issued. 17 (iii) All premiums paid and any policy fee paid for the policy shall 18 be refunded to the insured within thirty days from the date that the 19 insurer is notified of the cancellation. However, if the insurer has 20 paid any claim, or has advised the insured in writing that a claim will 21 be paid, the thirty day free look right pursuant to this section is 22 inapplicable and instead the policy provisions relating to cancellation 23 apply to any refund. 24 (k) The disclosures required in this section shall be in addition to 25 any other disclosure requirements required by law or regulation. 26 § 4253. Penalties. (a) A person who violates any provision of this 27 article is liable to the state for a civil penalty to be determined by 28 the superintendent, not to exceed five thousand dollars for each 29 violation, or, if the violation was willful, a civil penalty not to 30 exceed ten thousand dollars for each violation. The superintendent may 31 establish the acts that constitute a distinct violation for purposes of 32 this section. However, when the issuance, amendment, or servicing of a 33 policy or endorsement is inadvertent, all of those acts constitute a 34 single violation for purposes of this section. 35 (b) The penalty imposed by this section shall be imposed by and deter- 36 mined by the superintendent. The penalty imposed by this section is 37 appealable. 38 § 4254. Violations. (a) Whenever the superintendent shall have reason 39 to believe that a person has engaged or is engaging in this state in a 40 violation of this article, and that a proceeding by the superintendent 41 in respect thereto would be to the interest of the public, he or she 42 shall issue and serve upon that person an order to show cause containing 43 a statement of the charges in that respect, a statement of that person's 44 potential liability under this part, and a notice of a hearing thereon 45 to be held at a time and place fixed therein, which shall not be less 46 than thirty days after the service thereof, for the purpose of determin- 47 ing whether the superintendent should issue an order to that person to 48 pay the penalty imposed by this article and to cease and desist those 49 methods, acts, or practices, or any of them, that violate this article. 50 (b) If the charges are found to be justified, the superintendent shall 51 issue and cause to be served upon that person an order requiring that 52 person to pay the penalty imposed by this article and to cease and 53 desist from engaging in those methods, acts, or practices found to be in 54 violation of this article. 55 (c) Hearings shall be conducted according to the procedure designated 56 by the superintendent. However, the superintendent shall not interfereA. 2357--B 5 1 with or abridge the rights of a policyholder's right to seek remedies in 2 a court of law. 3 (d) Parties to such hearings shall be entitled to have the proceedings 4 and the order reviewed by means of any remedy provided by the super- 5 intendent. 6 (e) The jurisdiction of the superintendent shall not be exclusive and 7 nothing in this article shall be deemed to preclude review by the attor- 8 ney general of the state of New York. 9 § 4255. Rules and regulations. The superintendent may adopt reason- 10 able rules and regulations, as are necessary to administer this article, 11 in accordance with existing procedures under this chapter, however, no 12 rules or regulations may interfere with or abridge a policyholder's 13 right to seek remedies in a court of law. 14 § 2. This act shall take effect on the thirtieth day after it shall 15 have become a law.
