AB 2411 - Pet Insurance Guidelines - California Key Vote

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Title: Pet Insurance Guidelines

Vote Smart's Synopsis:

Vote to pass a bill regulating pet insurance policies.

Highlights:

  • Requires that in connection with the sale of a new, amended, or renewed policy of pet insurance effective July 1, 2011, a pet insurer shall reasonably disclose to the consumer, as follows (Sec. 6):
    • Whether the policy excludes coverage due to a preexisting condition, hereditary disorder, or congenital anomaly or disorder;
    • Any policy provision that limits coverage through a waiting or affiliation period, a deductible, coinsurance, or an annual or lifetime policy limit; and
    • Whether the insurer reduces coverage or increases premiums based on claims experience in any preceding policy period.
  • Specifies that if a pet insurer uses any of the terms stated above, the insurer shall include a definition of the term in the policy and make that definition accessible through a link on the main page of the insurer's website (Sec. 6).
  • Requires pet insurers that use a benefit schedule to determine claim payments under a pet insurance policy to follow these instructions (Sec. 6):
    • Include the applicable benefit schedule in the policy; and
    • Disclose all benefit schedules used by the insurer under its pet insurance policies through a link on the main page of the insurer's website.
  • Directs a pet insurer that determines claim payments under a pet insurance policy based on usual and customary fees, or any other reimbursement limitation based on prevailing veterinary service provider charges, to follow the following procedures (Sec. 6):
    • Include a usual and customary fee limitation provision in the policy that clearly describes the insurer's basis for determining usual and customary fees and how that basis is applied in calculating claim payments; and -Disclose the insurer's basis for determining usual and customary charges under the policy via a link on the main page of the insurer's website.

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