§ 8805. Policy conditions.
362 words·~2 min read·
/de/title-18/chapter-88-pet-insurance-act/8805·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
(1)A pet insurer may issue a policy that excludes coverage on the basis of 1 or more preexisting conditions with appropriate disclosure to the consumer. The pet insurer has the burden of proving that the preexisting condition exclusion applies to the condition for which a claim is being made.
(2)A condition for which coverage is afforded on a policy may not be considered a preexisting condition on a renewal of the policy.
(b)A pet insurer may issue a policy that imposes a waiting period on effectuation of the policy that does not exceed 30 days for an illness or orthopedic condition not resulting from an accident. A waiting period for accidents is prohibited.
(1)A pet insurer utilizing a waiting period permitted under this subsection
(b)shall include a provision in the contract that allows the waiting period to be waived upon completion of a medical examination. A pet insurer may require the examination to be conducted by a licensed veterinarian after the purchase of the policy.
a. The policyholder must pay for a medical examination under subsection
(b)of this section, unless the policy specifies that the pet insurer must pay for the examination.
b. A pet insurer may specify an element to be included as part of the examination and require documentation thereof, but a specification may not unreasonably restrict a consumer’s ability to waive a waiting period under subsection
(b)of this section.
(2)A waiting period, and a requirement applicable to a waiting period, must be clearly and prominently disclosed to consumers prior to the policy purchase.
(3)A waiting period may not be applied to a renewal of existing coverage.
(c)A pet insurer may not require a veterinary examination of the covered pet for the insured to have the insured’s policy renewed.
(d)If a pet insurer includes a prescriptive, wellness, or noninsurance benefit in the policy form, the benefit is made part of the policy contract and must follow applicable laws and regulations under this title.
(e)An insured’s eligibility to purchase a pet insurance policy must not be based on participation, or lack of participation, in a separate wellness program.