§ 4706. Policy conditions.

404 words·~2 min read·/pa/title-40/chapter-47/4706

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

(a)Preexisting conditions.--

(1)A pet insurer may issue pet insurance policies that exclude coverage on the basis of one or more preexisting conditions if the pet insurer follows the disclosure requirements of section 4705 (relating to policy disclosures).

(2)A pet insurer has the burden of proving that the preexisting condition exclusion under paragraph

(1)applies to the condition for which a claim is being made.

(3)A condition for which coverage is afforded on a pet insurance policy may not be considered a preexisting condition upon any renewal of the pet insurance policy.

(b)Waiting periods.--

(1)A waiting period under a pet insurance policy for an accident is prohibited.

(2)A waiting period under a pet insurance policy for an illness or orthopedic condition not resulting from an accident is permitted in accordance with the following:

(i)The waiting period may not exceed 30 days.

(ii)The waiting period, and the requirements applicable to any waiting period, must be clearly and prominently disclosed to a prospective insured prior to the purchase of the pet insurance policy.

(iii)The pet insurance policy must contain a provision that allows for the waiver of a waiting period upon completion of a medical examination in accordance with the following:

(A)The pet insurer may require the medical examination to be conducted by a veterinarian.

(B)The medical examination shall be paid for by the insured, unless the pet insurance policy specifies that the pet insurer will pay for the medical examination.

(C)The pet insurer may specify elements to be included as part of the medical examination and require documentation regarding the medical examination, provided that the specifications do not unreasonably restrict the waiver.

(c)Examination not required upon renewal.-- A pet insurer may not require a veterinary examination of a pet covered under a pet insurance policy when the insured seeks a renewal of the pet insurance policy.

(d)Wellness benefits.--

(1)If a pet insurer includes any prescriptive, wellness or noninsurance benefits in the pet insurance policy form, those benefits become part of the policy contract and must follow all applicable insurance laws and regulations.

(2)An insured's eligibility to purchase a pet insurance policy may not be based on participation, or lack of participation, in a separate wellness program.

(e)Acceptance.-- A pet insurer shall accept a claim submitted by an insured electronically or through physical mail.

40c4707s