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The Legislative Service Commission staff updates the Revised Code on an ongoing basis, as it completes its act review of enacted legislation. Updates may be slower during some times of the year, depending on the volume of enacted legislation.

Chapter 3970 | Pet insurance

 
 
 
Section
Section 3970.01 | Definitions.
 

As used in this chapter:

(A) "Chronic condition" means a condition that can be treated or managed, but not cured.

(B) "Congenital anomaly or disorder" means a condition that is present from birth, whether inherited or caused by the environment, which may cause or contribute to illness or disease.

(C) "Hereditary disorder" means an abnormality that is genetically transmitted from parent to offspring and may cause illness or disease.

(D) "Orthopedic condition" means a condition affecting the bones, skeletal muscle, cartilage, tendons, ligaments, and joints. "Orthopedic condition" includes elbow dysplasia, hip dysplasia, intervertebral disc degeneration, patellar luxation, and ruptured cranial cruciate ligaments. "Orthopedic condition" does not include cancer or metabolic, hemopoietic, or autoimmune diseases.

(E) "Pet insurance" means a property insurance policy that provides coverage for accidents and illnesses of pets.

(F) "Preexisting condition" means any condition for which any of the following are true prior to the effective date of a pet insurance policy or during any waiting period:

(1) A veterinarian provided medical advice.

(2) The pet received previous treatment.

(3) Based on information from verifiable sources, the pet had signs or symptoms directly related to the condition for which a claim is being made.

(G) "Renewal" means to issue and deliver, at the end of a pet insurance policy period, a policy that supersedes a policy previously issued and delivered by the same pet insurer or an affiliated pet insurer, and which provides types and limits of coverage substantially similar to those contained in the policy being superseded.

(H) "Veterinarian" means an individual who holds a valid license to practice veterinary medicine under Chapter 4741. of the Revised Code or from the appropriate licensing entity in the jurisdiction in which the veterinarian practices.

(I) "Veterinary expenses" means the costs associated with medical advice, diagnosis, care, or treatment provided by a veterinarian, including the cost of drugs prescribed by a veterinarian.

(J) "Waiting period" means a period of time specified in a pet insurance policy that is required to elapse before some or all of the coverage in the policy begins.

(K) "Wellness program" means a subscription- or reimbursement-based program that is separate from a pet insurance policy and provides goods or services to promote the general health, safety, or well-being of the pet.

Last updated September 23, 2024 at 11:43 AM

Section 3970.02 | Scope and purpose.
 

(A) The purpose of this chapter is to promote the public welfare by creating a comprehensive legal framework within which pet insurance may be sold, issued, and delivered in this state.

(B) The requirements of this chapter apply to pet insurance policies that are:

(1) Issued to any resident of this state;

(2) Sold, solicited, or negotiated in this state;

(3) Delivered or issued for delivery in this state.

(C) Pet insurers and pet insurance policies are subject to all other applicable laws, except that the specific provisions of this chapter supersede any conflicting general provisions of law that would otherwise apply.

Last updated September 23, 2024 at 12:10 PM

Section 3970.03 | Limitations and exclusions.
 

(A) If a pet insurance policy includes any of the terms defined in section 3970.01 of the Revised Code, those terms shall have the same meaning prescribed by that section, and the policy shall restate the definition of each such term. The pet insurer shall also make the definition available through a clear and conspicuous link on the main page of the pet insurer's or pet insurer's program administrator's publicly accessible web site.

(B) This chapter does not prohibit or limit the types of exclusions a pet insurer may use or apply to a pet insurance policy. This chapter does not require a pet insurer to use or apply to a pet insurance policy any of the limitations or exclusions defined in section 3970.01 of the Revised Code.

Last updated September 23, 2024 at 12:11 PM

Section 3970.04 | Disclosures.
 

(A) A pet insurance policy shall include all of the following:

(1) Disclosure of whether the pet insurance policy excludes coverage due to any of the following:

(a) A preexisting condition;

(b) A hereditary disorder;

(c) A congenital anomaly or disorder;

(d) A chronic condition.

(2) Disclosure of whether the pet insurance policy excludes coverage for any reason other than those listed in division (A)(1) of this section and, if so, the following statement:

"Other exclusions may apply. Please refer to the exclusions section for more information."

(3) Disclosure of whether the pet insurance policy or rider limits coverage through a waiting period, affiliation period, deductible, coinsurance, or an annual or lifetime policy limit;

(4) Disclosure of whether the pet insurer reduces coverage or increases premiums based on the insured's claim history, the age of the covered pet, or a change in the geographic location of the insured;

(5) Disclosure of whether the underwriting company differs from the brand name used to market and sell the pet insurance policy or rider.

(B)(1) Pet insurance may be canceled by the purchaser within thirty days after the purchaser first receives the associated policy, rider, or certificate. The pet insurer shall issue a full refund to the purchaser within thirty days after receiving timely notice of cancellation under this division, so long as no claim has been made under the pet insurance. The purchaser may provide notice of cancellation to the pet insurer or through the insurance agent from which the pet insurance was purchased.

(2) Pet insurance policies shall include a notice prominently printed on the first page, or attached to the first page, that provides specific instructions for canceling the insurance under division (B)(1) of this section. The notice shall include the following statement, or a substantially similar statement:

"You have thirty (30) days from the day you receive this pet insurance policy, rider, or certificate to review it and, if you decide not to keep it, cancel the pet insurance. You do not have to tell the company why you are canceling the insurance. If you decide not to keep the insurance, you may cancel it by giving notice to the company at its administrative office or to the insurance agent from which you bought the insurance. If you cancel the insurance within that time, and have not filed a claim, the company is required by law to grant a full refund within 30 days after it receives your notice of cancellation. The refund will be sent directly to the person who paid for the insurance. The pet insurance policy, rider, or certificate will be void as if it had never been issued."

(C) A pet insurer shall clearly disclose a summary description of the basis or formula on which the pet insurer determines claim payments under the policy. This information shall also be posted through a clear and conspicuous link on the main page of the pet insurer's or pet insurer's program administrator's publicly accessible web site.

(D) A pet insurer that uses a benefit schedule to determine claim payment under a pet insurance policy shall do both of the following:

(1) Clearly disclose the applicable benefit schedule in the policy.

(2) Disclose all benefit schedules used by the pet insurer under its pet insurance policies through a clear and conspicuous link on the main page of the pet insurer's or pet insurer's program administrator's publicly accessible web site.

(E) 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, shall do both of the following:

(1) Include a usual and customary fee limitation provision in the policy or rider that clearly describes the pet insurer's basis for determining usual and customary fees and how that basis is applied in calculating claim payments;

(2) Disclose the pet insurer's basis for determining usual and customary fees through a clear and conspicuous link on the main page of the pet insurer's or pet insurer's program administrator's publicly accessible web site.

(F) If any medical examination by a licensed veterinarian is required to effectuate coverage, the pet insurer shall clearly and conspicuously disclose the required aspects of the examination prior to purchase of a pet insurance policy and, if applicable, disclose that examination documentation may result in a preexisting condition exclusion.

(G) A pet insurer shall clearly and conspicuously disclose to the purchaser any requirements relating to waiting periods.

(H) A pet insurer shall include a summary of all pet insurance provisions required by divisions (A) to (G) of this section in a separate document titled "Insurer Disclosure of Important Policy Provisions," and do both of the following:

(1) Post the document through a clear and conspicuous link on the main page of the pet insurer's or pet insurer's program administrator's publicly accessible web site;

(2) Upon delivery of any new pet insurance policy, provide the purchaser with a copy of the document in at least twelve point font.

(I) At the time a pet insurance policy is issued or delivered to a policyholder, the pet insurer shall include a written disclosure with both of the following:

(1) The address and customer service telephone number of the pet insurer or the agent;

(2) If the policy is issued or delivered by an agent, a statement advising the policyholder to contact the agent for assistance.

(J) The disclosures required by this section are in addition to any other disclosures required by law.

Last updated September 23, 2024 at 12:11 PM

Section 3970.05 | Policy conditions.
 

(A) A pet insurance policy may exclude coverage on the basis of one or more preexisting conditions so long as the pet insurer discloses the exclusion as required by section 3970.04 of the Revised Code. The pet insurer has the burden of proving that the preexisting condition exclusion applies to the condition for which a claim is made.

(B) A condition for which coverage is afforded under a pet insurance policy shall not be considered a preexisting condition under any renewal of that policy.

(C) A pet insurer may issue a pet insurance policy that imposes a waiting period upon effectuation of the policy, subject to all of the following conditions:

(1) The waiting period shall not exceed thirty days for illnesses or orthopedic conditions not resulting from an accident.

(2) The waiting period shall not apply to an accident.

(3) The policy contract shall allow the waiting period to be waived upon completion of a medical examination, to which all of the following apply:

(a) The pet insurer may require the examination to be conducted by a licensed veterinarian after the purchase of the policy.

(b) The medical examination shall be paid for by the policyholder, unless the policy contract specifies that the pet insurer will pay for the examination.

(c) The pet insurer may specify elements to be included as part of the examination and require documentation thereof, provided the specifications do not unreasonably restrict a consumer's ability to waive the waiting period.

(4) The waiting period and all associated requirements are clearly and prominently disclosed to the consumer prior to the purchase of the pet insurance policy.

(5) The waiting period shall not be applied to a renewal of existing coverage.

Last updated September 23, 2024 at 12:12 PM

Section 3970.06 | Wellness programs.
 

(A) No pet insurer shall condition eligibility to purchase pet insurance on participation, or lack of participation, in a separate wellness program.

(B) No pet insurer or agent shall market a wellness program as pet insurance.

(C) If a wellness program is sold by a pet insurer, all of the following apply:

(1) The purchase of the wellness program shall not be a requirement to purchase pet insurance;

(2) The costs of the wellness program shall be separate and identifiable from any premiums or other costs for pet insurance sold by a pet insurer or agent;

(3) The terms and conditions for the wellness program shall be separate from any pet insurance sold by the pet insurer or agent;

(4) The products or coverage available through the wellness program shall not duplicate products or coverage available through the pet insurance;

(5) The advertising of the wellness program shall not be misleading and shall comply with division (C)(6) of this section;

(6) The pet insurer or agent shall clearly disclose both of the following to consumers:

(a) That wellness program is not pet insurance;

(b) The address and customer service telephone number of the pet insurer or agent.

(D)(1) All coverage included in a pet insurance policy is considered insurance, regardless of whether the coverage is described as a wellness benefit.

(2) Except as otherwise provided in division (D)(3) of this section, if a wellness program undertakes to indemnify another party, pays a specified amount upon determinable contingencies, or provides coverage for a fortuitous event, the program is transacting the business of insurance and is subject to the requirements of this chapter and all other applicable laws.

(3) A wellness program contract directly between a service provider and a pet owner that involves only those two parties is not transacting the business of insurance unless the contract has other characteristics of insurance.

Last updated September 23, 2024 at 12:13 PM

Section 3970.07 | Pet insurer training.
 

(A) No pet insurer shall sell, solicit, or negotiate a pet insurance product until after the agent is appropriately licensed and has completed the required training identified in division (C) of this section.

(B) A pet insurer shall ensure that the pet insurer's agents are trained under division (C) of this section and have been appropriately trained on the coverage and conditions of its pet insurance products.

(C) A pet insurer transacting pet insurance shall be trained on the following topics:

(1) Preexisting conditions and waiting periods;

(2) The differences between pet insurance and wellness programs;

(3) Hereditary disorders, congenital anomalies or disorders, and chronic conditions, and how pet insurance policies and riders interact with those conditions or disorders;

(4) Rating, underwriting, renewal, and other related administrative topics.

(D) No additional training is required for a pet insurer or agent that has completed the training requirements of another state, if those requirements are the same or substantially similar to the requirements of this section.

Last updated September 23, 2024 at 12:13 PM

Section 3970.08 | Rules.
 

The superintendent of insurance may adopt rules in accordance with Chapter 119. of the Revised Code for the purposes of administering and enforcing this chapter, which may include penalties for violations of this chapter.

Last updated September 23, 2024 at 12:13 PM