Chapter recap
Pet Insurance
Pet insurance definitions: congenital, hereditary, chronic
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Congenital = present from birth (inherited OR environmental).
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Hereditary = genetically transmitted from parent to offspring.
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Chronic = can be treated or managed, but not cured.
What pet insurance pays for: veterinary expenses
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Veterinary expenses = medical advice, diagnosis, care or treatment by a veterinarian, including prescribed drugs.
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Outline cites §12880(g); current text is §12880(k) and adds dental care and supervised services.
Required disclosures: exclusions, limits and claim history
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Disclose 4 exclusions: preexisting, hereditary, congenital, chronic.
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Disclose limits: waiting period, deductible, coinsurance, annual or lifetime limit.
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Disclose whether claim history reduces coverage or raises premium.
How claims are calculated: formula, benefit schedule, usual and customary
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Claim formula: summary in the policy + link on the website main page.
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Benefit schedule: applicable one in the policy; all of them on the website.
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Usual and customary: policy provision explaining the basis + website link.
The Insurer Disclosure document and the 30-day free look
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"Insurer Disclosure of Important Policy Provisions": website link + with a new policy in at least 12-point type.
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Free look: at least 30 days; return to the insurer or the selling agent.
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Refund within 30 days; no free look once a claim is paid or promised in writing.
The 12-point boldface notice: who to call, and in what order
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§12880.6 notice: 12-point boldface, at issue or delivery.
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Includes the department's address, toll-free number and website, plus insurer or agent contacts.
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Contact the department only after the insurer or agent fails to resolve the problem.
Enforcement: hearings and penalties
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Hearing: not less than 30 days after the order to show cause is served.
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Penalty: up to $5,000 per violation; up to $10,000 if willful.
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Proved charges also bring a cease and desist order.
CA
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