Senate Bill 1338 (2024) — Pet insurance
SB 1338
Florida Bills
Florida Senate - 2024 SB 1338 By Senator DiCeglie 18-00373-24 20241338__ Page 1 of 13 CODING: Words stricken are deletions; words underlined are additions. A bill to be entitled 1
An act relating to pet insurance; creating ch. 644, 2 F.S., to be entitled “Pet Insurance”; providing a 3
short title; creating s. 644.001, F.S.; providing 4 legislative purpose; providing applicability; 5 providing construction; creating s. 644.002, F.S.; 6 defining terms; requiring pet insurers to use certain 7 terms as defined in this act and include such 8
definitions in their policies and on their website or 9 on their program administrator’s website; creating s. 10 644.003, F.S.; requiring pet insurers to disclose 11 certain information; requiring pet insurers to provide 12 a certain
summary description; requiring pet insurers 13 who use a benefit
schedule to disclose certain 14 information; specifying requirements for pet insurers 15 that determine claim payments based on usual and 16 customary fees; specifying requirements if a medical 17 examination by a licensed veterinarian is required to 18 effectuate coverage; requiring pet insurers to provide 19 policyholders with a
summary of policy disclosures and 20 additional disclosures at a specified time; specifying 21 that certain disclosures are in addition to other 22 specified disclosure requirements; authorizing a 23 policyholder to return a pet insurance policy, 24 certificate, or rider and have the full premium 25 refunded under certain circumstances; requiring that 26 pet insurance policies, certificates, and riders must 27 contain a specified notice; creating s. 644.004, F.S.; 28 authorizing a pet insurer to issue policies that 29
Florida Senate - 2024 SB 1338 18-00373-24 20241338__ Page 2 of 13 CODING: Words stricken are deletions; words underlined are additions. exclude coverage on the basis of a preexisting 30 condition under certain circumstances; specifying a 31 burden of proof for pet insurers relating to 32 preexisting conditions; authorizing pet insurers to 33 issue policies that impose certain waiting periods for 34 certain purposes; prohibiting pet insurers from 35 issuing policies with waiting periods for accidents; 36 requiring pet insurers to waive certain waiting 37 periods upon completion of a medical examination; 38 requiring that such waiver be explained in the policy; 39 authorizing pet insurers to require that such 40 examination be conducted by a licensed veterinarian; 41 requiring that such examination be paid for by the 42 policyholder under certain conditions; authorizing pet 43 insurers to make certain specifications and require 44 documentation relating to such examination; 45 prohibiting pet insurers from requiring a medical 46 examination to renew a pet insurance policy; requiring 47 prescriptive, wellness, or noninsurance benefits to 48 conform to certain laws and regulations under certain 49 circumstances; creating s. 644.005, F.S.; prohibiting 50 pet insurers and insurance producers from marketing a 51 wellness program as pet insurance; specifying that 52 coverages listed in an insurance policy are insurance; 53 providing requirements for wellness programs sold by 54 pet insurers or insurance producers; requiring pet 55 insurers and insurance producers to disclose certain 56 information; creating s. 644.006, F.S.; prohibiting 57 insurance producers from selling, soliciting, or 58
Florida Senate - 2024 SB 1338 18-00373-24 20241338__ Page 3 of 13 CODING: Words stricken are deletions; words underlined are additions. negotiating a pet insurance product unless the 59 producer is licensed and has completed certain 60 training; requiring pet insurers to ensure their 61 producers are trained; specifying requirements for 62 such training; providing that training requirements of 63 another state satisfy training requirements in this 64 state under certain conditions; creating s. 644.007, 65 F.S.; requiring the Financial Services Commission to 66 adopt certain rules; specifying that the commission 67 has certain powers of administration and enforcement; 68 providing an effective date. 69 70 Be It Enacted by the Legislature of the State of Florida: 71 72
Section 1.
Chapter 644, Florida Statutes, consisting of ss. 73 644.001-644.007, is created and entitled “Pet Insurance.” 74
Section 2. This act may be cited as the “Pet Insurance 75 Act.” 76
Section
Section 644.001, Florida Statutes, is created to 77 read: 78 644.001 Purpose and scope.— 79
(1) The purpose of this
chapter is to promote the public 80 welfare by creating a comprehensive legal framework within which 81 pet insurance may be sold in this state. 82
(2) This
chapter applies to all of the following: 83 (
a) Pet insurance policies that are issued to any resident 84 of this state or that are sold, solicited, negotiated, or 85 offered in this state. 86 (
b) Pet insurance policies or certificates that are 87
Florida Senate - 2024 SB 1338 18-00373-24 20241338__ Page 4 of 13 CODING: Words stricken are deletions; words underlined are additions. delivered or issued for delivery in this state. 88
(3) All other applicable provisions of the insurance laws 89 of this state continue to apply to pet insurance except that the 90 specific provisions of this
chapter supersede any general 91 provisions of law which would otherwise be applicable to pet 92 insurance. 93
(4) This
chapter may not be construed to prohibit or limit 94 the types of exclusions pet insurers may use in their policies 95 or require pet insurers to have any of the limitations or 96 exclusions specified in s. 644.003. 97
Section
Section 644.002, Florida Statutes, is created to 98 read: 99 644.002
Definitions.— 100
(1) As used in this chapter, the term: 101 (a) “Chronic condition” means a condition that can be 102 treated or managed, but not cured. 103 (b) “Commission” means the Financial Services Commission. 104 (c) “Congenital anomaly or disorder” means a condition that 105 is present from birth, whether inherited or caused by the 106 environment, which may cause or contribute to illness or 107 disease. 108 (d) “Department” means the Department of Financial 109 Services. 110 (e) “Hereditary disorder” means an abnormality that is 111 genetically transmitted from parent to offspring and may cause 112 illness or disease. 113 (f) “Orthopedic” refers to conditions affecting the bones, 114 skeletal muscle, cartilage, tendons, ligaments, or joints.
It 115 includes, but is not limited to, elbow dysplasia, hip dysplasia, 116
Florida Senate - 2024 SB 1338 18-00373-24 20241338__ Page 5 of 13 CODING: Words stricken are deletions; words underlined are additions. intervertebral disc degeneration, patellar luxation, and 117 ruptured cranial cruciate ligaments.
It does not include cancers 118 or metabolic, hemopoietic, or autoimmune diseases. 119 (g) “Pet insurance” means a property insurance policy that 120 provides coverage for accidents and illnesses of pets. 121 (h)1. “Preexisting condition” means any condition for which 122 any of the following are true before the effective date of a pet 123 insurance policy or during any waiting period: 124 a. A veterinarian provided medical advice. 125 b. The pet received treatment. 126 c.
Based on information from verifiable sources, the pet 127 had signs or symptoms directly related to the condition for 128 which a claim is being made. 129 2.
A preexisting condition does not include a condition 130 that was covered under a preceding policy period before the 131 renewal of the policy so long as there was no break in the 132 superseding policy period. 133 (i) “Renewal” means the issuing and delivering at the end 134 of an insurance policy period a policy which supersedes a policy 135 previously issued and delivered by the same pet insurer or 136 affiliated pet insurer and which provides types and limits of 137 coverage substantially similar to those contained in the policy 138 being superseded. 139 (j) “Veterinarian” means an individual who holds a valid 140 license to practice veterinary medicine from the appropriate 141 licensing entity in the jurisdiction in which he or she 142 practices. 143 (k) “Waiting period” means the period of time specified in 144 a pet insurance policy which is required to transpire before 145
Florida Senate - 2024 SB 1338 18-00373-24 20241338__ Page 6 of 13 CODING: Words stricken are deletions; words underlined are additions. some or all of the coverage in the policy can begin. Waiting 146 periods may not be applied to renewals of existing coverage. 147 (l) “Wellness program” means a subscription-based or 148 reimbursement-based program that is separate from an insurance 149 policy which provides goods and services to promote the general 150 health, safety, or well-being of the pet. 151
(2) If a pet insurer uses any of the terms defined in this 152
section in a pet insurance policy, the pet insurer must use the 153 terms as they are defined in this
section and include the 154
definitions of those terms in the policy. The pet insurer shall 155 also make the
definitions of all of the terms used in its pet 156 insurance policy which are defined in this
section available 157 through a clear and conspicuous link on the main page of the pet 158 insurer’s or the pet insurer’s program administrator’s website. 159
Section
Section 644.003, Florida Statutes, is created to 160 read: 161 644.003 Required disclosures; right to return.— 162
(1) A pet insurer shall disclose all of the following to 163 consumers: 164 (a)1. Whether the policy excludes coverage due to any of 165 the following: 166 a. A preexisting condition. 167 b. A hereditary disorder. 168 c. A congenital anomaly or disorder. 169 d. A chronic condition. 170 2. If the policy includes any other exclusions not listed 171 in subparagraph 1., the pet insurer must state the following in 172 the disclosure: “Other exclusions may apply. Please refer to the 173 exclusions
section of the policy for more information.” 174
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b) Any policy provision that limits coverage through a 175 waiting or affiliation period, a deductible, coinsurance, or an 176 annual or lifetime policy limit. Waiting periods and the 177 requirements applicable to them must be clearly and prominently 178 disclosed to consumers before the policy purchase. 179 (
c) Whether the pet insurer reduces coverage or increases 180 premiums based on the insured’s claim history, the age of the 181 covered pet, or a change in the geographic location of the 182 insured. 183 (
d) Whether the underwriting company differs from the brand 184 name used to market and sell the product. 185
(2) Before issuing a pet insurance policy, a pet insurer 186 shall provide, through a clear and conspicuous link on the main 187 page of the pet insurer’s website or the website of the 188 insurer’s program administrator, a
summary description of the 189 basis or formula for the pet insurer’s determination of claim 190 payments under the policy. 191
(3) A pet insurer that uses a benefit
schedule to determine 192 claim payments under a pet insurance policy must clearly 193 disclose both of the following: 194 (
a) The applicable benefit
schedule in the policy. 195 (
b) All benefit schedules used by the pet insurer under its 196 pet insurance policies through a clear and conspicuous link on 197 the main page of the pet insurer’s or pet insurer’s program 198 administrator’s website. 199
(4) A pet insurer that determines claim payments under a 200 pet insurance policy based on usual and customary fees, or any 201 other reimbursement limitation based on prevailing veterinary 202 service provider charges, shall do both of the following: 203
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a) Include a usual and customary fee limitation provision 204 in the policy which clearly describes the pet insurer’s basis or 205 formula for determining usual and customary fees and how that 206 basis or formula is applied in calculating claim payments. 207 (
b) Disclose the pet insurer’s basis for determining usual 208 and customary fees through a clear and conspicuous link on the 209 main page of the pet insurer’s or pet insurer’s program 210 administrator’s website. 211
(5) If any medical examination by a licensed veterinarian 212 is required to effectuate coverage, the pet insurer must clearly 213 and conspicuously disclose the required aspects of the 214 examination before the policy is purchased and must disclose 215 that examination documentation may result in a preexisting 216 condition exclusion. 217
(6) A pet insurer shall include a
summary of all policy 218 disclosures required in subsections (1)-(5) in a separate 219 document titled “Insurer Disclosure of Important Policy 220 Provisions.” The pet insurer shall post the document by way of a 221 clear and conspicuous link on the main page of the pet insurer’s 222 or pet insurer’s program administrator’s website. 223
(7) At the time a pet insurance policy is issued or 224 delivered to a policyholder, the pet insurer shall provide the 225 policyholder with a copy of the Insurer Disclosure of Important 226 Policy Provisions document required under subsection (6) in at 227 least 12-point type. At such time, the pet insurer shall also 228 include a written disclosure with all of the following 229 information: 230 (
a) The department’s mailing address, toll-free telephone 231 number, and website. 232
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b) The address and customer service telephone number of 233 the pet insurer or the insurance producer. 234 (
c) If the policy was issued or delivered by an agent or a 235 broker, a statement advising the policyholder to contact the 236 agent or broker for assistance. 237
(8) The disclosures required in this
section are in 238 addition to any other disclosures required by law, rule, or 239 regulation. 240 (9)(
a) Unless a policyholder has filed a claim, the 241 policyholder has the right to return the pet insurance policy, 242 certificate, or rider to the insurer within 30 days after his or 243 her receipt of the pet insurance policy, certificate, or rider 244 and to have the full premium refunded if, after examination of 245 the policy, certificate, or rider, the policyholder is not 246 satisfied for any reason. 247 (
b) Pet insurance policies, certificates, and riders must 248 have a notice prominently printed on the first page or attached 249 thereto which includes specific instructions to accomplish a 250 return under paragraph (a). The notice must state, in 251 substantially similar form, the following: 252 253 You have 30 days from the day you receive this policy, 254 certificate, or rider to review it and return it to 255 the insurer if you decide not to keep it. You do not 256 have to tell the insurer why you are returning it.
If 257 you decide not to keep it, simply return it to the 258 insurer at its administrative office or return it to 259 the agent/insurance producer that you bought it from 260 as long as you have not filed a claim. You must return 261
Florida Senate - 2024 SB 1338 18-00373-24 20241338__ Page 10 of 13 CODING: Words stricken are deletions; words underlined are additions. it within 30 days after the day you first received it. 262 The insurer will refund the full amount of any premium 263 paid within 30 days after it receives the returned 264 policy, certificate, or rider. The premium refund will 265 be sent directly to the person who paid it. The 266 policy, certificate, or rider will be void as if it 267 had never been issued. 268
Section
Section 644.004, Florida Statutes, is created to 269 read: 270 644.004 Policy restrictions.— 271
(1) A pet insurer may issue policies that exclude coverage 272 on the basis of one or more preexisting conditions with 273 appropriate disclosure to the consumer pursuant to s. 644.003. 274 The pet insurer has the burden of proving that the preexisting 275 condition exclusion applies to the condition for which a claim 276 is being made. 277 (2)(
a) A pet insurer may issue policies that impose waiting 278 periods upon effectuation of the policy which do not exceed 30 279 days for illnesses or orthopedic conditions not resulting from 280 an accident. A pet insurer may not issue policies that impose 281 waiting periods for accidents. 282 (
b) A pet insurer that imposes a waiting period permitted 283 in paragraph (
a) shall waive the waiting period upon completion 284 of a medical examination. The pet insurer shall include a 285 provision in its policy which explains such waiver. Pet insurers 286 may require that such examination be conducted by a licensed 287 veterinarian after the purchase of the policy. 288 (
c) The policyholder must pay for the medical examination 289 under paragraph (
b) unless the policy specifies that the pet 290
Florida Senate - 2024 SB 1338 18-00373-24 20241338__ Page 11 of 13 CODING: Words stricken are deletions; words underlined are additions. insurer will pay for the examination. 291 (
d) A pet insurer may specify elements to be included as 292 part of the examination under paragraph (
b) and require 293 documentation that such elements were included, provided the 294 specifications do not unreasonably restrict the ability to waive 295 the waiting periods as provided in paragraph (b). 296
(3) A pet insurer may not require a medical examination by 297 a veterinarian of the covered pet for the insured to renew the 298 policy. 299
(4) If a pet insurer includes any prescriptive, wellness, 300 or noninsurance benefits in the pet insurance policy, such 301 benefits are made part of the policy and must conform to all 302 applicable laws and regulations in the insurance code. 303
Section
Section 644.005, Florida Statutes, is created to 304 read: 305 644.005 Sales practices for wellness programs.— 306
(1) A pet insurer or an insurance producer may not market a 307 wellness program as pet insurance. Coverages included in the pet 308 insurance policy described as wellness benefits are insurance. 309
(2) If a wellness program is sold by a pet insurer or an 310 insurance producer, all of the following conditions must be met: 311 (
a) The purchase of the wellness program may not be a 312 requirement for the purchase of pet insurance. 313 (
b) The costs of the wellness program must be separate and 314 identifiable from any pet insurance policy sold by a pet insurer 315 or an insurance producer. 316 (
c) The terms and conditions for the wellness program must 317 be separate from any pet insurance policy sold by a pet insurer 318 or an insurance producer. 319
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d) The products or coverages available through the 320 wellness program may not duplicate products or coverages 321 available through the pet insurance policy. 322 (
e) The advertising of the wellness program may not be 323 misleading and must be in accordance with subsection (3). 324
(3) A pet insurer or an insurance producer shall clearly 325 disclose all of the following to consumers, printed in 12-point 326 boldface type: 327 (
a) That wellness programs are not insurance. 328 (
b) The address and customer service telephone number of 329 the pet insurer or producer. 330 (
c) The department’s mailing address, toll-free telephone 331 number, and website address. 332
Section
Section 644.006, Florida Statutes, is created to 333 read: 334 644.006 Insurance producer training.— 335
(1) An insurance producer may not sell, solicit, or 336 negotiate a pet insurance product until after the producer is 337 appropriately licensed and has completed the required training 338 identified in subsection (3). 339
(2) Insurers shall ensure that its producers are trained 340 under subsection (3) and that its producers have been 341 appropriately trained on the coverages and conditions of its pet 342 insurance products. 343
(3) The training required under this
section must include 344 information on all of the following topics: 345 (
a) Preexisting conditions and waiting periods. 346 (
b) The differences between pet insurance and noninsurance 347 wellness programs. 348
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c) Hereditary disorders, congenital anomalies or 349 disorders, and chronic conditions and how pet insurance policies 350 interact with those conditions or disorders. 351 (
d) Rating, underwriting, renewal, and other related 352 administrative topics. 353
(4) If an insurance producer satisfies the training 354 requirements of another state which are substantially similar to 355 the provisions of subsection (3), the producer is deemed to have 356 satisfied the training requirements in this state. 357
Section
Section 644.007, Florida Statutes, is created to 358 read: 359 644.007 Rulemaking authority and enforcement.—The 360 commission shall adopt rules to administer this
chapter and has 361 the same powers of administration and enforcement of this 362
chapter as it has with respect to casualty or surety insurers in 363 general under the Florida Insurance Code. 364