Florida Senate - 2024 COMMITTEE AMENDMENT
Bill No. SB 1338
Ì159918TÎ159918
LEGISLATIVE ACTION
Senate . House
Comm: RCS .
02/08/2024 .
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The Committee on Banking and Insurance (DiCeglie) recommended
the following:
1 Senate Amendment (with title amendment)
2
3 Delete everything after the enacting clause
4 and insert:
5 Section 1. Section 624.604, Florida Statutes, is amended to
6 read:
7 624.604 “Property insurance” defined.—“Property insurance”
8 is insurance on real or personal property of every kind and of
9 every interest therein, whether on land, water, or in the air,
10 against loss or damage from any and all hazard or cause, and
11 against loss consequential upon such loss or damage, other than
12 noncontractual legal liability for any such loss or damage.
13 Property insurance may include pet insurance that provides
14 coverage for accidents and for illnesses or diseases of pets.
15 Property insurance may contain a provision for accidental death
16 or injury as part of a multiple peril homeowner’s policy. Such
17 insurance, which is incidental to the property insurance, is not
18 subject to the provisions of this code applicable to life or
19 health insurance. Property insurance does not include title
20 insurance, as defined in s. 624.608.
21 Section 2. Paragraph (hh) is added to subsection (1) of
22 section 626.9541, Florida Statutes, to read:
23 626.9541 Unfair methods of competition and unfair or
24 deceptive acts or practices defined.—
25 (1) UNFAIR METHODS OF COMPETITION AND UNFAIR OR DECEPTIVE
26 ACTS.—The following are defined as unfair methods of competition
27 and unfair or deceptive acts or practices:
28 (hh) Sales practices for pet wellness programs.—
29 1. A pet insurance agent may not market a wellness program
30 as pet insurance.
31 2. If a wellness program is sold by a pet insurance agent:
32 a. The purchase of the wellness program may not be a
33 prerequiste to the purchase of pet insurance;
34 b. The costs of the wellness program must be separate and
35 identifiable from any pet insurance policy sold by the pet
36 insurance agent;
37 c. The terms and conditions of the wellness program must be
38 separate from any pet insurance policy sold by the agent;
39 d. The products or coverages available through the wellness
40 program may not duplicate the products or coverages available
41 through the pet insurance policy; and
42 e. The advertising of the wellness program must not be
43 misleading.
44 Section 3. Section 627.71545, Florida Statutes, is created
45 to read:
46 627.71545 Pet insurance; noninsurance wellness programs.—
47 (1) This section may be cited as the “Pet Insurance Act.”
48 (2) The purpose of this section is to promote the public
49 welfare by creating a comprehensive regulatory framework within
50 which pet insurance may be sold in this state.
51 (3) This section applies to all of the following:
52 (a) Pet insurance policies that are issued to any resident
53 of this state or that are sold, solicited, negotiated, or
54 offered in this state.
55 (b) Pet insurance policies or certificates that are
56 delivered or issued for delivery in the state.
57 (4)(a) This section may not be construed to prohibit or
58 limit the types of exclusions pet insurers may use in their
59 policies or to require pet insurers to include in such policies
60 any of the limitations or exclusions specified in subsection
61 (9).
62 (b) All other applicable provisions of the Florida
63 Insurance Code apply to pet insurance, except that this section
64 supersedes any general provisions of the Florida Insurance Code
65 which otherwise apply to pet insurance.
66 (5)(a) As used in this section, the term:
67 1. “Chronic condition” means a condition that can be
68 treated or managed, but not cured.
69 2. “Congenital anomaly or disorder” means a condition that
70 is present from birth, whether inherited or caused by the
71 environment, and that may cause or contribute to illness or
72 disease.
73 3. “Hereditary disorder” means an abnormality that is
74 genetically transmitted from parent to offspring and may cause
75 illness or disease.
76 4. “Orthopedic” refers to a condition that affects the
77 bones, skeletal muscle, cartilage, tendons, ligaments, or
78 joints. Orthopedic conditions include, but are not limited to,
79 elbow dysplasia, hip dysplasia, intervertebral disc
80 degeneration, patellar luxation, and cranial cruciate ligament
81 rupture but do not include any cancer or any metabolic,
82 hematopoietic, or autoimmune disease.
83 5. “Pet insurance” means an insurance policy that provides
84 coverage for accidents and for illnesses and diseases of pets.
85 Such insurance reimburses a policyholder for expenses associated
86 with medical advice, diagnosis, care, or treatment provided by a
87 veterinarian, including, but not limited to, the cost of drugs
88 prescribed by the veterinarian.
89 6. “Pet insurance policy” or “policy” includes pet
90 insurance certificates.
91 7. “Preexisting condition” means a condition for which any
92 of the following is true before the effective date or during a
93 waiting period applicable to a pet insurance policy:
94 a. A veterinarian provided medical advice.
95 b. The pet received previous treatment.
96 c. Based on information from verifiable sources, the pet
97 had signs or symptoms directly related to the condition for
98 which a claim is being made.
99
100 A condition for which coverage is afforded on a policy is not
101 deemed to be a preexisting condition on any renewal of the
102 policy.
103 8. “Renewal” means the issuance and delivery at the end of
104 an insurance policy period of a policy that supersedes the
105 policy previously issued and delivered by the same pet insurer
106 or affiliated pet insurer and that provides types and limits of
107 coverage substantially similar to those contained in the policy
108 being superseded.
109 9. “Veterinarian” means a health care practitioner who is
110 licensed to engage in the practice of veterinary medicine in
111 Florida under chapter 474.
112 10. “Waiting period” means the period of time specified in
113 a pet insurance policy which is required to run before some or
114 all of the coverage in the policy may begin. This period may not
115 be applied to renewals of existing coverage.
116 11. “Wellness program” means a subscription or
117 reimbursement-based program that is separate from an insurance
118 policy and that provides goods and services to promote the
119 general health, safety, or well-being of the covered pet. If the
120 subscription or program includes language such as “undertakes to
121 indemnify another,” “pays a specified amount upon determinable
122 contingencies,” or “provides coverage for a fortuitous event,”
123 the subscription or program is transacting in the business of
124 insurance and is subject to the Florida Insurance Code. This
125 definition is not intended to classify a contract directly
126 between a service provider and a pet owner which involves only
127 the two parties as being the business of insurance, unless other
128 indications of insurance also exist.
129 (b) If a pet insurer uses any of the terms defined in
130 paragraph (a) in a pet insurance policy, the pet insurer must
131 use the definition of each term as provided in paragraph (a) and
132 must include each such definition in the policy. The pet insurer
133 must also make such definitions available through a clear and
134 conspicuous link on the main page of the website of the pet
135 insurer or the pet insurer’s program administrator.
136 (6)(a) A pet insurer transacting pet insurance must
137 disclose the following to pet insurance applicants and
138 policyholders:
139 1. Whether the policy excludes coverage due to any of the
140 following:
141 a. A chronic condition;
142 b. A congenital anomaly or disorder;
143 c. A hereditary disorder; or
144 d. A preexisting condition.
145 2. If the policy includes any other exclusions not listed
146 in subparagraph 1., the pet insurer must state the following in
147 the disclosure: “Other exclusions may apply. Please refer to the
148 exclusions section of the policy for more information.”
149 3. Any policy provision that limits coverage through a
150 waiting period, a deductible, a coinsurance payment, or an
151 annual or lifetime policy limit. Waiting periods and applicable
152 requirements must be clearly and prominently disclosed to
153 applicants before the policy purchase.
154 4. Whether the pet insurer reduces coverage or increases
155 premium based on the policyholder’s claim history, the age of
156 the covered pet, or a change in the geographic location of the
157 policyholder.
158 5. Whether the underwriting company differs from the brand
159 name used to market and sell the pet insurance.
160 (b) Before issuing a pet insurance policy, a pet insurer
161 shall, through a clear and conspicuous link on the main page of
162 the pet insurer’s or the pet insurer’s program administrator’s
163 website, provide a summary description of the basis or formula
164 for the pet insurer’s determination of claim payments under the
165 policy.
166 1. A pet insurer that uses a benefit schedule to determine
167 claim payments under a pet insurance policy must clearly
168 disclose both of the following:
169 a. The applicable benefit schedule in the policy.
170 b. All benefit schedules used by the pet insurer under its
171 pet insurance policies through a clear and conspicuous link on
172 the main page of the pet insurer’s or pet insurer’s program
173 administrator’s website.
174 2. A pet insurer that determines claim payments under a pet
175 insurance policy based on usual and customary fees, or any other
176 reimbursement limitation based on prevailing veterinary service
177 provider charges, shall do both of the following:
178 a. Include a usual and customary fee limitation provision
179 in the policy which clearly describes the pet insurer’s basis or
180 formula for determining usual and customary fees and the manner
181 in which that basis or formula is applied in calculating claim
182 payments.
183 b. Disclose the pet insurer’s basis for determining usual
184 and customary fees through a clear and conspicuous link on the
185 main page of the pet insurer’s or pet insurer’s program
186 administrator’s website.
187 (c) If any medical examination of the pet by a veterinarian
188 is required to effectuate coverage, the pet insurer must clearly
189 and conspicuously disclose any requirement for the examination
190 before the policy is purchased and must disclose that
191 examination documentation may result in a preexisting condition
192 exclusion.
193 (d) A pet insurer shall create a summary of all policy
194 disclosures required in paragraphs (a), (b), and (c) in a
195 separate document titled “Insurer Disclosure of Important Policy
196 Provisions.” The pet insurer shall post the document through a
197 clear and conspicuous link on the main page of the pet insurer’s
198 or pet insurer’s program administrator’s website.
199 (e) At the time a pet insurance policy is issued or
200 delivered to a policyholder, the pet insurer shall provide the
201 policyholder with a copy of the Insurer Disclosure of Important
202 Policy Provisions document required under paragraph (d), in at
203 least 12-point type. At such time, the pet insurer shall also
204 include a written disclosure with all of the following:
205 1. Contact information for the Division of Consumer
206 Services of the department, including a link and toll-free
207 telephone number, for consumers to submit inquiries and
208 complaints relating to pet insurance products regulated by the
209 department or office.
210 2. The address and customer service telephone number of the
211 pet insurance agent.
212 (f) The disclosures required in this subsection are in
213 addition to any other disclosures required by the insurance code
214 or rules prescribed by the commission.
215 (7) Unless the policyholder has filed a claim under the pet
216 insurance policy, a pet insurance applicant or policyholder may
217 examine and return the policy or rider to the pet insurer or pet
218 insurance agent or broker within 30 days after the applicant or
219 policyholder obtains the receipt and is entitled to the premium
220 refunded if, after examining the policy or rider, he or she is
221 not satisfied for any reason.
222 (8) A pet insurance policy and rider must have a notice
223 prominently printed on or attached to the first page which
224 includes specific instructions to accomplish a return, in type
225 at least as large as any type appearing on the policy or rider
226 contract and in substantially the following language:
227
228 You have 30 days from the day you receive this policy,
229 certificate, or rider to review it and return it to
230 the company if you decide not to keep it. You do not
231 have to tell the company why you are returning it. If
232 you decide not to keep policy, certificate, or rider,
233 simply return it to the company at its administrative
234 office or return it to the insurance agent or broker
235 who you bought it from as long as you have not filed a
236 claim. You must return policy, certificate, or rider
237 within 30 days after the day you first received it in
238 order to receive a refund. The company must refund the
239 full amount of any premium paid within 30 days after
240 it receives the returned policy, certificate, or
241 rider. The premium refund will be sent directly to the
242 person who paid it. The policy, certificate, or rider
243 will be void as if it had never been issued.
244
245 (9)(a) A pet insurer may issue a policy that excludes
246 coverage on the basis of one or more preexisting conditions with
247 appropriate written disclosure to the applicant or policyholder.
248 The pet insurer has the burden of proving that the preexisting
249 condition exclusion applies to the condition for which a claim
250 is being made.
251 (b)1. A pet insurer may issue a policy imposing a waiting
252 period before the effective date of a new policy which does not
253 exceed 30 days for illnesses or diseases or for orthopedic
254 conditions not resulting from an accident. A pet insurer may not
255 issue a policy imposing a waiting period for accidents.
256 2. A pet insurer issuing a policy that imposes a waiting
257 period shall include a provision in its contract which allows
258 the waiting period to be waived upon completion of a medical
259 examination of the pet by a veterinarian. The pet insurer may
260 require the examination to be conducted by a veterinarian after
261 the purchase of the policy.
262 a. A medical examination required under this subparagraph
263 must be paid for by the policyholder, unless the policy
264 specifies that the pet insurer will pay for the examination.
265 b. A pet insurer may specify requirements for the
266 examination and require documentation that the requirements have
267 been satisfied, provided that the specifications do not
268 unreasonably restrict the ability of the applicant or
269 policyholder to waive the waiting period.
270 (c) A pet insurer may not require a medical examination of
271 the covered pet for the policyholder to renew a policy.
272 (d) If a pet insurer includes any prescriptive, wellness,
273 or noninsurance benefit in the policy form, the benefit is made
274 part of the policy contract and must comply with all of the
275 applicable provisions of the Florida Insurance Code.
276 (e) An applicant’s eligibility to purchase a pet insurance
277 policy may not be based on his or her participation, or lack of
278 participation, in a separate wellness program.
279 (10)(a) Pet insurers must ensure that its agents are
280 trained on the topics specified in paragraph (b) and that its
281 agents have been appropriately trained on the coverages and
282 conditions of its pet insurance products.
283 (b) The training required under this subsection must
284 include information on all of the following topics:
285 1. Preexisting conditions and waiting periods.
286 2. The differences between pet insurance and noninsurance
287 wellness programs.
288 3. Chronic conditions, congenital anomalies or disorders,
289 and hereditary disorders and the way pet insurance policies
290 address those conditions or disorders.
291 4. Rating, underwriting, renewal, and other related
292 administrative topics.
293 (11) The commission may adopt rules necessary to administer
294 this section.
295 Section 4. This act shall take effect January 1, 2025.
296
297 ================= T I T L E A M E N D M E N T ================
298 And the title is amended as follows:
299 Delete everything before the enacting clause
300 and insert:
301 A bill to be entitled
302 An act relating to ; providing an effective date.