An Act Regarding Pet Insurance
Maine Legislature, Session 130, LD 0482
Committee Amendment CA_A_S460 (Senate)

COMMITTEE AMENDMENT"~" to S.P. 186, L.D. 482, "An Act Regarding Pet 
Insurance" 
Amend the bill by striking out everything after the enacting clause and inserting the 
following: 
'Sec. 1. 24-A MRSA c. 44 is enacted to read: 
CHAPTER 44 
PET INSURANCE 
§3151. Short title 
This chapter may be known an_d cited as "the Pet Insurance Act." 
§3152. Scope and applicability 
This chapter establishes requirements for the sale, solicitation, negotiation or offer of 
pet insurance in this State. 
1. Applicability. The requirements of this chapter apply to pet insurance policies that 
are sold, solicited, negotiated or offered in this State and that are issued to any resident of 
this State and to policies or certificates that are delivered or issued for delivery in this State. 
2. General provisions of Title 24-A. All applicable provisions of this Title apply to 
pet insurance, except that the specific provisions of this chapter supersede any general 
provisions of this Title that would otherwise be applicable to pet insurance. 
§3153. Definitions 
As used in this chapter, unless the context otherwise indicates, the following terms 
have the following meanings. 
1. Chronic condition. "Chronic condition" means a condition that can be treated or 
managed, but not cured. 
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COMMITTEE AMENDMENT" A "to S.P. 186, L.D. 482 ( .5- '--I le~ 
2. Congenital anomaly or disorder. "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. 
3. Hereditary disorder. 
"Hereditary disorder" means an abnormality that is 
genetically transmitted from parent to offspring and may cause illness or disease. 
4. Orthopedic. "Orthopedic" refers to conditions affecting the bones, skeletal muscle, 
cartilage, tendons, ligaments and joints, including, but not limited to, elbow dysplasia, hip 
dysplasia, intervertebral disc degeneration, patellar luxation and cranial cruciate ligament 
ruptures but not including cancers or metabolic, hemopoietic or autoimmune diseases. 
5. Pet insurance. "Pet insurance" means property insurance that provides coverage 
for accidents and illnesses of pets. 
6. Preexisting condition. "Preexisting condition" means a condition for which any of 
the following are true prior to the effective date of a pet insurance policy or during a waiting 
period: 
A. A veterinarian provided medical advice regarding the condition; 
B. The pet received previous treatment for the condition; or 
C. Based on information from verifiable sources, the pet had signs or symptoms 
directly related to the condition for which a claim is being made. 
7. Renewal. "Renewal" means to issue and deliver at the end of an insurance policy 
period a policy that supersedes a policy previously issued and delivered by the same insurer 
or an affiliated insurer and that provides types and limits of coverage substantially similar 
to those contained in the policy being superseded. 
8. Veterinarian. "Veterinarian" means an individual who holds a valid license to 
practice veterinary medicine from the appropriate licensing entity in the jurisdiction in 
which the individual practices. 
9. Veterinary expenses. "Veterinary expenses" means the costs associated with 
medical advice, diagnosis, care or treatment provided by a veterinarian, including, but not 
limited to, the cost of drugs prescribed by a veterinarian. 
10. Waiting period. "Waiting period" means the period of time specified in a pet 
insurance policy that is required to transpire before some or all of the coverage in the policy 
begins. 
11. Wellness program. 
"Wellness program" means a subscription-based or 
reimbursement-based program that is separate from an insurance policy and that provides 
goods and services to promote the general health, safety or well-being of a pet. 
§3154. Policy definitions and exclusions 
1. Use of defined terms. If an insurer uses any of the terms that are defined in section 
3153 in a pet insurance policy, the insurer shall use the definition of each of those terms as 
set forth in section 3153 and include the definition of those terms in the policy. The insurer 
shall also make the definition available through a clear and conspicuous link on the main 
page of the insurer's or insurer's program administrator's publicly accessible website. 
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COMMITTEE AMENDMENT" A "to S.P. 186, L.D. 482 ( S-L/ (.Q b) 
2. Exclusions. This chapter does not limit or prohibit the types of exclusions an insurer 
may use in a pet insurance policy or require an insurer to include any of the limitations or 
exclusions described rn section 3155. 
§3155. Required disclosures 
1. Disclosures. An insurer transacting pet insurance' shall disclose to consumers: 
A. Whether the policy excludes coverage due to any of the following: 
(1) A preexisting condition; 
(2) A hereditary disorder; 
(3) A congenital anomaly or disorder; or 
( 4) A chronic condition; 
B. Whether the policy includes any other exclusions and, if so, add the following 
statement: "Other exclusions may apply. Please refer to the exclusions section of the 
policy for more information."; 
C. Any policy provision that limits coverage through a waiting period or affiliation 
period, a deductible, coinsurance or an annual or lifetime policy limit; 
D. Whether the 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; and 
E. Whether the underwriting company differs from the brand name used to market and 
sell the product. 
2. Right to examine and return a policy. Unless the insured has filed a claim under 
a pet insurance policy, an applicant for pet insurance has the right to examine and return a 
policy, certificate or rider to the insurer or the insurer's producer within 15 days of its 
receipt and to have the premium refunded if, after examination of the policy, certificate or 
rider, the applicant is not satisfied for any reason. A pet insurance policy, certificate or 
rider must have a notice prominently printed on or attached to the first page including 
specific instructions for returning a policy. 
The following statement or language 
substantially similar to the following statement must be included: 
"You have 15 days from the day you receive this policy, certificate or rider to 
review it and return it to the company if you decide not to keep it. You do not 
have to tell the company why you are returning it. If you decide not to keep it, 
simply return it to the company at its administrative office or you may return 
it to the insurance producer that you bought it from as long as you have not 
filed a claim. You must return it within 15 days of the day you first received 
it. The company will refund the full amount of any premium paid within 3 0 
days after it receives the returned policy, certificate or rider. The premium 
refund will be sent directly to the person who paid it. The policy, certificate 
or rider will be void as if it had never been issued." 
3. Basis for claims payments. An insurer shall clearly disclose a summary description 
of the basis on or formula by which the insurer determines claim payments under a pet 
insurance policy within the policy, prior to issuance of the policy and through a clear and 
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COMMIITEEAMENDMENT"A "to S.P. 186, L.D. 482 (S-Clui b') 
conspicuous link on the main page of the insurer's or insurer's program administrator's 
publicly accessible website. 
4. Use of benefit schedule. An insurer that uses a benefit schedule to determine claim 
payments under a pet insurance policy shall: 
A. Clearly disclose the applicable benefit schedule in the policy; and 
B. Disclose all benefit schedules used by the insurer under its pet insurance policies 
through a clear and conspicuous link on the main page of the insurer's or insurer's 
program administrator's publicly accessible website. 
5. Fees. An 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 expenses, shall: 
A. Include a usual and customary fee limitation provision in the policy that clearly 
describes the insurer's basis for determining usual and customary fees and how that 
basis is applied in calculating claim payments; and 
B. Disclose the insurer's basis for determining usual and customary fees through a clear 
and conspicuous link on the main page of the insurer's or insurer's program 
administrator's publicly accessible website. 
6. Medical examination. If a medical examination by a licensed veterinarian is 
required to effectuate coverage under a pet insurance policy, the insurer shall clearly and 
conspicuously disclose the required aspects of the examination prior to purchase and 
disclose that documentation of the examination may result in a preexisting condition 
exclusion. 
7. Waiting period. A waiting period and any applicable requirements for that waiting 
period must be clearly and prominently disclosed to consumers prior to the pet insurance 
policy purchase. 
8. Summary of policy provisions. An insurer shall include a summary of all policy 
provisions required in this section in a separate document titled "Insurer Disclosure of 
Important Policy Provisions." The insurer shall post the "Insurer Disclosure of Important 
Policy Provisions" document required in this subsection through a clear and conspicuous 
link on the main page of the insurer's or insurer's program administrator's publicly 
accessible website. In connection with the issuance of a new pet insurance policy, the 
insurer shall provide the consumer with a copy of the "Insurer Disclosure of Important 
Policy Provisions" document required in this subsection in at least 12-point type upon 
delivery of the policy. 
9. Written disclosure. At the time a pet insurance policy is issued or delivered to a 
policyholder, the insurer shall include a written disclosure with the following information, 
printed in 12-point boldface type: 
A. The bureau's mailing address and toll-free telephone number and a link to the 
bureau's publicly accessible website; 
B. The address and customer service telephone number of the insurer or the producer 
of record; and 
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COMMITTEE AMENDMENT" fi- "to S.P. 186, L.D. 482 LS- G\ loDy 
C. If the policy was issued or delivered by a producer, a statement advising the 
policyholder how to contact the producer for assistance. 
10. Additional disclosures. The disclosures required in this section are in addition to 
any other disclosure requirements required by law, rule or regulation. 
§3156. Policy conditions 
1. Exclusion. An insurer may issue a pet insurance policy that excludes coverage on 
the basis of one or more preexisting conditions with appropriate disclosure to the consumer. 
The insurer has the burden of proving that the preexisting condition exclusion applies to 
the condition for which a claim is being made. 
2. Waiting periods. An insurer may issue a pet insurance policy that imposes a waiting 
period upon effectuation of the policy as long as that waiting period does not exceed 30 
days for illnesses or orthopedic conditions not resulting from an accident. A waiting period 
for illnesses or orthopedic conditions resulting from an accident is prohibited. An insurer 
may not impose a waiting period on the renewal of existing coverage. An insurer imposing 
a waiting period as permitted by this . subsection shall include a provision in the pet 
insurance policy contract that allows the waiting period to be waived upon completion of 
a medical examination. An insurer may require the examination to be conducted by a 
licensed veterinarian after the purchase of the policy. A medical examination conducted 
pursuant to this subsection must be paid for by the policyholder, unless the policy specifies 
that the insurer will pay for the examination. An insurer may specify elements to be 
included as part of the examination and require documentation of the elements, as long as 
the specifications do not unreasonably restrict a consumer's ability to waive the waiting 
period. 
3. Renewal. An insurer may not require a veterinary examination of the covered pet 
for the insured to have the pet insurance policy renewed. A condition for which coverage 
is afforded on a policy may not be considered a preexisting condition on any renewal of 
the policy. 
4. Other benefits. If an insurer includes any prescription, wellness or noninsurance 
benefits in the pet insurance policy form, those benefits become part of the pet insurance 
policy contract and the provision of those benefits must follow all applicable laws in this 
Title and any rules adopted pursuant to those laws. 
5. Participation in wellness program. An insurer may not condition a person's 
eligibility to purchase a pet insurance policy on participation, or lack of participation, in a 
separate wellness program. 
§3157. Wellness programs 
1. Marketing. An insurer or insurance producer may not: 
A. Market a wellness program as pet insurance; or 
B. Market a wellness program during the sale, solicitation or negotiation of pet 
insurance. 
2. Sale of wellness program; If a wellness program is sold by an insurer or insurance 
producer, the following requirements apply: 
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COMMITTEEAMENDMENT"A "to S.P. 186, L.D. 482 ( S-L(Lo.~ 
A. The purchase of a wellness program may not be a requirement of the purchase of 
pet insurance; 
B. The costs of a wellness program must be separate and identifiable from any pet 
insurance policy sold by an insurer or insurance producer; 
C. The terms and conditions for a wellness program must be separate from any pet 
insurance policy sold by an insurer or insurance producer; 
D. The products or coverages available through a wellness program may not duplicate 
products or coverages available through the pet insurance policy; and 
E. The advertising of a wellness program may not be misleading and must differentiate 
the wellness program from pet insurance. 
3. Disclosure. An insurer or insurance producer shall clearly disclose the following to 
consumers of wellness program products. printed in 12-point boldface type: 
A. That wellness programs are not insurance; 
B. The bureau's mailing address and toll-free telephone number and a link to the 
bureau's publicly accessible website; and 
C. The address and customer service telephone number of the insurer or the producer 
of record. 
4. Wellness benefits. Any coverages included in a pet insurance policy contract 
described as "wellness benefits" are considered insurance. 
If a wellness program 
undertakes to indemnify another party. pays a specified amount upon determinable 
contingencies or provides coverage for a fortuitous event. it is transacting the business of 
insurance and is subject to the requirements of this Title. except that a contract directly 
between a service provider and a pet owner that involves only those 2 parties is not 
transacting the business of insurance unless other indications of insurance also exist. 
§3158. Insurance producer requirements 
1. Training. An insurance producer may not sell, solicit or negotiate a pet insurance 
product until after the producer is appropriately licensed and has completed the required 
training identified in subsection 2. 
2. Requirements. An insurer shall ensure that any producer holding an appointment 
has been appropriately trained on the features of any pet insurance product offered by the 
producer. The training required under this subsection must include information on the 
following topics: 
A. Preexisting conditions and waiting periods; 
B. The differences between pet insurance and noninsurance wellness programs; 
C. Hereditary disorders, congenital anomalies or disorders and chronic conditions and 
how pet insurance policies interact with those conditions or disorders; and 
D. Rating, underwriting, renewal and other related administrative topics. 
§3159. Enforcement 
The superintendent may assess a civil penalty or take any other action permitted under 
section 12-A against any person that violates any provision of this chapter. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT" ft "to S.P. 186, L.D. 482 ( S- L\ lod) 
§3160. Rules 
The superintendent may adopt rules to implement this chapter. Rules adopted pursuant 
to this section are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A. 
§3161. Effective date 
This chapter takes effect January I, 2023.' 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or section 
number to read consecutively. 
SUMMARY 
This amendment replaces the bill. The amendment enacts requirements for the sale of 
pet insurance in this State, using model legislation developed by the National Association 
of Insurance Commissioners. The bill does the following. 
1. It defines terms used in pet insurance policies and contracts. 
2. It requires insurers to make specific disclosures to consumers about the terms and 
conditions of a pet insurance policy and how claims are paid and gives policyholders the 
right to return a policy within 15 days. 
3. It allows pet insurance policies to include exclusions for preexisting conditions as 
long as they are disclosed to consumers. 
• 
4. It allows pet insurance policies to include a waiting period for illnesses or orthopedic 
conditions but not accidents and provides that the waiting period may not exceed 30 days. 
An insurer must waive a waiting period if the covered pet undergoes a medical examination 
paid for by the policyholder. 
5. It prohibits insurers and producers from marketing wellness programs as insurance 
and marketing wellness programs while selling, soliciting or negotiating pet insurance. 
Insurance producers must also be trained before selling pet insurance. 
The requirements take effect January 1, 2023 and apply to pet insurance policies that 
are sold, solicited, negotiated or offered in this State and to policies issued to any resident 
of the State and certificates delivered or issued for delivery in this State. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Fiscal Detail and Notes 
Approved: 03/23/22 ;:!;Pae. 
LD482 
LR 632(02) 
An Act Regarding Pet Insurance 
Fiscal Note for Bill as Amended by Committee Amendment ''.iq' [S- ll la~ 
Committee: Health Coverage, Insurance and Financial Services 
Fiscal Note Required: Yes 
Fiscal Note 
Minor cost increase - Other Special Revenue Funds 
Additional costs to the Department of Professional and Financial Regulation are expected to be minor and can be 
absorbed within existing budgeted resources. 
LR0632(02) - Fiscal Note - Page 1 of 1