Notice to California Residents
INSURER DISCLOSURE OF IMPORTANT POLICY PROVISIONS
Pumpkin Insurance Coverage only
Accident & Illness
Please read below for important information to help you understand our coverage. Keep in mind, we will not reduce coverage or increase premium due to claims history.
We use certain terms in our policy documents and want to make sure you understand how they are used. Following are some common DEFINITIONS:
Pet insurance – means an individual or group insurance policy that provides coverage for Veterinary expenses.
Pre-existing condition – means any condition for which a veterinarian provided medical advice, the pet received treatment for, or the pet displayed signs or symptoms consistent with the stated condition prior to the effective date of a pet insurance policy or during any waiting period.
Reimbursement percentage – means co-insurance.
Veterinarian – means an individual who holds a valid license to practice veterinary medicine from the Veterinary Medical Board pursuant to Chapter 11 (commencing with Section 4800) of Division 2 of the Business and Professions Code or other appropriate licensing entity in the jurisdiction in which he or she practices.
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 can begin.
Coverage for the following conditions will be EXCLUDED.
Pre-existing condition: Pre-existing conditions are not covered by our plans. However, If your pet’s pre-existing condition is curable and has been cured and free from treatment and symptoms for a period of 180 days it is a new occurrence. This does not apply to ligament and knee conditions.
Ligament and Knee conditions are considered bilateral and related, regardless of cause; meaning an occurrence on one side of the body affects both sides of the body.
Other exclusions apply. Please refer to the exclusions section of the policy (What Is Not Covered) for more information.
There are WAITING PERIODS that apply before certain coverages are effective. A 14 day accident and illness waiting period applies to the first policy period. Diagnosis and treatment for ligament and knee conditions are subject to a 14 day waiting period on all policies. Conditions that occur during or before a waiting period are considered pre-existing.
Reimbursement of covered expenses is subject to the annual policy limit listed on your declarations page.
Please continue reading for information on Claims, Deductibles, and Reimbursement Percentage.
We offer a choice of annual deductible options. The annual deductible applies to each policy period. We subtract that deductible amount from the covered expenses before calculating your reimbursement percentage.
After the deductible is met, you are responsible for your portion of the covered expenses in addition to any amounts not covered by the policy. We then pay our portion of the covered expenses subject to the annual limits.
Determination of Claim Payouts
Our coverage provides reimbursement up to the applicable annual limit for the actual costs for covered expenses that you incur during the policy period, after subtracting your deductible and applying the reimbursement percentage, listed on the declaration page.