Notice to Ohio Residents
OHIO INSURER DISCLOSURE OF IMPORTANT POLICY PROVISIONS
Please read below for important information to help you understand our coverage.
Underwriter, Producer, Brand Information
Insurance is underwritten by Independence American Insurance Company (NAIC #26581.
Newcastle, DE). The insurance underwriter is different than the brand name and the agency
that markets and sells the products. Insurance plans are marketed and produced by Pumpkin
Insurance Services Inc. (NPN#19084749).
Definitions
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.
Orthopedic condition. “Orthopedic condition” means a condition affecting the bones, skeletal muscle, cartilage, tendons, ligaments, and joints. “Orthopedic condition” includes elbow dysplasia, hip dysplasia, intervertebral disc degeneration, patellar luxation, and ruptured cranial cruciate ligaments. ”Orthopedic condition” does not include cancer or metabolic, hemopoietic, or autoimmune disease.
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 any waiting period:
1. A veterinarian provided medical advice;
2. The pet received previous treatment; or
3. Based on information from verifiable sources, the pet had signs or symptoms
directly related to the condition for which a claim is being made.
Preexisting condition does not include, for a renewal of a pet insurance policy, a condition for which coverage was afforded on the previous policy.
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 pet insurer or an
affiliated pet insurer and which provides types and limits of coverage substantially similar to
those contained in the policy being superseded.
Veterinarian. “Veterinarian” means an individual who holds a valid license to practice
veterinary medicine under Chapter 4741 of the Revised Code or from the appropriate licensing entity in the jurisdiction in which the veterinarian practices.
Veterinary expenses. “Veterinary expenses” means the costs associated with medical advice,
diagnosis, care, or treatment provided by a veterinarian, including the cost of drugs prescribed by a veterinarian.
Waiting Period. “Waiting period” means the period of time specified in a pet insurance policy that is required to elapse before some of all of the coverage in the policy begins.
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.
Premium Increases Due to Pet Age and Geographic Location
Insurance plan premiums will increase as the covered pet gets older. Insurance plan premiums may increase or decrease due to the policyholder’s geographic location. We will not reduce coverage or increase premium due to claims history.
Policy Limits
Reimbursement of covered expenses is subject to the annual policy limit you select at enrollment and is listed on your declarations page.
Deductible
Reimbursement Percentage
We offer a choice of reimbursement percentage options. 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.
Policy Exclusions
This policy excludes coverage for pre-existing conditions as defined above and in the policy.
Other exclusions may apply. Please refer to the exclusions section of your policy (What is Not Covered) for more information.
Waiting Periods
There are WAITING PERIODS that apply before certain coverages are effective. For accident and illness policies, a 14 day illness coverage waiting period applies to the first policy period. Any Illness, congenital anomaly or disorder, hereditary disorder and orthopedic illness that occur during or before a waiting period are considered pre-existing and excluded from coverage.
You may elect at your cost to pursue a Waiting Period Health Assessment. If you and your pet meet the requirements of the Waiting Period Health Assessment, then the waiting period may be modified. A copy is available online or by calling customer service.
In order for us to modify the waiting period, you must meet each of the following requirements:
1. A qualifying exam of your pet by a veterinarian that includes an assessment of all body systems and parts;
2. Results of the exam need to be documented at the time of exam on our completed Waiting Period Assessment Form;
3. The qualifying exam may occur within 3 days prior to or 7 days after your initial policy effective date; and
4. The Waiting Period Assessment Form must be provided to us within 30 calendar days of your qualifying exam.
If the Waiting Period Health Assessment requirements are met, the waiting period will be waived to either the policy period effective date or the day after the qualifying exam, whichever is later. This waiver does not alter the pre‐existing conditions exclusion.
PET-OH-Notice-0824-PUMPKIN
Requirement 34979