Notice to Pennsylvania Residents
Applicable for policies with effective dates on or after 2/3/2025
PENNSYLVANIA 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).
Pennsylvania Insurance Department Contact Information
Pennsylvania Insurance Department
1326 Strawberry Square
Harrisburg, PA 17120
https://insurance.pa.gov/
1-877-881-6388
Please read below for important information to help you understand our coverage. Your coverage starts on the effective date listed on the Declarations Page.
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.
Hereditary Disorder. “Hereditary disorder” means an abnormality that is genetically transmitted from parent to offspring and may cause illness or disease.
Insurance Producer. “Insurance Producer” Means a person that sells, solicits or negotiates contracts of insurance.
Insured. “Insured” Means a person on whose behalf a pet insurer is obligated to pay or reimburse covered veterinary expenses under a pet insurance policy.
Orthopedic Condition. “Orthopedic Condition” Means as follows:
(1) A condition affecting the bones, skeletal muscle, cartilage, tendons, ligaments or joints.
(2) The term includes elbow dysplasia, hip dysplasia, intervertebral disc degeneration, patellar luxation and ruptured cranial cruciate ligaments.
(3) The term does not include cancer or a metabolic, hemopoietic or autoimmune disease.
Pet Insurance Policy. “Pet Insurance Policy” means property insurance policy, certificate or rider that provides coverage for accidents and illnesses of pets.
Pet Insurer. “Pet Insurer” Means an insurer that issues a pet insurance policy.
Practice of Veterinary Medicine: “Practice of Veterinary Medicine” Includes, but is not limited to, the practice by any person who (i) diagnoses, treats, corrects, changes, relieves or prevents animal disease, deformity, injury or other physical, mental or dental conditions by any method or mode, including the prescription or administration of any drug, medicine, biologic, apparatus, application, anesthetic or other therapeutic or diagnostic substance or technique, (ii) performs a surgical operation, including cosmetic surgery, upon any animal, (iii) performs any manual procedure upon an animal for the diagnosis or treatment of sterility or infertility of animals, (iv) represents himself as engaged in the practice of veterinary medicine, (v) offers, undertakes, or holds himself out as being able to diagnose, treat, operate, vaccinate, or prescribe for any animal disease, pain, injury, deformity, or physical condition, (vi) uses any words, letters, or titles in such connection or under such circumstances as to induce the belief that the person using them is engaged in the practice of veterinary medicine and such use shall be prima facie evidence of the intention to represent himself as engaged in the practice of veterinary medicine, (vii) performs diagnostic veterinary pathology, (viii) implants electronic identification, as determined by the board, upon any animal, (ix) renders advice or recommendation by any means, including the electronic transmission of data with regard to any of the above, or (x) removes any embryo from an animal for the purpose of transferring such embryo into another animal or cryopreserving such embryo, except it shall not be considered the practice of veterinary medicine when: (a) a person or his full-time employe removes or transfers an embryo from the person’s own animals for the purpose of transferring or cryopreserving the embryo so long as ownership of the animal is not transferred or employment of the person is not changed for the purpose of circumventing this act or (b) a person independently, with indirect veterinary supervision, implants any embryo into an animal.
Preexisting condition. “Preexisting condition” means condition for which any of the following apply regarding a pet prior to the effective date of a pet insurance policy for the pet or during any waiting period:
(1) A veterinarian provided medical advice regarding the pet.
(2) The pet received previous treatment.
(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.
Renewal. “Renewal” Or to renew, means the issuance and delivery by an insurer of a policy superseding at the end of the policy period a policy previously issued and delivered by the same insurer or affiliated insurer, such renewal policy to provide types and limits of coverage at least equal to those contained in the policy being superseded, or the issuance and delivery of a certificate or notice extending the term of a policy beyond its policy period or term with types and limits of coverage at least equal to those contained in the policy being extended: Provided, however, that any policy with a policy period or term of less than twelve months or any period with no fixed expiration date shall for the purpose of this act be considered as if written for successive policy periods or terms of twelve months.
Veterinarian. “Veterinarian” Means an individual who holds a valid license to engage in the practice of veterinary medicine from the appropriate licensing entity of the jurisdiction in which the individual engages in the practice of veterinary medicine.
Veterinary expenses. “Veterinary expenses” means 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 as follows:
(1) 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.
(2) A waiting period may not be applied to a renewal of existing coverage.
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-PA-Notice-0424-PUMPKIN
Requirement 34979