Emergency Protection Policy
Terms & Conditions

Last Updated: October 7, 2024

*NOTE: IF YOU ARE A NEW YORK RESIDENT, PLEASE SCROLL BELOW TO THE NEXT SECTION.

Upon Your payment of the premiums when due, and after the defined Waiting Period, We will provide the coverage as specifically described in this Group Policy for the Member’s Covered Pet(s) as shown in the Certificate.

FULLY EARNED PREMIUM DISCLOSURE: If Your Premium is paid by Electronic Funds Transfer or a Credit Card and You cancel your Certificate, the payment transaction fee listed in the Certificate will be deemed fully earned.

INSURING AGREEMENT

THE FOLLOWING COVERAGES APPLY SEPARATELY TO EACH MEMBER.

Various provisions in this Group Policy restrict coverage.  Please read the entire Group Policy carefully to determine rights, duties and what is and is not covered.

Throughout this Group Policy, the words “you”, “your”, or “Member” refer to the Member shown in the Certificate.  The word ‘Named Insured’ refer to the Named Insured shown on the Group Policy Declarations. The words “we”, “us”, and “our” refer to the Company providing this insurance.  The term “insured” means any individual or entity that qualifies as an “insured” under the terms of this Group Policy and any endorsements made a part of this Group Policy.

Other words and phrases that appear in Bold have special meaning. Refer to Section IV Definitions.

The successful payment of your premiums constitutes your acceptance of all terms and conditions contained in this Group Policy and Certificate.

PART I - COVERAGE

1.    INSURING AGREEMENT.

We agree to insure the Member in accordance with the provisions of this Group Policy and of the Certificate, including any Endorsements thereto, with respect to Covered Services.

The Certificate and the Group Policy will set forth the entire contract between the Member and Us and no representation, promise or condition not contained therein shall modify the terms.

The term of a Certificate commences on the Effective Date as indicated in the Certificate and expires onthe Expiration Date as indicated on the Certificate, and unless You or We cancel it, the Certificate will renew automatically. The Member must notify Us promptly of the death of a Covered Pet and, if applicable, initiate the cancellation of a Certificate.

If premiums are unpaid, We may cancel this Certificate by sending a notice of cancellation as provided in section V. 2.

(a) In consideration of the payment of premium stated in the Certificate and the Coverage stated in this Group Policy and subject to the terms, conditions and exclusions contained in this Group Policy, We will reimburse the Member for Allowable Charges for Medically Necessary Treatments performed on the Member’s Covered Pet(s) for conditions that started after the Waiting Period and during the Certificate Term, and which result from Covered Emergencies, as further defined in Part IV include but are not limited to:

(1) Toxic Ingestion

(2) Choking and Difficulty Breathing; and

(3) Severe Blockages

Member authorizes us, at the time of enrollment and any time after to contact, and communicate with, any and all veterinary clinics or hospitals to obtain all available medical records that exist for your Covered Pet(s).

Member authorizes any and all veterinary clinics or hospitals to release to Us all medical records that exist for your Covered Pet(s). If you cannot (or refuse) to disclose a complete medical history for your Covered Pet(s) and also provide the necessary documentation when requested, we may deny your claim(s).

(b) Pre-existing Conditions will not preclude Coverage to the extent they need to be treated in connection with an Emergency.

2.    BENEFITS

Subject to the limits of liability described herein, We will reimburse the Member for Medically Necessary Treatment, including any taxes, arising out of an Emergency, including:

(a) Surgery;

(b) X-rays, ultrasounds, and other diagnostic tests;

(c) Endodontic Treatment arising directly from a covered Emergency;

(d) Euthanasia where necessary for humane reasons;

(e) Medical waste disposal;

(f) Professional Services rendered by Pawp, Inc.'s Veterinary Professional or the Member's Veterinary Provider in the immediate Treatment of the Emergency;

(g) Medical supplies required to perform covered procedures performed in a Veterinarian's office and other medical supplies, where deemed Medically Necessary by the Member's Veterinary Provider in the immediate Treatment of the Emergency;

(h) Laboratory tests required by the Member's Veterinary Provider in the Treatment of the Emergency;

(i) Hospitalization required in order for the Member's Veterinary Provider to deliver Professional Services to the Member's Covered Pet directly related to the Emergency;

(j) Medication as a direct result of the Emergency that is prescribed and directly administered by the Member's Veterinary Provider or by the Member following the instructions from the prescribing Veterinary Provider.

PART II - EXCLUSIONS

Please read the following exclusions carefully. If an exclusion applies, We will not provide Coverage under the Certificate. This Certificate will not provide Coverage for:

(1) Emergencies that occur prior to the Waiting Period upon the inception of Coverage;

(2) Failure by the Member to take the Covered Pet to a Veterinary Provider within twenty-four (24) hours after being advised by Pawp, Inc.'s approved Tele Triage Veterinary Professional to seek immediate care;

(3) Preventative care, including, but not limited to, wellness exams or tests; preventative Treatment, tests or diagnostic procedures; vaccinations; flea and other parasite prevention; spaying or castration (including preventative sterilization surgery, such as for Treatment for cryptorchidism, chimerism, or chromosomal abnormalities); grooming and de-matting;

(4) Any scheduled appointments for routine check-ups or anticipated procedures;

(5) The cost of boarding Member's Covered Pet unless related to a covered Emergency;

(6) Treatment for an Illness related to the teeth and/or gums, unless endodontic treatment for dental Injuries arising directly from a covered Emergency;

(7) Costs of Treatments arising from Member's decision to pursue a course of Treatment other than that which was recommended to the Member by a Veterinary Provider, including cost of Treatments continued after a Veterinary Provider has recommended a Covered Pet be euthanized for humane reasons;

(8) Treatment for any Injury or Illness deliberately caused by the Member, their family members, anyone living with them, or any other persons who have care, custody, or control of Member's Covered Pet;

(9) Treatment for Injury or Illness caused by the aggressive actions of another animal when that animal permanently or temporarily resides or is cared for in Member's household;

(10) Treatment for Injury or Illness caused by deliberate endangerment of the Member's Covered Pet, including but not limited to organized fighting;

(11) Treatment for Injury or Illness caused by persistent neglect of Member's Covered Pet;

(12) Treatment for any Injury or Illness resulting from activities related to racing, personal protection, law enforcement or guarding;

(13) Cosmetic, aesthetic, or elective surgery including tail docking, ear cropping, de-clawing or any other surgical procedure not related to an Emergency;

(14) Treatments for any Illness for which a vaccine is available for the Member's Covered Pet to prevent such Illness and for which vaccination is both recommended by a Veterinarian and rejected by the Member. For the purposes of this exclusion, such vaccinations shall include but not be limited to "core vaccinations" as stated by the American Animal Hospital Association Canine Vaccine Guidelines for your dog or "highly recommended vaccinations" as stated by the American Association of Feline Practitioners;

(15) Any administration Fees charged by a Veterinary Provider or others, including, for example, a chart set-up fee;

(16) Costs for any Treatment for:‍

a. Prosthetic limbs and devices;

b. Organ transplants;

c. Genetic/chromosome testing;

d. Vaccinations;

e. Deworming;

f. Routine check-ups;

g. X-rays or ultrasounds unrelated to an Emergency;

h. Prescription Medications unrelated to an Emergency;

i. Non-Emergency surgeries;

j. Follow-up appointments after an Emergency;

k. Emergencies arising from or in any way related to Covered Pet breeding or pregnancy issues, including but not limited to nursing, neonates, and weaning.

(17) Costs for any Treatment arising from or in anyway related to:

a.    avian, swine,or any other type of influenza or any mutant variation;

b.    intentional slaughterby, or under, the order ofany government or public or local authority;

c.    epidemics or pandemics as declared by the U.S. Department of Agriculture.

d.    arising from a nuclear reaction, radiation, radioactive contamination or the discharge of a nuclear device, whether controlled or uncontrolled, accidentally or otherwise;

e.    arising from or in any way related to a chemical, biological, bio-chemical or electromagnetic weapon, device, agent or material whether controlled or uncontrolled, accidentally or otherwise;

f.    arising from or in any way related to war, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection, military or usurped, strikes, riots, or civil commotion.

PART III - LIMITS OF INSURANCE

Regardless of the number of Claims made under a covered Emergency, or Injuries or Illnesses that occur during the Certificate Term, Our total liability to Member during the Certificate Term shall not exceed the amounts shown on the Certificate under Annual Maximum Limit.

Coverage ceases for the current Certificate Term for the Member after payment has been issued for one Covered Emergency, even if the costs of Treatment for that Emergency are less than the Annual Maximum Limit. Once the payment has been made to the Member no further Coverage for Treatments of any and all Injuries or Illnesses will be reimbursed for any future Treatments and/or Claims for that Member during the Certificate Term.

PART IV - DEFINITIONS

Except as otherwise defined in this Group Policy, the following terms appearing in boldface and then capitalized in the Group Policy have the following meaning:

(1) Allowable Charge(s) means the costs of the actual Medically Necessary Treatment(s) provided by the Member's Veterinary Provider and such costs as incurred by Pawp, Inc.'s designated Tele Triage Veterinarian Professional.

(2) Annual Maximum Limit is the maximum amount We will pay on behalf of a Member's Covered Pet in an annualperiod of insurance arising from a single Emergency.

(3) Chronic Condition is a detectible condition that, once developed, is deemed incurable or likely to continue for the remainder of a Covered Pet's life.

(4) Claim means the Member's notification that an Emergency has occurred, and such Emergency has been verified by Pawp, Inc. or Our designated Representative.

(5) Clinical Signs means observable changesin a Covered Pet's normal healthy state, bodily function or behavior.

(6) Coverage is the insurance described in this Group Policy.

(7) Covered Pet(s) means the domestic cat(s) or dog(s) named on the Certificate file with the Named Insured during the Certificate Term, not to exceed six (6) Covered Pets.

(8) Effective Date is the date Coverage commences as indicated in the Certificate.

(9) Emergency is such life-threatening situations confirmed by Pawp Inc.'s Tele Triage Veterinary Professional or Our designated Representative, either before or after treatment is sought, that such situation is or was life-threatening and recommends or recommended that the Member seek immediate Treatment for the Covered Pet.

(10) Expiration Date is the date Coverage expires as indicated in the Certificate.

(11) Fees are all inclusive including the charge for the Emergency Coverage provided by a licensed Veterinarian. The latter will be determined by Us and Pawp, Inc. Further understood, the Carrier and Pawp, Inc. may credit and debit such Fees as necessary.

(12) Illness means sickness, disease, or any change in a Covered Pet's normal, healthy state, which is not caused by Injury to the Covered Pet.

(13) Insured means the Named Insured and each Member.

(14) Injury means physical harm or damagearising from an accident necessitating a reported Emergency.

(15) Medically Necessary means directly and materially related to a covered Illness or Injury, in Our reasonable judgment

(16) Medication means any medications prescribed or recommended by a Veterinary Provider and approved by the Food and Drug Administration (FDA) of the United States or accepted for inclusion in the Homeopathic Pharmacopoeia of the United States for veterinary use. Medication also includes medical supplies required to administer those Medications.

(17) Member(s) are those Covered Pet owners who have subscribed to the PAWP Emergency Health and Tele Triage health program.

(18) Professional Services are services provided by a Veterinary Provider in diagnosing, treating, operating, or prescribing for a Covered Pet in connection with an Emergency.

(19) Pre-existing Condition(s) which are covered means:

a.    A Chronic Condition observed by you or your Veterinary Provider prior to the end of the Waiting Period for the Member's Covered Pet(s) and any related conditions; or

b.    An Illness or Injury that first occurred or showed Clinical Signs prior to the end of the Waiting Period for the Member's Covered Pet and any related conditions. Undiagnosed conditions with the same Clinical Signs as those in a. or b. above are also considered pre-existing.

(20) Tele Triage as specified in this Coverage is the limited triage and medical advice of a non-diagnosis and non-proscription nature to assist the Member if they should seek care from a licensed Veterinary Provider.

(21) Treatment means any examination, consultation, hospitalization, anesthesia, surgery, X-rays, MRI or CT scans, alternative or complementary therapies, laboratory tests, nursing or other care provided and administered by a Veterinary Provider.

(22) Veterinarian means a currently licensed Doctor of Veterinary Medicine.

(23) Veterinary Provider means a Veterinarian, veterinary technician or veterinary nurse currently licensed in the state in which Treatment is performed.

(24) Veterinarian Professional means Veterinarian, veterinary technician or veterinary nurse providing tele-advice and Tele Triage consultations to the Member. Such individuals are providing non-diagnosis and non-proscribing services of a triage nature to the Member.

(25) Waiting Period means the time period of fourteen (14) days starting from the Effective Date for each Covered Pet as indicated on the Certificate for Injuries and Illnesses.. Emergencies that occur during the Waiting Period, as well as Emergencies that arise from or are related to conditions that occur during the Waiting Period, will be excluded from your policy's Coverage as not reimbursable.

(26) We, Us, Our, Ours, The Company means the Company providing the insurance, as shown in the Certificate (not necessarily shown bold or capitalized for readability).

PART V - OTHER TERMS AND CONDITIONS

(1) MEMBER REPORTING

On a monthly basis, the Named Insured will provide The Company with a bordereau of active Members in a format as mutually agreed.

(2) CANCELLATION

(a) Insurer or Member

This Certificate may be cancelled at any time due to nonpayment of premium as provided below.

Otherwise, We may only cancel for one or more of the following reasons:

i. If the Certificate was obtained through fraud, misrepresentation or concealment in your application, the content of which is specifically incorporated into and as a material term of this policy; or in pursuing a claim under this Group Policy.

ii. We have agreed to issue a new Group Policy with the same or an affiliated company.

iii. The Department of Insurance of the state governing the Group Policy determines that a continuation of the Group Policy could place Us in violation of that state's insurance laws.

iv. Loss of Reinsurance.

v. A Member's failure to comply with the Group Policy terms and conditions in a manner that prejudices or negatively impacts Our ability to properly assess or evaluates any Claim or other materials rights under the Group Policy.

vi. The Member has been found by a licensed Veterinarian/vet technician to have grossly mistreated and/or abused the Covered Pet, the Coverage can be cancelled immediately.

With respect to cancellation, this Group Policy is neither severable nor divisible. Any cancellation will be effective for Coverages for the Named Insured and any Member. If this Group Policy is canceled, Coverage will not be provided as of the effective date of the cancellation.

We will provide written notice of cancellation under this Group Policy by mailing or electronic delivering to the Member notice of cancellation at least:

(1)  Fifteen (15) calendar days before the effective date of cancellation if we cancel for non-payment of premium; or

(2)  Forty-five (45) calendar days before the effective date of cancellation if we cancel for any other reason.

a.    We will mail or deliver our notice to the Member’s address shown in the Certificate.

b.    Notice of cancellation will state the effective date of cancellation.  The Certificate Term will end on that date.

(b) Member

Members may cancel their Certificate at any time by advanced electronic notification or writing to Pawp, Inc. Notice must include the date for cancellation to be effective (Post notification). If the Member cancels their Certificate, any Premium refund due will be calculated on a pro rata basis and returned within thirty (30) business days after the effective date of cancellation. If Your Premium is paid byElectronic Funds Transfer or Credit Card, the Payment Transaction Fee listed in the Certificate will be deemed fully earned.

(3) NONRENEWAL

If We decide not to renew or not continue this policy, We will mail notice of non-renewal to the Member shown on the Certificate at the last known address appearing in Our records. Notice, including the reason for non-renewal, will be mailed at least forty-five (45) days before the end of the policy period.

(4) MISREPRESENTATION, CONCEALMENT OR FRAUD

The Member's Coverage is void in any case of fraud, intentional concealment, or misrepresentation of a material fact. If you have provided false, misleading, and/or dishonest information, we may not pay the claim, may void that Certificate, and may be required by law to report it to governmental authorities.

(5) OTHER INSURANCE

A Member may have other insurance that responds to the same incidents to which this Certificate responds. If that isthe case, We will pay Our share of the Allowable Charges. Our share is the proportion that the applicable Limits of Insurance under this Certificate bears to the Limits of Insurance of all insurance covering on the same basis. It is Member's responsibility to notify Us in the event that other insurance is in force.

(6) TRANSFER

This policy may not be transferred to another entity without The Company's written consent, and such consent will not be unreasonably withheld.

(7) TERRITORY

This policy applies only to Emergencies occurring during the Certificate Term shown in the Certificate, and which occur within the United States of America.

(8) TERMINATION OF COVERAGE

If the Member moves to a state where this Group Policy is not available, Your coverage under this Group Policy will automatically terminate thirty (30) days after We receive notification of such move.

(9) ELECTRONIC DELIVERY

By accepting the terms of this insurance as evidenced by the payment of premiums, the Member agrees that this policy, any endorsements, and any notices shall be delivered by electronic mail via the internet.

(10) JURISDICTION AND CHOICE OF LAW

The sole venue for any dispute, claim or controversy regarding or arising under or concerning application or interpretation of the terms of this policy, or any matter related in any way or arising therefrom, shall be solely in the State of Vermont and the parties hereto agree that the laws of the State of Vermont shall govern this policy, its interpretation and the agreement and transaction contemplated herein.

Further, any action or proceeding seeking to enforce any provision of, or based on any right arising out of, this policy shall be brought against any of the parties in the courts of the State of Vermont,County of Washington, or, if it has or can acquire jurisdiction, in the United States District Court of Vermont, and each of the parties hereby consents to the jurisdiction of such courts (and the appropriate appellate courts) in any such action or proceeding and waives any objection to venue laid therein.

Process in any action or proceeding referred to in the preceding sentence may be served on any party anywhere in the world.

Pawp, Inc. acknowledges and agrees that the policy was solicited and issued in the State of Vermont.

PART VI - CONDITIONS

1.    Duties in Event of a Claim

a.    All Claims documentation must be submitted to and received by Pawp, Inc. within fourteen (14) calendar days of the date of the Member's visit to the Veterinary Provider, through the submission of a copy of the invoice and supporting medical records for the Emergency services.

b.    Upon receipt of the final invoice for your Covered Pet's Emergency care, you shall submit such invoice via our electronic portal, Pawp App, or contact Us at the telephone number contained in the materials; sent to you or listed on Our website. We will review the invoice and confirm the total cost of the Emergency. We may contact the Member’s Veterinary Provider or Veterinary Professional to confirm the information provided as well as raise any questions about the subject care. We will review the invoice and confirm the total cost of the Emergency. Once an Emergency has been approved and Duties have been met, We will provide payment of up to $3,000 paid to the Member directly upon timely receipt of the requested information and payment instructions from the Member.. You are financially responsible to your Veterinarian for the payment of all fees and costs.

c.    We will administer Claims and may utilize the services of a third-party administrator. Claims determinations shall be final.

d.    In the event the Member elects to ‘opt-out’ of filing a Claim, We will honor such request and incur no liability by the Member making such election.

e.    If you disagree with the coverage provided on any claim, you may request a review of the decision using Our voluntary appeals process. If you believe We wrongly affirmed denial of your claim through this appeals process, you can request further review by an independent third-party Veterinarian We ha’ve selected. We select these Veterinarians solely on their ability to decide on issues of medical nuance and have no other relationship or affiliation with Us. Their decision will be final and binding on Us. Disagreements regarding direct policy exclusions, timing of coverage, and policy wording interpretations are not eligible for review and this process.