California’s regulator usefully distinguishes reimbursement based on the billed charge from a benefit schedule or usual-and-customary limitation. That is a general contract-reading distinction, not a claim that California law governs a New York policy. Ask the New York insurer which basis appears in your offer.
Consider an invented $2,000 eligible veterinary invoice and an already met deductible. Under a fictional policy paying 80% of the full eligible invoice, reimbursement would be $1,600 and the owner would retain $400. Under another fictional design that allows only $1,500 for the same services before applying 80%, reimbursement would be $1,200 and the owner would retain $800.
The $400 difference is not a finding about any named insurer or a typical NYC charge. It shows why “80% reimbursement” alone cannot price your retained risk. Add excluded services, remaining deductibles and applicable payout caps using the actual formula before relying on a result.