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Pet Insurance Coverage

Understanding What Is or Isn't Covered

Understanding your pet insurance policy is a critical step to making sure there are no surprises when you go to submit a claim. First, you'll need to determine if your pet has any conditions that are defined as pre-existing, and second, you need to review the list of exclusions, which will be a list of generally excluded conditions outlined in the policy document. Exclusions that are not covered by your policy are ineligible for reimbursement.

Plan Types

Accident and Illness

Can be used for both accidents and illnesses, but not treatments like vaccinations, dental cleanings, and heartworm testing etc., which are considered routine or scheduled care. This by far is the type of coverage that most pet owners choose.

Accident Only

Accident coverage is specifically designed for injuries like a broken bone. Each company will define what they consider an accident, and what they consider an illness or disease. So just be aware that even though you believe the condition to be an accident, the insurance company may not agree with you. One of the items that gets disputed a lot is whether cruciate or dysplasia injuries can be considered an accident. Some pet insurance companies specifically define theses as illnesses, so ensure that you clarify this with your insurer.

Wellness & Prevention

Some companies also offer policies to cover wellness and prevention. This type of policy covers treatments like annual exams, vaccinations, dental cleanings, and heartworm testing. For those companies that offer it, this coverage can typically be added to Accident & Illness or Accident Only policies. For some pet owners, because they know what their pet will require each year, they may choose to instead budget for these amounts since they remain fairly consistent year over year.

Covered Conditions

Once you've decided that pet insurance is right for you, the conditions covered or not covered will be an important item to consider next when determining which policy and provider suit your needs best. Conditions are described as the medical events for which your pet will and won't be eligible for coverage.

Claims for conditions should be eligible for payment as long as they are not pre-existing, specifically excluded by the policy, or occur during the stated waiting periods. Typically, a claim that occurs during the waiting period is considered a pre-existing condition. In addition to general exclusions and pre-existing exclusions, there are other reasons that a claim would not be eligible. For instance, the claim occurred outside the policy period, or you have already claimed the maximum annual limits on your policy. Companies vary slightly in their definition of eligible claims and pre-existing conditions. So it’s important to read the policy document to understand.

Hereditary Conditions are those that are passed on in the genes from the parents. These are often referred to as Genetic Disorders. But it's important to understand that even if a hereditary trait is passed on from a parent, it doesn't necessarily mean that it will ever manifest itself as a condition.

Congenital Conditions, on the other hand, are those that are present at birth from developmental anomalies or defects while still in the uterus. These are often obvious at birth, but they too may not be obvious in early life.

Most companies cover Hereditary and Congenital Conditions if they have not manifested as a condition or disease before policy issuance and any subsequent waiting periods. Any Hereditary or Congenital Condition that has already manifested itself will be considered a pre-existing condition and will be excluded from coverage by ALL companies. This is another reason to insure your pet very early in life, before any Hereditary and any other pre-existing conditions are present.

It is important to read and understand each company's definition of Hereditary and Congenital Conditions, what their policy says about coverage and their definition of a pre-existing condition.

In general, pre-existing conditions are those conditions that have occurred before the date that a policy takes effect. Some pre-existing conditions are permanent because the condition can’t be cured. An example of this would be hypothyroidism or atopic dermatitis. Both are treatable and controllable, but not curable. Some pre-existing conditions can be temporary and, if demonstrated to be cured for a period of time, can be removed as a pre-existing exclusion. An example of this could be an ear infection that occurred once in the past and that has been demonstrated as cured for a set period of time. Each company varies in its approach to permanent versus temporary. So if this applies to your situation, you need to understand the policy wording.