Pet insurance explained

There’s a lot to consider when choosing a pet insurance policy. With so many insurers now offering plans to suit a growing range of needs and budgets, you can guarantee the right policy for you and your pet is out there!

However, when it comes to choosing your plan, it’s important to know what’s covered and what’s not. Policy coverage exclusions, where certain conditions are not covered in certain circumstances, and minimum waiting times, where the insurer specifies an amount of time that needs to pass before claims can be made, are designed to minimize fraudulent claims and bring down the cost of premiums for everyone. However, if you fail to check the policy details carefully you could be left out of pocket when you come to make a claim.

We’ve answered some of the most common questions around pet insurance policies, so you can be better informed when it comes to choosing a policy that’s right for you and know what to expect when making a claim.

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Your pet may not have experienced any serious health problems so far, but a nasty accident or sudden bout of illness may mean you face paying hefty bills from your veterinarian, and with no financial support from an insurer, you could be left significantly out of pocket.

What’s more, veterinary treatment for ongoing conditions can potentially add up to hundreds, or even thousands of dollars, which is why so many people prefer to know the bulk of the cost of their pet’s health care is taken care of, no matter what life has in store.

The cost of your pet insurance will vary depending on what’s included in your policy. The coverage included in plans can range from basic accident and illness coverage to complete nose-to-tail protection.

Most insurers offer varying co-payment and deductible options, and the age and breed of your pet and where you live can also affect your monthly insurance premium costs, which is why it’s important to compare a range of insurers to find a policy which best suits your individual needs and budget.

There are multiple pet insurance providers operating in the U.S. marketplace, and many of them offer a variety of pet insurance plans. However, the pet health insurance process is more or less the same for each plan:

  • Firstly, you need to choose the best pet insurance policy for you and your pet. Find out how Pet Insurance Review, along with thousands of pet parents, can help you choose the right policy.
  • Once you’ve chosen your policy, you’ll be able to personalise your plan by selecting your deductible and co-pay or reimbursement percentage options. You’ll normally be able to choose between an annual or per condition deductible and how much you pay of each claim, and will have the choice of a co-pay amount between 10% and 40% payable by you. Be sure to check exactly what your policy offers. You will then need to pay for your pet health insurance coverage on a monthly basis.
  • Should your pet fall ill or become injured, you can visit any licensed veterinarian for treatment. You will usually need to pay the whole veterinarian fee up front, unless you are insured by Trupanion and eligible for Direct Pay
  • You can then submit a claim to your insurance company and will be reimbursed for treatment covered by your policy. If your veterinarian has signed up for Trupanion Direct Pay the veterinarian will bill them directly and only bill you for your contribution.

The majority of pet insurance policies require you to pay any veterinarian fees yourself and then submit a claim to the insurer to be reimbursed at a later date. The speed of this process varies from insurer to insurer but is generally getting faster, with some claims being settled within a few days.

However, Trupanion has recently released Direct Pay software, a service which allows veterinarians to bill the insurer directly for eligible procedures and treatments, meaning you never need to be out of pocket. Read our article discussing this new policy here.

Direct Pay is software that allows pet parents to give permission for veterinarian clinics to bill the insurer directly for eligible treatments, instead of having to pay the entire cost themselves and then get reimbursed at a later date.

Currently Direct Pay is available with Trupanion Pet insurance and in a limited way with a couple of other insurers, if requested. When you take out your policy, you will agree a percentage that you will pay for each covered procedure or condition (usually between 10% and 40%) and an annual deductible amount. When you are paying for treatment covered by your pet insurance policy, you will only pay your contribution to the veterinarian and they will contact Trupanion to arrange for the rest to be paid directly by the insurer. If your veterinarian is not currently using the Trupanion software, ask them if they will sign up as it costs nothing to use.

Read our article discussing this new concept here.

The deductible is the amount you must pay to the insurance company before they pay out anything against your claim. The deductible amounts vary between insurers, and you will normally need to choose how much you would like to pay, and whether you would like a per condition, or annual deductible when you take out your policy.

If you take out a per condition deductible, your deductible payments will be totalled across each claim related to the same condition until your deductible limit is reached and then the insurance company will pay for any additional expenses (excluding your co-pay option) regardless of how much time passes. If you make a claim for a new condition, the deductible amount will reset, and any previous deductible payments will not be counted against this new condition.

Annual deductible payments will be totalled across the year, regardless of whether your pet suffers from the same or different medical conditions, and will reset every 12 months.

For both types of deductible, it is important to submit a claim for every vet bill you receive for each condition so that all the payments you make are counted against your per condition or annual deductible amount.

A co-pay, or co-payment, is the percentage of the total medical expenses you must pay once your deductible limit has been reached. For example, if your veterinary bill is $2,000 and you have a deductible of $500 and a co-pay of 20%, you would pay your $500 deductible and a co-pay of $300. Your insurer will then reimburse you $1200 to cover the rest of the cost of treatment.

Similar to your deductible amount, you can usually choose your co-pay amount when you take out your policy.

Most pet insurance providers won’t cover treatment for any pre-existing conditions. This means that if your pet is suffering from a medical condition, or is showing signs of a medical condition before the date your policy starts or during the policy waiting period, any treatment related to the condition is unlikely to be covered by your insurance policy.

A recurring health problem, or a condition such as diabetes or cancer, will normally be classed as a pre-existing condition by your insurer. While any claims for treatment related to this condition will not be valid, you’ll still be covered for accidents and any additional preventative care or wellness options under your plan.

Because pre-existing conditions aren’t covered by most pet insurance providers, it’s important to take out health insurance for your pet while they’re still young. The great news is that most pet insurance providers will enroll pets from as young as 6 weeks old.

Many policies allow you to choose your policy limits, and there are several different types of limits offered by different insurers. By selecting a limit on your coverage you may reduce your premiums but need to cover any costs over and above the limits on your policy.

 

A per condition limit means that there is a limit to the amount you can claim for all treatments relating to the same condition. For example, if you have a per condition limit of $1,000 you can claim up to a maximum of $1,000 (excluding any deductible and the percentage of each claim you pay) for treating a single condition. For example, you can make claims for all covered conditions and accidents, so you might claim for your dog’s diabetes for up to $1,000, and for a leg injury for up to $1,000 of treatment, and so on for each different accident or condition. If an injury or condition reoccurs, this is classed as the same condition and you would only be able to claim back what has not yet been claimed out of the maximum limit of $1,000. The maximum claim amount might then reset to $1,000 per condition at the beginning of the next 12 months of your policy, but you need to check if the maximum limit per condition is per year or in a pet’s lifetime.

 

An annual limit means that there is a single limit which applies to all claims which you make on your policy. For example, if your annual limit is $10,000 you would be able to make claims for up to $10,000 for all covered treatments for your pet, excluding your deductible and the percentage of each claim you pay. This amount would reset to $10,000 when you renew your policy at the end of the policy year.

If the amount you need to claim within the year exceeds the annual limit, you will need to pay the treatment costs for the remainder of the year yourself. Once you have renewed your policy at the end of the year, you will be able to start claiming for veterinary care costs again.

 

A lifetime limit means that you will be able to claim for all illnesses and conditions your pet may develop throughout their lifetime, up to a set amount, if coverage is continuous. However, the cost of your premiums may increase, so it’s always best to check the details of your policy each time you renew.

Most pet insurance policies will include a waiting period after enrollment. During this period, you will not be able to make any claims for accidents or illnesses, and if your pet does fall ill, this will be classed as a pre-existing condition. The initial waiting periods for accidents and illnesses will vary in length depending on your insurer, however it is normally around 48 hours for accidents and 14 days for illnesses, effective from the start date of your policy.

Most insurers will also have a waiting period for orthopedic conditions, which can range from 14 days to 12 months. This means that if your pet develops an orthopedic issue in the waiting period, you will not be able to make a claim. Your pet insurance company may be able to decrease the orthopedic condition waiting period if your pet has an orthopedic exam within the first 14 days of taking out your policy, and you can provide your insurer with a report card from your veterinarian which details your pet’s current health.

Each insurer will have different waiting periods, and some waiting periods may also be subject to age restrictions, so it’s important to be clear of the limitations listed in your policy before you enroll.

Some policies exclude bilateral conditions and some exclude only specified bilateral conditions. It’s important to check your policy especially if your pet is a breed that has a tendency to develop bilateral conditions such as hip dysplasia.

A bilateral condition is a condition which can occur on both sides of the body, for example, hip dysplasia on both hip joints. Some insurers will limit how much they will cover bilateral conditions, while others may just exclude specific bilateral conditions, such as cruciate ligament (ACL) injuries or Patella issues.

This means that if your pet develops a condition that is not covered bi-laterally, the treatment on the first limb would be covered but if the condition then occurs on the other side of the body, the treatment of the second knee would not be covered. Similarly, if your pet has had treatment for an excluded bi-lateral condition before you took out your policy, treatment for the limb on the other side of the body would not be covered.

A maximum pay-out per incident limit may also apply to bilateral conditions in some policies. This means that if you submitted a claim for hip dysplasia on your dog’s left leg two years into the policy, and a year later they developed the same condition in their right leg, the insurer would class them as the same incident and you would only be able to claim back what is left of the maximum pay-out limit after the left leg injury.

Larger, more active dogs are at increased risk of developing hip dysplasia. It is more common in the following breeds:

  • Labrador Retriever
  • German Shepherd
  • Newfoundland
  • Rottweiler
  • Golden Retriever
  • St. Bernard
  • Boxer
  • French Bulldog

While dogs of any age or breed can develop ACL injuries, they are more common in the following breeds:

  • Labrador Retriever
  • German Shepherd
  • Newfoundland
  • Rottweiler
  • Golden Retriever
  • St. Bernard
  • Bichon Frise

As bilateral conditions are likely to affect both sides of your pet’s body, if your policy includes a bilateral exclusion, it’s important to always check which restrictions apply.

When you visit your veterinarian to seek advice for your pet’s illness or condition, you will be charged an exam fee in addition to the cost of the treatment which your pet receives. The cost of the exam fee will vary depending on where you live and whether you see a specialist veterinarian. Exam fees for emergency appointments may also be higher than routine exam fees.

While some insurers will cover exam fees, others will not. Not covering the cost of the veterinarian exam fee enables pet insurance providers to make their plans more affordable, as it encourages pet owners to only take their pet to see their veterinarian when absolutely necessary. However, if your pet needs to receive emergency treat during an evening or weekend, once the exam fee and deductible have been subtracted from your vet bill, the amount you are reimbursed may be much lower than expected.

If you want to be sure that your exam fees are covered, regardless of whether it is an emergency or specialist appointment, be sure to check with your insurer before you enroll.

If your pet is diagnosed which a condition such as diabetes, bladder stones or heart disease, they may require a prescription diet to provide them with a better quality of life or prolong their lifespan. Prescription diets are often more expensive than regular pet food and are normally only available through your veterinarian.

Prescription diets are generally not covered by your pet insurance policy. Some insurers will agree to cover the cost of a prescription diet if it is to help treat a short-term health problem, for example to help dissolve bladder stones. However, if the diet has been prescribed by your veterinarian to help treat an on-going condition and it is also available to buy over the counter, it’s unlikely that you will be able to make a claim for these expenses on your pet insurance policy.

If your veterinarian has recommended a prescription diet to aid weight loss, this will not be covered by your policy.

Conditions related to breeding and whelping are often not covered in your pet insurance policy. If you choose to breed your dog, you can purchase specialist breeder’s insurance which can help you cover the cost of any veterinary care. It will also help cover the cost of any veterinary treatment the puppies receive once they’re born.

Some pet insurance providers offer accident and illness cover away from home. This means that if you are a U.S. resident and you are travelling with your pet within North America, you will be able to claim on your pet insurance should your pet fall ill. This is also true of those living in Canada who are travelling with their pet whilst still in the country.

It is unlikely that you will be able to claim back for any costs if you need to cancel your vacation if your pet falls ill unexpectedly. Some insurers will also apply a maximum claim amount to these types of claims, so it’s important to know what’s covered in your policy before you leave home.

The short answer is no. Wellness plans are designed to spread the cost of routine pet care, typically used to pay for vaccinations and preventative care, routine examinations and some dental care, for example. If your pet falls ill, is injured in an accident, or eats something they shouldn’t, the veterinarian care needed to treat them will not be covered by your Wellness Plan.

Pet Health Insurance that provides illness and accident coverage is the only type of policy that will give you the peace of mind that your pet will be cared for should the unexpected or unthinkable happen. Read more about the differences between Wellness Plans and Pet Insurance policies in our article Pet insurance vs. pet wellness plans.

 

The information above is non-specific to any particular pet insurance policy and should be regarded as a basic overview of the type of features that may feature in a policy. Always refer to your insurer for specific, accurate information on your policy features.