There are high monthly premiums which cover immunizations and office visits, but everything else is out of pocket. I found the place to be dis-functional. Some of the staff seems poorly trained and disinterested. I have had a hard time communicating with the veterinarians that I have come in contact with; they don't listen very well and and they don't seem competent. (I have, however, heard very positive comments about different veterinarians from other people). This is not the place to go if you have an animal with a serious, chronic health condition. They are not qualified to deal with such situations.