My cat has been seen since aug of 2014 for anal gland issues. Vet says that they are defective and not emptying on their own. Trupanion does not cover expression which is really terrible saying that it's maintenance. It really isn't. My cat has had infections because of this. They will cover that but not expression to prevent the infection from happening again. Doesn't make sense. I've called twice now and still they won't cover it.