I have a 9 y/o Alaskan Malamute named Avalanche. I originally had another pet insurance on him at first, but when I found out their coverage wasn't year-to-year, and any condition found in a prior year's plan was considered "pre-existing" and therefore not covered, I switched immediately.
PetPlan has been amazing! In the several years I've had it on Avalanche, they've been the best decision. If you have a pet, you have to have PetPlan. In one year, Avalanche lost a toe to cancer, and also blew out his CrCl ligament (like a human's ACL) and needed TPLO surgery to fix his knee. In that year alone, PetPlan paid me back more than I ever paid into the plan, from the day I signed up. Currently, Avalanche has kidney disease, which requires 3x/week sub-Q fluid treatment. He just had surgery to remove a tumor from his shoulder, and he's about to start chemotherapy. All of which has been covered.
PetPlan reimburses you what you paid. They don't do the "average cost" of whatever it is, in your area. If you paid X, they pay you back X minus your deductible and co-pay. It's been amazing. The new app makes submitting claims even easier!