Posted: 08/07/2023 | BY: Content Writer
How does pet insurance work?
You’ve finally found the perfect dog and you’re ready to take him home but how can you afford expensive vet bills? Don’t worry, pet insurance is here! Pet insurance is a great way to protect your new furry friend from costly medical expenses that will definitely come up throughout their lifetime. In this page, we go over what is pet insurance, how does pet insurance work, and what does pet insurance cover?
In 2021, there’s a lot to consider when choosing a pet insurance policy. With so many pet insurance companies 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!
Before signing up with just any insurance company or plan, it’s important to know some important things beforehand: What is pet insurance? What does pet insurance cover? How does pet insurance work?
When it comes to choosing your pet health insurance, pet owners should consider the following:
policy coverage exclusions, conditions not covered in certain circumstances, minimum wait times(where the insurer requires a specific amount of time that must pass before claims can be made. These wait times are designed to minimize fraudulent claims and bring down the cost of premiums for everyone with pet insurance policies. If you fail to carefully check the policy details, you could find yourself paying out-of-pocket when you make a claim.
We’ve answered the most common questions around pet insurance plans, so you will know what to expect when making a claim and be better informed when it comes to choosing a policy that’s right for you.
Frequently Asked Questions About Pet Insurance:
Pet health insurance is basically the equivalent of human health insurance. It covers your pet’s veterinary bills in case of illness or injury. It can also cover things like pet wellness visits, pet dental cleanings, vaccinations and the cost of spay/neuter procedures.
Some pet insurance plans are more expensive than others so it’s important to do your research to see how much pet insurance costs before purchasing one for your furry family member. The most comprehensive plans cover everything from checkups to any and all significant illnesses.
Most pet insurance plans have extensive coverage, while some pet insurance plans, only cover certain, specific things. It’s important to find a pet insurance plan that works for you and your pet in the event of an unexpected emergency like an illness or injury.
If your pet were to get sick or injured what would you do? What if your dog or cat needed surgery? Pet insurance can help cover the cost of all these things! You can start by comparing pet insurance plans here at Pet Insurance Review.
So what does pet insurance typically cover? Here is a breakdown of what pet insurance coverage looks like:
Covered by Pet Insurance?
|Unexpected injury caused by an event not related to an underlying illness or disease.
|Most pet insurance policies cover unexpected physical injuries provided the injury was not caused deliberately by the pet parent or household member.
|Unexpected acute injury related to a sudden illness requiring medical care.
|The majority of pet insurance companies will cover acute, unexpected illnesses, provided they are not pre-existing.
|Emergency treatment for an injury or illness that requires immediate care.
|Pet insurance policies generally cover emergency care; however, additional costs, such as administrative fees, boarding, and pet transportation, may not be included.
|Chronic conditions, which once diagnosed, are determined incurable or lifelong conditions.
|Yes, provided the chronic condition is not pre-existing.
|Insurance companies have different definitions for pre-existing conditions, which may influence whether a chronic illness qualifies for coverage.
|Hereditary (not present at birth) and congenital diseases (present at birth)
|Dependent upon the policy.
|Some policies will cover hereditary and congenital diseases, but only through additional purchased coverage. Other policies cover these conditions by default, while some other companies will not cover them at all.
|Pre-existing conditions, or medical conditions that existed before the pet insurance coverage began.
|No pet insurance company covers pre-existing conditions, although some company’s definitions of “pre-existing” may vary.
|Breed-specific conditions are health problems or medical conditions found in certain breeds.
|Dependent upon the policy.
|Some insurance companies will not cover the treatment for breed-specific conditions.
|Wellness or health maintenance, including preventative care
|Dependent upon the policy.
|Many insurance policies do not cover wellness or maintenance plans. Others will do so, but for an additional cost to the policyholder.
Your pet may not have experienced any serious health problems so far, but a nasty accident or sudden bout of illness may mean you are left forced to pay unexpected vet bills. Without financial support from a pet insurance company, you could be left paying significant amounts of money out-of-pocket. Pet insurance protects both your pet and your pocketbook.
Veterinary treatment for ongoing conditions can potentially add up to hundreds, or even thousands of dollars, which is why so many people prefer that the bulk of the cost of their pet’s health care will be taken care of, no matter what life has in store.
Some people choose not to get pet insurance because they believe that their pets will never need treatment for anything serious and consider pet insurance as something that’s only good for emergencies. Others find it important to have because it gives them peace of mind knowing they can afford to care for their pet if something were to happen to their beloved furry friend.
To learn more, read “Is Pet Insurance Worth It?” This article explores this topic much more extensively.
At Pet Insurance Review, we always recommend getting pet insurance. From our point of view, and the point of view of many other pet parents, pet insurance is worth it for the majority of pet parents.
If you’re ready to get started, here is a tool to find free pet insurance quotes from the top pet insurance providers.
The cost of pet insurance for your dog or cat 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.
Pet insurance costs are based on your:
- Pet’s age (older pets are usually more expensive)
- Pet’s Breed (there are breeds that are prone to issues, due to hereditary diseases)
- Location (if you live in a city where there is a high crime rate, you will need to pay more than if you live in an area with low-crime or in an affluent neighborhood).
An example is that a 10-year-old dog named Lola is spayed and is living in Houston, Texas. She is insured by Healthy Paws. The average monthly premium is $223.
The average cost of pet insurance varies from $15 to $200 per month. Dog insurance is a bit more expensive than cat insurance. But in general, the higher-priced plans have a higher deductible and will pay for more treatments before you pay anything out of pocket. The less expensive ones are not as comprehensive, and they are only meant to cover accidents.
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 pet insurance premiums, which is why it’s important to compare a range of insurers to find a policy which best suits your individual needs and budget.
If you want to learn more, read “Pet Insurance Cost: How much is Pet Insurance, Is it affordable?“. This article explores this topic much more extensively.
There are multiple pet insurance companies operating in the marketplace and many of them offer a variety of pet insurance plans. However, the process to get pet health insurance is, more or less, the same for each plan:
1. Compare and find the best pet insurance plan for you and your pet. Here at Pet Insurance Review you can compare prices and coverage from the top providers and read thousands of reviews that can help you choose the right policy. Ask yourself these questions?
- What coverage do I want? Do I need full coverage or only accident and illness coverage?
- What is my budget to pay for the monthly premiums?
- Do I have a particular pet insurance provider in mind?
- Do I need a pet insurance plan or a pet wellness plan?
2. Once you’ve chosen your policy, you’ll be able to personalize your pet insurance plan by selecting your deductible and co-pay or reimbursement percentage options. You will typically be able to choose between an annual or per condition deductible as well as the amount you pay for each claim. You will also 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.
3. Pay the monthly pet insurance premiums and stay up to date with all the documents and vaccines for your cat or dog.
4. Should your pet become ill or injured, you can visit any licensed veterinarian for treatment. Most pet insurance plans will require you to pay for the entire vet bill up front. If you are insured by Trupanion you may be eligible for Direct Pay, this way you won’t need to pay the fees upfront.
5. 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 costs.
6. Get reimbursed by your pet insurance company up to 100% of the claim depending on the pet insurance plan you choose.
That is in summary how pet insurance works. It’s that easy!
The majority of pet insurance policies require you to pay any vet bills 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 paid out in as little as a few days.
Some insurance companies will pre-approve you for a future operation and pay the veterinarian directly. In this case, you will only have to pay a co-pay amount at the time of treatment. Ask your insurer how they handle vet bills-if it’s not clear from their website or product literature.
Most pet insurance companies do require that you pay any outstanding veterinarian fees before reimbursing these costs – check with your chosen provider for specific details.
The deductible is the amount you must pay to the pet insurance company before they pay out anything against your claim. These 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 totaled 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 amounts will be totaled 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.
The best pet insurance is the one that is right for you. One dog or cat insurance plan may not be a good fit for you, while another would be perfect. This is why it’s so important to compare pet insurance plans before committing to an insurance company. This way you can avoid any surprises later on.
Choosing the best pet insurance plan isn’t about finding the cheapest option. It’s all about finding the coverage that best meets your needs and budget; without sacrificing your pet’s health by giving him the best possible veterinary care.
What Pet Insurance Company Should I Choose?
This is a question pet owners often ask themselves. There are numerous pet insurance companies to select from, and each of them makes lofty claims about what they can do for you and your pet. It’s critical to evaluate different pet insurance providers after comparing them so you can find the best policy and price.
When it comes time to enroll in a plan, you need to make sure the pet insurance plan is one that provides adequate coverage at an affordable price.
It’s also critical to look for pet insurance companies that provide excellent customer service, as you will need them to be there for you when you need it most. You will need to be able to interact with someone directly about your questions and concerns, as well as to receive cost information that is simple to comprehend.
It’s also important to look into pet insurers with the best pet health care network; this will ensure your pet is covered at every vet, depending on what policy you opt for.
Here are the top providers based on reviews from pet parents just like you!
Most pet insurance providers won’t cover treatment for any pre-existing conditions in any basic plan. 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.
Some providers will include these pre-existing conditions on the higher priced plans.
A recurring health problem, or a condition such as diabetes or cancer, will normally be classified as a pre-existing condition by your insurer. While any claims for treatment related to this condition will not be included, 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 companies, it’s important to take out health insurance for your pet while they’re still young. The great news is that most pet insurance companies will enroll pets as young as 6 weeks old.
Getting pet insurance while your pet is young is even better when you consider covering the costs of hereditary and congenital conditions before they develop. This way, these conditions will not be considered pre-exisiting, and will be covered by most pet insurance plans, if enrolled early.
Many pet insurance plans allow you to choose your policy limits. By selecting a limit on your coverage you may reduce your monthly premiums but will 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 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 become ill, this will be classified as a pre-existing condition. The initial waiting periods for accidents and illnesses 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
- Golden Retriever
- St. Bernard
- 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
- 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 treat 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 most pet insurance plans 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 purchase pet insurance.
If your pet is diagnosed with 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 companies offer accident and illness cover away from home. This means that if you are a U.S. resident and you are traveling 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 traveling 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. Pet 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.
In the end, you choose, but explore the point of view of veterinarians. Talk to your vet, ask them about it, and if you need more information, there are a ton of resources you can find on our site here are a couple of useful links:
At Pet Insurance Review, we always recommend getting pet insurance. From our point of view, and many other pet parents agree, there is no question, pet insurance is a must.