The number one complaint we hear from consumers about pet insurance is that their insurance company won’t cover their pet’s condition because it is “pre-existing.”
While we understand it’s very frustrating to have your pet undergo a costly treatment, only for the insurance claim to be denied, more likely than not you agreed to the terms regarding pre-existing conditions when you bought the policy.
In this article, we’ll go through the reasons why insurance companies don’t cover pre-existing conditions and what you can do if they determine your pet suffers from one.
WHAT IS A PRE-EXISTING CONDITION?
Pet insurance companies define a pre-existing condition as any illness or condition that a covered pet was afflicted by or showed symptoms of before the effective date of the policy or during the policy waiting period. This definition includes recurring illnesses or conditions as well as injuries and associated complications.
Something to keep in mind is that many plans with a 12-month cover will reset pre-existing conditions upon policy renewal, in order to exclude any ongoing, recurring, or chronic illness. This means that any conditions your pet suffers from during the policy coverage period will be considered pre-existing conditions once the plan is renewed.
DOES PET INSURANCE COVER PRE-EXISTING CONDITIONS?
In general, pet insurance companies do not cover pre-existing conditions, but each company’s definition of said conditions may vary.
If you and your veterinarian weren’t aware of a condition before obtaining the policy, chances are it will be insured, unless it manifests itself prior to the commencement of coverage. If your insurance company sets a policy waiting period, it may be that any symptoms that show or conditions that occur during that time will not be covered for the life of the policy.
The sooner you request insurance for your pet, the better your chances will be of covering any conditions that may affect it.
WHY DON’T PET INSURANCE COMPANIES COVER PRE-EXISTING CONDITIONS?
The very nature of an insurance company is that it will assess the risk of the person, pet, or thing being covered to determine how likely it is they will end up paying out more in claims than the policyholder will pay to them in premiums.
In other words, the insurance company sells you a policy and counts on you never having to use it.
If your pet has already suffered from a particular illness, it’s more likely that it will afflict them again in the future. Since this represents a financial loss for the insurance company, they won’t cover pre-existing conditions.
For example, a ruptured cruciate ligament on your pet’s left knee might be considered a bilateral condition. If it develops on the right knee later on, it won’t be covered because your pet has already shown a predisposition for ruptured cruciate ligaments.
WHAT PRE-EXISTING CONDITIONS CAN BE COVERED, IF ANY?
Some insurance companies differentiate between curable and incurable pre-existing conditions. Curable conditions are those that don’t reoccur after an exclusionary period. During the exclusionary period, which may be between six months and a year, the condition is not covered.
Once the period ends without the pet showing signs of the condition, the insurance company will restore coverage for that specific malady.
Some conditions that might be covered by your policy after the exclusionary period are respiratory, ear, or urinary tract infections; common gastrointestinal upsets like vomiting or diarrhea; and dermatitis or other types of skin rashes.
Dormant conditions that flare up in the future don’t count as a curable pre-existing condition and will not be covered by most insurers.
On the other hand, incurable conditions are those that cannot be completely healed, even if treatment relieves the symptoms. Some incurable conditions are diabetes, cancer, and arthritis.
Speaking of cancer, many companies will cover pets that were diagnosed and treated for cancer before purchasing the policy. Generally, though, if there are complications from the treatment, or if cancer metastasizes in another part of the body, the condition won’t be covered.
HOW DOES THE INSURANCE COMPANY KNOW IF MY PET HAS A PRE-EXISTING CONDITION?
Similar to how life insurance companies ask you for a physical medical exam before selling you a policy, the insurer will ask to review your pet’s medical file before covering your pet. Often, they’ll ask for your veterinarian’s contact information when you first sign up for a policy.
The company will contact your vet, who then provides a copy of your pet’s file. Using this information, insurers assess their risk and determine if your pet suffers from any pre-existing conditions.
What happens if you don’t have a vet or it's been a while? In these cases, you may have to find one and schedule a visit. Many insurance companies won’t cover a pet that hasn’t seen a veterinarian within the last 12 months. They do this to make sure they have the most recent information on your pet’s health.
IF MY PET HAS A PRE-EXISTING CONDITION, SHOULD I STILL GET PET INSURANCE?
If your pet has a pre-existing condition, it shouldn’t discourage you from purchasing insurance. Though the policy won’t cover that specific pre-existing condition, depending on the gravity of the illness or injury, this may not make much of a difference.
For instance, say the issue is that your pet contracted a disease which remains dormant. Even if insurance won’t pay for treating a recurrence of the illness, it will still provide coverage for any other problems that may arise, as well as emergency care. Moreover, there may not even be another flare-up of the disease.
On the other hand, maybe your pet has been relatively healthy, barring a few minor problems, but is getting on in years. Insurance can help mitigate the costs of future illnesses or conditions associated with aging. You can also get insurance just for emergencies, which tend to be the treatments that cost the most.
Emergency-only policies are considerably more affordable than those with broader coverage that can help pay for surgeries, medication, and rehabilitation for your pet.
ARE THERE ALTERNATIVES TO PET INSURANCE?
An alternative to pet insurance could be a credit card geared towards medical expenses. CareCredit, for example, offers financing options for 6, 12, 18, or 24 months, with zero interest on payments less than $200, provided you make the minimum monthly payments and clear the balance at the end of the promotional period. Otherwise, the standard APR is 26.99%. This is an excellent option for pets with pre-existing conditions that require costly treatment.
A similar alternative is Pet Assure, a veterinary discount plan that gives you a 25% discount on all medical care provided by your vet, including wellness visits, dental care, spaying/neutering, and emergency care.
Think of it as a membership to a big box store— the more you use the membership, the more it pays for itself. This can be a good option for owners of multiple pets who can’t necessarily afford the premiums on four cats and two dogs, for example.
Pet Assure reviews are positive across the board when used for pre-existing conditions that insurance won’t cover. The only issue is that not all vets are members of the program, but that can easily be solved by checking if there’s a participating office near you before enrolling.
United PetCare works in much the same way as Pet Assure since it is a membership savings program. Members receive rebates for regular visits, vaccinations, procedures, surgeries, and medications.
The bill is discounted at the time of service, and you can expect it reduced 20-50%, for a monthly cost between $10.60 to $13.90. These last options all enter into effect immediately and have no waiting period.
One caveat against United PetCare is that it only works in California, Arizona, Nevada, Texas, and Colorado. United PetCare Reviews also present a recurring problem with customer service and difficulties in canceling the program.
SHOULD I JUST OPEN A PET HEALTH SAVINGS ACCOUNT?
Some people recommend that you open a pet health savings account instead of paying monthly premiums, arguing that most policies aren’t worth the cost over a long period of time, especially when you have a generally healthy animal.
Though it’s true that most pet owners won’t get back in benefits what they’ve paid in premiums, this is actually a good thing, since it means your pet was healthy. The idea behind pet insurance is to help defray the costs for emergency treatments that you’d have trouble paying for out-of-pocket, and a savings account may not actually be enough to do so.
Many pet owners adopt a three-pronged strategy for financing their pet’s needs and opt for some insurance for emergencies and unexpected situations, a savings account for wellness care, and either a regular credit card or something like CareCredit for deductibles.
This means they’ve covered all the bases and can rest assured that life-and-death decisions for their pet won’t be determined by an immediate lack of funds.
Whatever decision you make, bear in mind that since most insurance policies don’t offer coverage for pre-existing conditions, it behooves you to insure your animal friend as soon as possible. That way, if any condition does develop, it will happen after it’s already covered.