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Pet Insurance Coverage: What You Need to Know

Colin GrubbMar 29, 2017

What Does Pet Insurance Cover?

Pet Insurance typically covers all accidents and illnesses that could befall your pet. It can also cover genetic, congenital and chronic conditions, provided that signs of these conditions were not present prior to purchasing the policy. Some also include dental coverage, but this usually refers to dental trauma caused by an accident.

Pet insurance plans generally come in three types: comprehensive, accident-only, and wellness. The comprehensive option is generally going to be the most expensive; it is also the most popular because it covers both accidents and illnesses. Should your pet get injured crossing a busy street, develop hip dysplasia, or fall victim to cancer, they are going to be covered. Accident only policies are cheaper but only cover procedures related to healing the pet after an injury.

Wellness plans are offered either as an add-on to a comprehensive policy, or as a standalone policy itself. They generally run around the same price as an accident-only policy. Wellness plans cover things like routine physical exams, flea and tick prevention, heartworm medication, spaying or neutering, and other preventative interventions. Although wellness policies are gaining in popularity, in our opinion they are typically not worth it as the cost of routine veterinary care is negligible. Even in your pet's first year of life the out of pocket cost would usually be the same or less than the combined annual premium of a wellness plan.

Below are some common medical treatments covered by pet insurance plans:

  • Diagnostic testing
  • Hospitalization
  • MRI
  • CT Scan
  • Ultrasound
  • Prescriptions
  • Cancer treatments
  • Dental treatments (non cosmetic)
  • Surgery
  • Rehabilitation

The routine exam fees your vet will charge you are usually not included in coverage, although there are some comprehensive + wellness plans that are exceptions to the rule. These plans are, on average, the most expensive. The best plans allow you to set a reimbursement percentage that pays out on the actual veterinarian bill(s). Let’s look at an example:

Billy is an 8-year-old Golden Retriever who develops lymphoma. Between the diagnosis, visits to the oncologist, testing, chemotherapy, hospitalization, and prescription medicines, the total cost of all bills related to treating the condition amount to $12,381.

Billy’s owners chose a pet insurance plan with a $500 deductible and 90% reimbursement. Billy’s owner’s out-of-pocket expense after the whole ordeal – including the deductible – was $1,689. Their pet insurance plan came up with $10,693.

Below are some other common conditions covered by pet insurance:

  • Heart Disease
  • Cataracts
  • Ear Infection
  • Diabetes
  • Ingestion of a Foreign Body
  • Allergies
  • Heart Murmur
  • Broken Bones
  • Luxating Patella
  • Bladder Stones
  • Hip Dysplasia
  • Kidney Failure
  • Auto Accident

What Does Pet Insurance Not Cover?

Pet insurance does not cover pre-existing conditions, meaning any illness or congenital condition that was evident before purchase will not be covered. However, some companies will make allowances for certain pre-existing diseases if the pet has been cured and symptom-free for a certain amount of time–usually 6-12 months.

Common pre-existing, curable conditions that you may get coverage for include gastrointestinal disorders, ear infections, urinary tract infections, respiratory disorders, and skin rashes like dermatitis, vomiting and diarrhea.

Conditions that would not be covered if the pet were diagnosed before the policy purchase include:

  • Hip dysplasia
  • Cancer
  • Heart Disease
  • Diabetes
  • Arthritis
  • Hyperthyroidism
  • Orthopedic Conditions

Miscellaneous Items NOT COVERED by Pet Insurance

As mentioned above, unless you purchase a plan with a wellness component -- which we find generally cost-prohibitive -- routine preventative care such as vaccines, physical exams, heartworm prevention, flea and tick control, deworming, nail clipping, etc. will not be covered. Pet insurance will not cover injuries sustained because of inhumane treatments either.

Below is a list of selected procedures not covered:

  • Tail Docking
  • Ear Cropping
  • Micro-chipping
  • De-clawing
  • Dew Claw Removal
  • Specialty diets
  • Boarding
  • Grooming
  • Homeopathic or holistic treatments

This is just to serve as a general survey as to what typical pet insurance plans include and exclude. All companies offer different policies. If you’d like to compare all the best options, check out our Top Ten Pet Insurance Plans of this year.