Understanding Pet Insurance: What's Included and What Is Not

Written by: Lindsay Giguiere



Time to read 4 min

There’s no doubt that pet insurance policies can help alleviate concerns about unplanned veterinary expenses which can easily run into thousands of dollars, as they offer reimbursement for veterinary bills resulting from accidents or illnesses.

However, it's crucial to understand the extent of coverage and potential exclusions before selecting a policy. In this article, we look at what pet insurance typically covers, the different types of policies available, and the standard exclusions to help pet owners make informed decisions about their furry friends' healthcare.

What Does Pet Insurance Cover?

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When your pet falls ill or gets into an accident, pet insurance can be a valuable safety net, covering various unexpected veterinary expenses. The coverage provided may include:

Accident-Only Coverage

This policy focuses on pet-related accidents and is usually more affordable. Accident-only coverage includes veterinary care and necessary medications, scans, and procedures for incidents such as broken bones, burns, cuts, eye injuries, ingestion of foreign objects or toxic substances, and more.

Accident and Illness Coverage

An accident and illness plan is the most comprehensive pet insurance, offering coverage for unexpected accidents and illnesses. In addition to accident-related incidents, this policy covers treatments for allergies, breed-specific conditions, cancer, diabetes, heart disease, surgeries, specialist care, prescription medications, and more.

Wellness Plan Coverage

Wellness or preventative care plans cover routine care, including annual vet visits, vaccinations, flea and tick control, teeth cleaning, and regular checkups. This coverage is often available as an add-on to the base pet insurance policy.

Add-On Coverage

Many insurance providers offer additional coverage options for specific needs, including wellness care, spaying and neutering, behavioral treatment, boarding, dental illness, liability coverage, physical therapy, and more.

What Does Pet Insurance Not Cover?

While pet insurance covers various medical expenses, there are specific exclusions that pet owners should be aware of, such as:

Pre-Existing Conditions

Pet insurance policies do not cover conditions, diagnoses, symptoms, or treatments that existed before the policy's start date. Enrolling pets in insurance as early as possible is advisable to avoid denied claims due to pre-existing conditions.  Check out the waiting periods for any policy’s pre-existing conditions exclusions. For example, there may be a 180-day waiting period for cruciate ligament claims and up to 12 months for certain common conditions.

Bilateral Conditions

When a medical issue affects both sides of your pet's body, the insurance provider may consider it pre-existing if symptoms have already developed on one side. For example, suppose your pet has hip dysplasia in one hip before the policy's waiting period is complete. In that case, the condition in the other hip may not be covered.

Congenital or Developmental Conditions

Pet insurance may exclude coverage for conditions present at birth or those that interfere with the animal's growth and development. Coverage may be extended if no signs or symptoms are present when the policy begins. Some of the most common congenital conditions in dogs are:

  • Hip Dysplasia: A hereditary condition where the hip joint doesn't develop properly, leading to arthritis and pain.
  • Luxating Patella: The kneecap dislocates from its normal position, causing lameness and discomfort.
  • Cleft Palate: A gap in the roof of the mouth, which can lead to difficulty in eating and breathing.
  • Congenital Heart Defects: Malformations in the heart's structure that affect blood flow and oxygenation.
  • Hernias: Gaps in the abdominal wall or diaphragm, allowing organs to protrude.
  • Heart Murmurs: Abnormal blood flow causing noise, indicating potential heart issues.
  • Cataracts: Clouding of the eye lens, affecting vision.

Early detection and intervention are key for managing congenital conditions. Consult your veterinarian for proper guidance and care.

Death of a Pet

Pet insurance is not equivalent to life insurance, and expenses related to the death of a pet are typically not covered.

Elective Procedures

Procedures deemed medically unnecessary, such as spaying and neutering or ‘cosmetic’ procedures such as ear cutting or tail docking, are typically excluded from coverage.

Experimental Treatments

Experimental treatments in dogs refer to medical procedures, therapies, or interventions that are not yet widely established or approved by regulatory authorities but are being investigated for their potential effectiveness in treating various conditions. These treatments often involve cutting-edge research and innovative approaches to address health issues in dogs. It's important to note that the use of experimental treatments in dogs is typically conducted under controlled and monitored conditions, such as clinical trials, to assess safety and efficacy. Some examples of experimental treatments in dogs include:

  • Stem Cell Therapy: Stem cells are being studied for their potential to regenerate damaged tissues and treat conditions like osteoarthritis and spinal cord injuries.
  • Gene Therapy: Genetic techniques are explored to correct or replace defective genes responsible for inherited disorders.
  • Immunotherapy: Immune-based therapies aim to stimulate the dog's immune system to target and eliminate cancer cells.
  • Cancer Vaccines: Experimental vaccines are being developed to prevent or treat specific types of cancer in dogs.

Non-Veterinary Services

Standard pet insurance plans usually do not cover non-medical services, including boarding, grooming, transportation, food and nutritional supplements, waste disposal, etc.

Pregnancy or Birth

Costs related to breeding, pregnancy, or birth and conditions resulting from these events are rarely covered.

Preventable Diseases

This exclusion is important to be aware of. If you fail to vaccinate your pet, in line with the recommended schedule, against well-known and preventable diseases, the insurance provider may not cover related treatments.

Theft of a Pet

Expenses associated with stolen or lost pets, including rewards or the cost of putting up flyers, are typically not covered. However, some providers offer add-on coverage for these costs.

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Pet Insurance Coverage in Summary

Pet insurance can be an affordable solution to the financial burden of unexpected veterinary expenses. With the right coverage, you can have peace of mind, knowing that emergency care for your pet will not result in difficult financial decisions.

Gaining a clear understanding of the extent of coverage provided by your chosen policy, as well as familiarizing yourself with the exclusions, plays a pivotal role in your ability to make a well-informed decision. By delving into the specifics of what your pet insurance policy encompasses and what situations it may not address, you empower yourself to select a plan that not only aligns seamlessly with your financial considerations but also ensures the well-being and vitality of your cherished furry companions. This knowledge equips you with the tools to navigate the realm of pet insurance with confidence, enabling you to safeguard your four-legged family members' health and happiness to the fullest extent possible.

Are you considering a health insurance policy for your pet? Want to learn more and get a quote for a personalized plan from Petinsurer through Felicitails? Click here now.