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What Does Pet Insurance Cover?
By Joan Pabón MONEY RESEARCH COLLECTIVE
What and how much a pet insurance policy may cover will depend on the type of plan and insurer you select. For instance, while most pet insurance companies offer three distinct types of pet insurance policies, covered conditions and coverage limits may vary considerably from one company to the next — even when comparing the same type of plan.
When looking to insure your furry companions, it can pay to know what the different types of policies generally do and don’t cover. You might be surprised to find the most common type of policies won’t reimburse you for routine or preventive care, for example.
In this article, we’ll address what the best pet insurance policies generally include and exclude from coverage.
Table of Contents
- What is covered by pet insurance?
- Types of pet insurance coverage
- How does pet insurance work?
- Pet insurance coverage bottom line
What is covered by pet insurance?
While pet insurance varies by company, among other factors, policies generally cover accidents and most illnesses as well as some exam fees, emergency care — including surgery — and prescription medication.
Types of pet insurance coverage
Most pet insurance companies offer three distinct types of pet insurance policies: accident-only policies, accident and illness policies, and wellness policies.
Let’s go over each type in detail.
1. Accident-only coverage
- More affordable than accident and illness policies
- May be best for younger, accident-prone pets
- Won't cover treatment for illnesses, hereditary or otherwise
- Preventative or routine care is not included
What is covered by accident-only insurance?
As the name suggests, accident-only pet insurance policies covers veterinary care costs associated with minor and major mishaps. Covered items can include accidental injuries of any kind (think cuts, abrasions, punctures, torn ligaments, fractures, broken bones, etc.), stings and bites, ingestion of foreign objects, poisoning and emergency dental services for problems like tooth fractures.
Accident-only policies will also cover any surgery and hospitalization costs that stem from an accident, as well as labs, X-rays, MRIs, CT scans and prescription medications for the treatment of a covered claim.
It’s worth noting that pet insurance is different from some other forms of insurance in that premiums won’t increase after a claim. However, pet insurers will take into account a breed’s predisposition to accidents when pricing policies. If, for example, your dog’s breed is predisposed to ingesting foreign objects — as is the case with Labradors — your monthly premium will likely reflect that risk.
What isn’t covered by accident-only insurance?
Accident-only pet insurance policies will not cover illnesses (including dental illness, chronic illness, etc.), genetic or congenital conditions, or diseases like cancer. Neither will these policies cover intentional injuries to the animal or those that arise from commercial activities like racing and organized fighting.
Lastly, and this is true for all types of pet insurance policies, pre-existing conditions — meaning those that began to develop before you enrolled your pet in coverage — will not be covered under accident-only plans.
2. Accident and illness coverage
- Coverage for both accidents and illnesses
- Breed-specific conditions are covered (if they aren't pre-existing)
- Many plans cover alternative care (like hydrotherapy and laser therapy)
- Costs more than accident-only policies
- Won't cover preventive or routine care
- Some plans will only cover up to an annual maximum
What is covered by accident and illness insurance?
Accident and illness policies — also called comprehensive policies — are pet insurance plans that cover all types of accidents as well as a long list of illnesses, from stomach upsets to cancer. Like accident-only policies, these plans will also reimburse you for emergency medical services and related costs, including diagnostic tests, sonograms and scans, surgery and prescription medications for the treatment of covered conditions.
Again, your pet insurance premiums won’t increase after you file a claim under an accident and illness policy, but insurance companies will charge more to insure pets whose breeds are prone to certain illnesses and behaviors. A policy for a dog breed prone to hip dysplasia, for example, will cost more than a policy for a mixed breed dog.
Other serious illnesses that are usually covered
While covered conditions will depend on your policy and insurance provider, many plans will cover the following hereditary and chronic illnesses under comprehensive policies.
| Dogs | Cats |
| Diabetes mellitus | Type II diabetes (due to obesity) |
| Arthritis | Skin allergies |
| Inflammatory bowel disease | Polycystic kidney disease (PKD) |
| Hyperthyroidism | Hypothyroidism |
| Hepatitis | Hip and elbow dysplasia |
Comprehensive coverage – what is and what isn’t included
Many, but not all, pet insurance providers include coverage for alternative therapies in their accident and illness policies. Alternative care may include acupuncture, laser therapy, hydrotherapy, physiotherapy, rehabilitative therapy, chiropractic care and more. Behavioral therapy for compulsive behaviors such as excessive licking, biting, digging, barking and litter box issues is also often included.
And again, even the most comprehensive of pet insurance policies will not cover conditions that developed before you enrolled your pet in coverage.
3. Wellness coverage
- Covers preventive and routine care, such as dental cleanings
- Includes coverage for annual wellness exams and vaccinations
- May not be worth the cost, depending on covered services
- Some companies only offer wellness coverage as an add-on
What is covered by wellness insurance?
Wellness pet insurance policies cover routine and preventative care costs, such as spaying and neutering, deworming, microchipping, vaccination, routine dental cleanings and regular or annual checkups. Because some of these services can only be rendered once over the pet’s lifetime — such as spaying/neutering — some pet parents may find wellness policies aren’t worth the cost. But, of course, you might think otherwise if you spend a lot of money on regular teeth cleaning for your pet.
Wellness plans do not cover accidents or illnesses, costs related to nursing or whelping, training, cosmetic or elective surgery, grooming or anal gland expression. Additionally, some pet insurers only offer wellness coverage as an add-on to accident-only or accident and illness policies — as opposed to a stand-alone policy— and limit coverage to a certain number of covered services per year (say, four vaccines per year).
How Does Pet Insurance Work?
Pet insurance may follow one of two payment models: reimbursement or vet direct pay. Other elements of pet insurance include waiting periods, deductibles, annual maximums and policy limits.
Reimbursement-based model vs. vet direct pay
Pet insurance policies mostly often follow a reimbursement model, where you pay for covered services out of pocket and then submit your receipts for reimbursement either online or through a mobile app. Unless they are specifically requested, you generally don’t have to include your pet’s medical records when you submit your receipts.
Some companies, however, offer the option to pay veterinarians directly, provided the vet agrees to that arrangement. Depending on the insurer, additional paperwork may be involved, and payments will be issued to the vet after the claim is processed, which could take some time.
Waiting periods
Another important thing to know about pet insurance is that policies generally have waiting periods before coverage kicks in. This means that if your pet gets sick or suffers an accident during the waiting period, you will not be reimbursed for those veterinary costs.
There may be differing waiting periods for illnesses, accidents and hereditary conditions, but that will depend on the pet insurance company. Generally, waiting periods for illnesses are around 14 days, while waiting periods for accidents can be anywhere between 48 hours and 15 days. Six-month waiting periods for conditions like hip dysplasia and cruciate ligament injuries are also common.
Deductibles
Like human health insurance, pet insurance policies also feature a deductible (generally on an annual basis) that you must meet before you can start getting reimbursed for covered services. At least two pet insurance companies offer a $0 deductible, but most will require you to choose from several options. Deductibles typically range between $50 and $1,000, with the most common option being $500. As a rule, the higher the deductible you choose, the lower your premium will be.
Only one company — that we know of — that has lifetime per-condition deductible as opposed to an annual one. Under this model, you would pay a deductible every time your pet develops a new condition, but you would only pay it once for the life of your pet. This option could be a good deal if your pet ends up being prone to one or two conditions over its life. If, on the other hand, your pet develops several different conditions during the same plan year, costs could quickly add up.
For more ways to save on pet insurance, read our guide on the best cheap pet insurance options.
Policy Limits
Once you have met your deductible, your pet insurance policy will reimburse you for a percentage of covered services. You can typically choose between a reimbursement percentage of 70%, 80% or 90%, but at least one company out there will cover 100% of eligible veterinary bills. If you choose a reimbursement level of 80%, for example, your coinsurance amount (the portion of the bill you’ll be responsible for) will be 20%. Higher reimbursement limits generally trigger higher policy premiums.
Most pet insurance plans also have an annual reimbursement limit. This means that after you’ve reached your annual limit, the plan will no longer reimburse you for covered medical expenses. While some insurers offer unlimited benefits, most require you to select a maximum of between $2,000 and $30,000 per year. Again, the higher the annual maximum, was a rule, the more expensive the policy.
Read our guide on how to buy pet insurance for more information on how to select the right policy limits for your pet’s needs (and your budget).
Pre-existing conditions
A common exclusion in all pet insurance policies is pre-existing conditions — those that developed before coverage began. For instance, if your pet was ever treated for skin allergies before you purchased pet insurance, your plan will not reimburse you for future instances of skin allergies.
However, some pet insurance companies will cover conditions that are considered curable or have been in remission (without any signs or symptoms) for a specified period — typically between 6 and 12 months.
The Bottom Line on Pet insurance Coverage
There are three main types of pet insurance policies: accident-only policies, accident and illness policies, and wellness policies. Coverage will vary depending on the plan you choose and the insurance company you purchase it from — in addition to the policy limits and deductible you select.
Accident and illness policies are the most popular and comprehensive type of coverage. These policies will cover all types of mishaps and illnesses, from a minor ear infection to major medical care after a car accident. Not surprisingly, comprehensive policies are the most expensive option out of the three.
Accident-only policies are a cheaper alternative, but will only cover accidents and related costs, including tests, surgery and hospitalization. Lastly, wellness policies will only cover routine and preventive care, like annual checkup fees and pet dental care.
If you’re still debating whether pet insurance is a wise investment, our guide on pet insurance costs can help you decide. If, on the other hand, you’re already sold on the idea of pet insurance, check out our guide to the best pet insurance companies to start comparison shopping.
Joan is a professional translator, writer and editor with a special interest in personal finance and insurance topics. She has been a contributing author and independent researcher at ConsumersAdvocate.org since 2017 and an editor at Money since 2019. Her work has been featured in MSN Money and Apple News.