What Does Pet Insurance Cover? Examples & How It Works – Business Insider

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A photo of a long-haired cat on a veterinarian's exam table.

In general, pet insurance covers accidents and illnesses. But you can also get routine care covered for an extra fee.
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  • Pet insurance can offset the costs of emergency veterinary care and treatment.
  • It works on a reimbursement model where you pay the vet and file a claim with your insurer to get repaid.
  • There are several types of pet insurance plans, and most exclude pre-existing conditions.

Pet insurance can help you with the costs of caring for your dog or cat. If they’re hurt, sick, or otherwise need medical care, your policy can kick in and help you shoulder the cost.

But family pet insurance, just like insurance for humans, varies quite a bit from one policy to the next. Not all medical services are covered by every policy, and in some cases, certain problems may be excluded entirely. Understanding what different pet insurance policies cover can help you choose the best one for your furry friend and your budget.

What do pet insurance policies cover?

Most basic pet insurance plans cover accidents and injuries, meaning if your dog breaks a bone or is hit by a car, your insurance company would cover some or all of the costs of diagnosis plus treatment.  

“There are many pet insurance plans you can choose from, each with its own coverage, ” says Yoni Kiehl, founder and president of pet insurance company Animalia . “You can choose the one which best suits you and your pet’s needs. ”

However , most pet insurance policies exclude pre-existing conditions, so if your pet has a health issue before you apply for coverage, your plan won’t cover the costs of treating or managing it — or treating or managing a new illness that was caused by the pre-existing condition. Other pet insurers exclude certain breeds altogether, as they’re more prone to health conditions.

Types of pet insurance coverage and what each covers

Most pet insurance companies offer several tiers of coverage, including a basic, accident-only plan, and a more comprehensive option. Many also offer additional, low-cost wellness packages that provide extra coverage with regard to annual check-ups and preventive care.

Accident-only

Accident-only plans cover your pet if they experience an unexpected injury, like breaking a bone or ingesting a toxin. They don’t protect illnesses or diseases that may arise, nor do they extend to behavioral issues or hereditary conditions.

Here’s a look at some common issues an accident-only plan would cover:

  • Broken bones
  • Bite wounds
  • Cuts and lacerations
  • Foreign object ingestion
  • Toxin ingestion and poisoning
  • Car accidents
  • Eye injuries
  • Sprains
  • Bee stings
  • Torn ligaments

If you have accident-only coverage, your policy should include X-rays, CT scans, MRIs, laboratory testing, and ultrasounds to diagnose the issue, as well as medications, emergency care, surgery , plus hospitalization to treat it.  

Accident and illness

With accident and illness protection — also known as comprehensive insurance coverage — you get all of the above, plus coverage for illness, disease, and other health conditions.

These may include:

  • Cancer
  • Hypothyroidism
  • Allergies
  • Intervertebral disc disease (IVDD)
  • Urinary tract infections
  • Diabetes
  • Arthritis
  • Lyme disease
  • Parasites
  • Parvo
  • Osteosarcoma
  • Hip dysplasia

This type of plan will also often cover behavioral therapy, emergency dental care, care from specialists, and sometimes even alternative therapies and complementary treatments, like acupuncture.  

“Most pet owners select accident and illness programs, as they provide comprehensive insurance, ” says Kari Steere, a licensed insurance agent at Pawlicy Advisor , a pet insurance comparison site.

Wellness strategy add-on

Wellness plans cover routine healthcare and preventive treatments. Unlike the traditional plans, these add-on packages cover the costs you can regularly expect as a pet owner — not just sudden ones.

Examples of wellness plan coverages include:

  • Annual exams
  • Vaccinations
  • Flea and tick preventatives
  • Heartworm preventatives
  • Spaying and neutering
  • Dental cleanings
  • Nutritional supplements 
  • Prescription food
  • Nail trimming
  • Anal gland expression
  • Grooming
  • Routine blood and fecal tests
  • Training
  • Microchipping
  • Cremation and burial 

Wellbeing add-ons typically come with a maximum annual coverage amount or even per category reimbursement limit. With Embrace pet insurance policy, for example , you get a $250 to $650 allowance per year.

How does pet insurance work?

In contrast to human health insurance plans, when you have a pet insurance policy, your insurer and veterinarian won’t communicate directly. Instead, you’ll be responsible for paying the bill at the time of service and then filing a claim with your insurance company to get reimbursed.  

“Most pet insurance policies function off a reimbursement design, which means you don’t have to worry about being in-network, ” says Steere. “You’ll pay a monthly or annual premium to maintain coverage, as well as a deductible before your reimbursement rate kicks in. ”

As Steere mentioned, dog insurance policies usually have a deductible. These policies also have a reimbursement rate, coverage limits, and a waiting period. Here’s what each of those mean in the context of pet insurance:

  • Waiting period: The waiting period is the time between activating your pet insurance policy and becoming eligible for coverage. With Lemonade , for example , the waiting period is between two days and six months, depending on the health condition. At Animalia, it’s just five days (or 30 for cancer coverage).
  • Deductible: Your deductible is how much you’re responsible for paying out of pocket before insurance pays anything. This typically ranges through $100 to $500.  
  • Reimbursement rate: This is how much of each claim your insurer will pay. An 80% reimbursement rate, for example , would pay 80% of the bill on a covered service (after you’ve met your deductible).  
  • Policy limits/coverage amount: Your policy limit is the maximum your insurance provider will pay for covered services across your coverage period (usually a calendar year). Some insurers don’t have protection limits.

Because pet insurance policies are reimbursement plans, you’ll want to make sure you have some way to pay unexpected veterinary bills up front, because there may be some time between submitting your claim and receiving reimbursement.  

“If clients are interested in family pet insurance, I recommend that they also find another financing option, like CareCredit or a credit card solely for the pet, in addition to the insurance, ” says Thomas Dock, director of communications at Noah’s Animal Hospitals in Indiana.  

“Then, if a major illness or injury happens to their pet, they can use CareCredit or the other card to pay the veterinarian, [and] submit their claim to insurance, ” Dock says. “In many cases, the reimbursement check will be sent from the pet insurance provider in time to pay off the credit card or CareCredit before interest starts accruing. ”

Will be pet insurance worth it?

Dog insurance may be worth it for many pet owners. The right choice, and right type of plan, will largely depend on your emergency fund and spending budget. Do you have enough to cover unpredicted veterinary bills if your pet is hurt or becomes ill? Could you foot the bill for a  life-saving treatment if it became necessary? If not, having pet insurance plan may offer a much-needed safety net.

For reference, the cost of radiation therapy for a dog with cancer is between $2, 500 and $7, 000 . Even less serious conditions like a broken bone can cost thousands of dollars.

“Having pet health insurance can help avoid any decisions on whether someone can afford the treatment their dog or cat needs to live their best life, ” states Sean Burgess, chief claims officer at Lemonade.

The breed, age, and overall health of your pet should also play a role in your decision to get pet insurance.

“Having the right dog insurance can provide valuable peace of mind, especially for pets whose breed is known to be predisposed in order to certain hereditary disorders, ” Steere says. But it’s not meant to be a “last-minute respite from known upcoming costs, inch she adds, so if your pet is already sick or injured, it may not help.

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