What Pet Insurance Won't Cover

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P​​et insurance can help take the sting out of sky-high medical bills, but your plan may not cover every vet visit. It pays to know what is and isn't covered by a standard accident and illness policy as you research the best pet insurance companies in the market.

What does pet insurance not cover?

According to Beth Wymer, an animal health and insurance expert with Pumpkin Pet Insurance, the "the most critical aspects of a policy" are the sections on exclusions and disclaimers.

Several common expenditures are rarely, if ever, included in accident and illness policies, which are the most popular among pet owners. Understanding those exclusions can help you avoid surprises later.

It’s also important to keep tabs on your claims and coverage limits. Some of the best pet insurance policies include unlimited lifetime payouts, but that isn’t always the case. Expenses incurred after you reach your coverage limits will not be paid, even if the accident or illness is normally covered.

Here’s a rundown of the most common exclusions, along with what they may mean for you.

Routine wellness exams and other preventative care

Unless you purchase a wellness plan or add-on, your accident and illness policy will not cover routine wellness exams and other preventative care costs.

Covered procedures and services generally include annual wellness exams, routine blood work, dental cleaning and flea and tick treatments.

Routine vet visits can help identify a pet’s unexpected illnesses in its early stages, and potentially spare your furry friend a more invasive and expensive procedure down the road. Preventive care coverage also allows for procedures such as vaccines and deworming treatments for puppies or kittens, which can easily run to several hundred dollars, according to the American Kennel Club and the Memphis-based PetVax hospital chain.

Wymer recommends that owners who want wellness coverage for their pets “look for companies that offer such plans as an add-on option." The cost of such an addition is fairly modest, starting at about $20 a month for a dog, according to a Money survey on the cost of pet insurance.

Just keep in mind that the return on this investment may be modest as well. Talk to your vet about the expected costs of preventive care to help you decide if adding wellness insurance is worthwhile.

If you already have an accident and illness policy, check its fine print. Failing to keep up with routine care can be costly when it comes to illness coverage. Wymer warns that some plans “won’t even cover treatment or care for preventable illnesses, like heartworm disease, if an owner didn’t stay up to date on routine care."

Dr. Sarah J. Cutler, a veterinarian based in Katonah, NY, echoes that risk. She cites the example of having had an insurance company deny coverage for a dental procedure because “there were notes in the records about tartar on the teeth, and the owners didn’t have the dog’s teeth cleaned right away.”

Treatment of pre-existing conditions

It’s standard for pet insurance not to cover a pet's pre-existing conditions — meaning ailments that existed prior to the policy going into effect. "Once a condition is deemed pre-existing, pet owners will be required to pay out of pocket for any associated treatments for the life of the animal," says Wymer.

What isn’t standard is how companies define such conditions. One company may exclude any condition diagnosed anytime before coverage began, while others look at the 18 months before enrollment (including the required waiting periods imposed) to identify which pre-existing conditions might qualify for coverage.

The varying definitions in pre-existing condition clauses made it hard for shoppers to compare policies accurately. These inconsistencies helped drive the industry toward standardizing such definitions, allowing pet owners to compare competing policies more easily. Pay attention to those definitions, especially if you're shopping for pet insurance for pre-existing conditions.

Some accident and illness policies may eventually cover certain pre-existing conditions. According to Wymer, some companies have what’s called a “curable conditions clause” in which “pre-existing conditions that are curable, treatment and symptom-free for 180 days, can be deemed cured and, therefore, are no longer excluded."

That clause, notes Dr. Cutler, allows coverage for recurring issues such as vomiting and diarrhea, which may otherwise be denied as pre-existing conditions “regardless of cause for the rest of the pet’s life."

Why does pet insurance not include pre-existing conditions? That’s a common question from pet owners buying pet insurance for the first time. In a nutshell, excluding coverage for pre-existing conditions helps insurance companies mitigate the risk of insuring pets with existing health problems.

If pre-existing conditions were covered, pet owners might hold off on purchasing insurance until after their pets were diagnosed with a serious illness or injury, which would be financially unsustainable for insurance providers. By excluding pre-existing conditions, pet insurance companies are able to stay solvent, pay claims and keep their current pricing structure.

Elective procedures

Pet insurance typically won't cover elective procedures, which refer to treatments or surgeries that aren't considered medically necessary. In many cases, elective procedures are cosmetic and therefore do not fall under the category of unexpected accidents or illnesses. Many even consider some of these electives inhumane, including tail docking, ear cropping, devocalization and declawing in cats.

Other elective procedures, such as microchipping, grooming and spay and neuter surgeries, are actually recommended by vets and even required by law. However, pet insurance won't cover these either and you'll need to pay for them out-of-pocket.

Pregnancy complications

Most pet insurance policies do not cover pregnancy complications or expenses related to breeding. This includes costs associated with prenatal care, delivery or complications that may arise during pregnancy or labor.

Pre-existing bilateral conditions

Bilateral conditions refer to health issues that affect both sides of the body symmetrically, such as cataracts in both eyes, hip dysplasia in both hips or cruciate ligament issues. Pet insurance policies will cover bilateral conditions on both sides as long as the issue wasn't diagnosed on either side of the body before the policy's effective date.

Diseases that are preventable with vaccinations

Pet insurance typically does not cover diseases that are preventable through vaccinations. Since vaccines are considered a routine part of pet care, the costs associated with vaccinations and any illnesses they would prevent (i.e. heartworm) are usually not covered by insurance.

Consult with your vet to make sure your pet is up to date on its vaccines and preventive treatments. Most insurers include a list of required vaccines in the insurance agreement, while others refer policyholders to the vaccination schedules suggested in the American Animal Hospital Association Canine Vaccine Guidelines and in the American Association of Feline Practitioners Feline Vaccination Guidelines.

Pets that are too young or too old

Pet insurance policies often have age restrictions, excluding coverage for pets that are either too young or too old. The minimum and maximum age limits vary by insurance provider and policy. Puppies and kittens may be excluded from coverage until they reach a certain age, such as eight weeks.

Meanwhile, senior pets may have limited coverage options due to their higher likelihood of age-related health conditions. Many pet insurance providers will decline new coverage to dogs and cats over 14 years of age, though existing coverage may extend beyond that age. On the other hand, standalone wellness plans and accident-only policies often extend coverage to pets of any age.

What does pet insurance cover?

Pet insurance plans can reimburse policyholders some of the costs of veterinary treatment for unforeseen accidents, injuries and illnesses. This encompasses surgeries, medications, diagnostic tests and emergency care.

However, not all veterinary expenses that fall under these categories are eligible for reimbursement. The specifics of your dog or cat insurance policy will depend on the type of coverage and the provider you choose.

Accidents

Pet insurance often covers the costs associated with accidental injuries, such as broken bones, lacerations and ingesting foreign objects. Treatment expenses, including emergency veterinary visits, diagnostics, surgeries, medications and hospitalization, may be covered under accident coverage.

Illnesses

Pet insurance can also cover some of the costs of treating various illnesses your pet may develop. These may include infections, respiratory problems, digestive issues, skin allergies and more. Covered treatments may include diagnostic tests, medications, surgeries and other necessary treatments.

Hospitalization

If your cat or dog requires hospitalization due to an accident or illness, pet insurance can cover the costs associated with their stay. This includes veterinary fees, medications, monitoring and specialized care. Overnight boarding for other reasons generally isn't covered by pet insurance.

Specialist care

Some pet insurance policies cover specialist care when medically necessary to treat an accident or illness. That may include expenses related to consultations with veterinary specialists such as cardiologists, dermatologists, oncologists and orthopedic surgeons. This coverage can offset the high costs of specialized diagnostics, treatments and procedures.

Diagnostic tests

Pet insurance may cover a range of diagnostic tests necessary to identify and assess your pet's health condition. That can include blood tests, X-rays, ultrasounds, MRIs and other procedures veterinarians may employ to diagnose or manage your pet's accident or illness.

Surgeries

Many pet insurance policies cover surgical procedures ranging from routine to complex, including tumor removal and orthopedic surgery. Most comprehensive plans also cover dental surgery, but other companies exclude these procedures from their base policies.

Spay or neuter surgery is not covered by accident and illness insurance plans as these procedures are a predictable expense. Some insurance companies offer standalone wellness care plans, however, that will reimburse all or part of the costs associated with spaying or neutering.

Medications

The cost of medications prescribed by a veterinarian, whether administered during an office visit, in a hospital setting or at home, may be covered by pet insurance. But reimbursement will still be contingent on whether your policy covers the related accident or illness.

Prescription medications may include antibiotics, pain relievers and ongoing medications required to treat chronic conditions. However, not all accident and illness policies cover vitamins, supplements and prescription food.

Furthermore, the companies that cover these products will only do so if the prescription food or supplement is prescribed for an eligible condition. Insurers won't reimburse you for a supplement or prescription food that's just part of your pet's general wellness plan (including weight loss).

Breaking down the different types of pet insurance coverage

Pet insurance offers a valuable safety net to help us protect our beloved pets' health and well-being. However, not all pet insurance policies are the same, and understanding the different types of coverage available is essential.

Accident and illness policies

Accident and illness policies, also called comprehensive pet insurance, cover accidents, illnesses and sometimes alternative therapies. These full-coverage pet insurance policies offer broad protection for unexpected expenses related to your dog or cat's health.

Accident-only coverage

This type of pet insurance focuses solely on accidents and injuries. It covers the costs of veterinary treatment for accidental injuries, including emergency care, surgeries, medications and hospitalization. Accident-only policies do not cover illnesses or routine wellness care.

Wellness coverage

Wellness coverage, also known as routine care or preventive care coverage, helps offset the costs of routine veterinary care. This may include vaccinations, annual exams, flea and tick prevention, dental cleanings and other preventative services.

Wellness coverage is usually offered as an add-on to accident and illness policies. This product is a separate subscription plan (with an added cost) which will reimburse you a fixed amount for eligible procedures and services.

Summary of Money's what pet insurance won't cover

It's crucial to understand what pet insurance does and doesn't cover before enrolling your pet in a policy so you can avoid expensive surprises when it comes time to file a pet insurance claim.

The good news is that pet insurance generally covers a wide range of expenses, making the coverage more extensive than the exclusions.

Pet insurance typically does not cover:

• Routine preventative care (wellness coverage can be added or purchased separately)

• Pre-existing conditions

• Elective procedures

• Pregnancy complications

• Bilateral conditions

• Diseases preventable with vaccinations

• Pets that are too young or too old (age restrictions vary by insurer)