What Does Pet Insurance Cover?

Pet insurance can be a great way to reduce medical bills for your pet's accidents and unexpected illnesses. However, the lack of coverage for some conditions often takes pet owners by surprise. For the most part, health issues that occur after you purchase your policy are eligible for coverage. However, routine check ups, pre-existing conditions, examination fees and preventative treatments are often not covered. To avoid being caught off guard when your pet needs treatment, make sure to read the fine print on your specific policy.

Pet Insurance Coverage Explained

Core coverage for most pet insurance plans includes accidents and illnesses. Accident coverage extends to bodily injuries that result from a specific, unexpected event, like if your pet falls down the stairs and breaks a leg. Illness coverage includes treatment for symptoms that are the result of an infection or disease. Keep in mind that any symptoms that can be traced to a preexisting condition won't be considered eligible for coverage. All insurers require that your pet gets a vet check up before enrolling to identify those preexisting conditions.

Accident CoverageIllness Coverage
  • Foreign body ingestion/swallowing a toy
  • Car accidents
  • Breaking or fracturing a bone
  • Lacerations
  • Insect bites (except fleas and ticks)
  • Infections
  • Ear illnesses
  • Eye illnesses
  • Flea borne illness

The list of covered and excluded conditions will vary by insurer. In general, you'll end up paying more to have more accidents and illnesses covered. Some insurers allow pet owners to purchase endorsements to their plan, or add-ons, which expand the core coverage. Common endorsements are for things like spaying or neutering, wellness exams and preventative treatments. This extra coverage will typically increase your monthly premium by at least $10 to $15 dollars.

Before signing your insurance contract and locking into a policy, it's important to scrutinize the insurer's language regarding covered and excluded conditions. Policy contracts are often filled with scary sounding exclusions like "congenital anomaly" (i.e., an inherited condition) and "osteochondritis dissecans" (i.e., cartilage detached from bone). Remember that the internet is your best friend—if you don't understand a condition listed on your policy, we highly recommend you search until you understand what it means. If you're still unsure if pet insurance is right for you, you can reach out to the insurance company to get more clarity.

Accident and Illness Coverage

The most inclusive type of pet insurance plan includes coverage for both accidents and illnesses. Aside from illnesses arising from preexisting conditions, most insurers will cover all sicknesses and diseases. These types of pet insurance plans typically cost around $45 a month for dogs and $25 for cats. Below are some of the most widely treated dog ailments, according to the pet insurance company PetsBest.

RankDog ConditionCat Condition
1AllergiesKidney failure
2Ear infectionsHyperthyroidism
3CancerCancer
4OsteoarthritisDiabetes mellitus
5MassAllergies
6Cruciate ligament injuryInflammatory bowel disease (IBS)
7Intestine issuesIntestine issues
8HypothyroidismFeline lower urinary tract disease (FLUTD)
9PyodermaUrinary tract infection
10LamenessEar infections

Pet insurance companies also offer "accident-only" plans that cover injuries but not illnesses. Insurance policies typically specify that the injuries must be unforeseen and unexpected to be considered an accident. This type of coverage includes most physical injuries that result from a specific incident, like a car accident or a bad fall. These plans are less comprehensive but more affordable, usually costing between $10 and $15 a month for both dogs and cats.

Pet Insurance Exclusions

Across all pet insurance companies, the list of excluded accidents and injuries is quite extensive. The most commonly excluded injuries are those that are a result of a hereditary issue—i.e., an injury that is triggered by genetic factors rather than a specific incident. Two other important exclusions of which to be aware are bilateral conditions and preexisting conditions.

Preexisting conditions: A preexisting condition is any ailment that was identified by a vet prior to your pet's enrollment into an insurance policy. No pet insurers will currently cover preexisting conditions. Additionally, illnesses or injuries that are related to or closely identified with a previous condition are often considered preexisting and are ineligible for coverage.

Bilateral conditions: These are a subset of preexisting conditions. If your dog had an injury to one side of the body, like a torn ACL on the left leg, then insurance companies reason that there's a higher chance it will happen to the right leg. Because of this higher risk for injury, most insurance companies won't cover any ailment that has already happened to one side of your pet.

Hereditary conditions: This mostly applies to larger dog breeds. Joint and ligament problems like hip dysplasia and torn ACLs are often excluded from coverage. This is because such issues are common for older and larger dogs, whose weight places a burden on their bone structure and joints. Treatment is expensive for these conditions, so many insurers won't include them in their eligible coverage.

Routine and preventative care: If you want routine and preventative care, you'll have to enroll into a wellness or health benefits package that will reimburse some of those health costs. However, paying an extra monthly premium to be partially reimbursed for a regular vet visit doesn't make sense in most cases. In general, it's usually a better idea to skip out on wellness coverage and pay for those costs out of pocket.

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