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The Ultimate Peace of Mind—A Pet Health Insurance Primer

You probably already recognize your pet’s health and wellbeing as a recurring—but worthwhile—expense. But unexpected expenses, such as an emergency surgery, sudden illness, or advanced diagnostic testing, can leave you in an emotionally and financially challenging position—torn between your limited bank account and your unlimited love for your pet.

The Ultimate Peace of Mind—A Pet Health Insurance Primer

Key takeaway

Pet health insurance can help you avoid having to make difficult decision based on funds, ensuring you have the financial means to secure your pet’s health care needs.

Y
ou probably already recognize your pet’s health and wellbeing as a recurring—but worthwhile—expense.

You anticipate predictable expenses, such as food, grooming, pet supplies, and annual veterinary care, which you account for in your budget. But unexpected expenses, such as an emergency surgery, sudden illness, or advanced diagnostic testing, can leave you in an emotionally and financially challenging position—torn between your limited bank account and your unlimited love for your pet. Pet health insurance can help you avoid this difficult situation, ensuring you have the financial means to secure your pet’s health care needs.

What is pet health insurance?

Pet health insurance is a veterinary health care plan you can purchase to reduce your pet’s expected and unexpected care expenses. Pet insurance providers generally offer various coverage options to suit your pet’s care and your financial needs—such as accident and illness protection, preventive or wellness care, and add-on options for specialized care or complementary therapies (e.g., chiropractic care, acupuncture, rehabilitation).

How does pet health insurance work?

Pet health insurance is similar to human health insurance. Your pet must meet certain health requirements, and you must pay the premium regularly, and meet a predetermined amount (i.e., deductible) before insurance coverage begins. Pet health insurance vocabulary includes the following familiar human health insurance terms and processes:

Premium payment  


Policyholders pay a monthly fee determined by their pet’s age, breed, health, and coverage type. Premium cost usually increases as your pet ages, however some providers offer a discount for every year your pet is claim-free.

Deductible


This is the out-of-pocket amount policyholders must spend on eligible veterinary care until their pet’s health insurance kicks in.

Payout or reimbursement limit

This is the maximum dollar amount your pet’s plan covers on qualifying care each year or during their lifetime.

Reimbursement or direct pay


Many pet health insurance providers operate through reimbursement. For this payout type, you pay your pet’s invoice, and submit a claim to receive reimbursement. Fortunately, reimbursement is generally quick and easy. Some larger pet insurance providers now offer direct pay to the veterinary hospital, which minimizes or eliminates your out-of-pocket expense.

“We recommend choosing a pet health insurance policy that provides comprehensive preventive (i.e., wellness) and accident coverage in addition to illness coverage.”

What coverage should I choose for my pet?

Shopping for pet health insurance can feel overwhelming. Some providers offer several coverage tiers and optional packages, while others offer only one plan type. Our Dr. Treat team recommends looking for a pet health insurance policy that provides comprehensive preventive (i.e., wellness) and accident coverage in addition to illness coverage, so that your pet’s expected and unexpected health care expenses are covered—providing you the ultimate peace of mind.

We encourage pet owners to do their research, ask questions, and review sample contracts before committing to a policy. Our Dr. Treat team suggests you familiarize yourself with these general pet insurance definitions as you begin to research policies:

Accident and illness 


This coverage level provides reimbursement for your pet’s care when an unexpected condition crops up, or they need nonelective procedures or treatment that range from minor illness to major injury, accident, or disease and hereditary conditions. Emergencies and life-altering conditions, such as bloat, being hit by a car, cancer, and intervertebral disc herniation, are included in this category. Depending on the insurance provider, accident and illness coverage may include eligible conditions’ fees for examination, diagnostic testing, hospitalization, treatment, and surgery.

Accident only 


The most-limited policy option some pet insurance providers offer, accident-only coverage excludes illness and disease. Accident-only coverage only reimburses you if your pet has an emergency (e.g., toxin ingestion, being hit by car, fall, animal bite), and is the only plan some providers offer for senior pets.

Preventive care (i.e., wellness or routine care) 


Preventive coverage includes your pet’s annual veterinary services, including certain vaccines, screening tests, and exams. Dental benefits, including an annual cleaning and X-rays under anesthesia, may be included as preventive care or in some accident and illness policies.

Riders or add-on policies


Some insurance providers allow you to customize your pet’s policy by adding supplemental coverage for services not included in their original plan. These reimbursed services may include postoperative recovery and rehabilitation, dentistry, alternative medicine, or training and behavior.

Can I continue to use Dr. Treat as my primary veterinary provider?

Pet health insurance does not operate in a network as does the human health insurance industry. Therefore, your pet can continue to receive care at your preferred veterinarian, or—during an emergency or travel—the nearest available care provider. However, because each policy and provider are different, our Dr. Treat team recommends you confirm this with your pet insurance company before committing to a plan.

My pet is sick or injured—are they still eligible for pet health insurance?

In general, pet health insurance policies do not cover pre-existing conditions (i.e., those diagnosed or suspected before your pet’s insurance coverage start date). However, your pet can still benefit from a policy, and is eligible for coverage of unrelated conditions. Some pet insurance providers may reclassify a pre-existing condition, and reinstate coverage if your pet goes without treatment or illness for a set period. Exclusions may apply—including bilateral orthopedic injuries (e.g., cruciate ligament tears, hip dysplasia)—so always read the contract’s fine print.

To prevent applicant dishonesty, most pet insurance providers set mandatory medical exclusion periods or waiting periods (e.g., several days to weeks) for illness and injury, and orthopedic claims. You cannot file claims against your pet’s insurance until after the waiting period ends.

What should I look for in a pet health insurance plan?

You have likely realized that pet health insurance policies are complex. Keep the following considerations in mind before committing to your pet’s insurance policy:

Pet needs


Consider your pet’s age, breed-related risks, known medical history, pre-existing conditions, and lifestyle when deciding which benefits they may need.

Budget options


While comprehensive pet insurance coverage is great, you need to ensure the plan fits your budget. Look for a customizable policy that allows you to select your premium, deductible, and payout amount.

Preventive care


Wellness benefits can reduce your pet’s risk for common health issues, enhance longevity, and reduce lifetime health care expenses.

Exclusions and limits 


Some pet insurance providers limit coverage for high-risk breeds, hereditary disorders, costly treatments, or chronic health issues, while other insurance providers put claim limits on specific conditions.

When should I insure my pet?

Insuring your pet at the earliest possible age—before pre-existing conditions arise—is always best. In general, insuring a young pet is more affordable, because their premiums are lower, they are healthier, and their waiting periods are usually uneventful. However, your pet is never too old to enroll in a health insurance plan. Many providers offer equal coverage for senior pets.

If you wait until your pet needs health insurance, their coverage will not be meaningful—and instead will be barred by exclusions, waiting periods, or lengthy medical record reviews. Purchasing an insurance policy during your pet’s healthiest years allows you to receive maximum benefits—and ultimate peace of mind—when potentially costly preventable and unexpected conditions arise.

Final notes

For more information on how to research and select a health insurance policy that matches your pet’s care and your financial needs, check out this North American Pet Health Insurance Association (NAPHIA) Pet Insurance Buying Guide.

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