What does pet insurance cover? Examples and how it works

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  • Pet insurance can cover the cost 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 reimbursed.
  • There are several types of pet insurance, and most exclude pre-existing conditions.

Pet insurance can help you with the cost of caring for your dog or cat. If they are injured, sick, or otherwise need medical attention, your policy can kick in and help you cover the costs.

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

What does a pet insurance policy cover?

Basic pet insurance plans cover accidents and injuries, meaning if your dog breaks a bone or gets hit by a car, your insurance company will cover some or all of the diagnostic and treatment costs.

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

However, pet insurance policies exclude pre-existing conditions, so if your pet has a health problem before you apply for coverage, your plan won’t cover the cost of treating or managing it, or the cost of treating or managing a new illness that develops. with a pre-existing condition. Other pet insurers exclude certain breeds altogether because they are more prone to health conditions.

Types of pet insurance and each of them

Most pet insurance companies offer several levels of coverage, including a basic, accident-only plan and a more comprehensive option. Many also offer additional, low-cost health packages that provide additional coverage for annual checkups and preventive care.

Only in case of an accident

Accident-only plans cover your pet if it suffers an unexpected injury, such as a broken bone or ingestion of poison. They do not cover illnesses or diseases that may occur, nor do they cover behavioral problems or hereditary conditions.

Here are some common issues that only an accident plan will cover:

  • Broken bones
  • Bite wounds
  • Cuts and wounds
  • Admission of foreign subjects
  • Intake of toxins and poisoning
  • Car accidents
  • Eye injuries
  • Sprains
  • The bee sting
  • Broken ligaments

If you only have accident coverage, your policy should cover X-rays, CT scans, MRIs, lab tests, and ultrasounds to diagnose the problem, as well as medications, emergency care, surgery, and hospitalization to treat it.

Accident and illness

With accident and sickness cover, also known as comprehensive cover, you get all of the above plus cover for sickness, diseases and other health conditions.

They can 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 include behavioral therapy, emergency dental care, specialist care, and sometimes even alternative therapies and complementary treatments like acupuncture.

“Most pet owners choose accident and illness plans because they provide comprehensive coverage,” says Kari Steer, a licensed insurance agent at Pawlicy Advisor, a pet insurance comparison website.

Health Plan Supplement

Health plans include routine health care and preventative care. Unlike traditional plans, these add-on packages cover the expenses you can expect as a regular pet owner, not just sudden ones.

Examples of health plan coverages include:

  • Annual exams
  • Vaccinations
  • Flea and tick preventatives
  • Heartworm preventatives
  • Spaying and neutering
  • Teeth cleaning
  • Food additives
  • Prescription food
  • Nail cutting
  • Anal gland expression
  • Behavior
  • Routine blood and stool tests
  • Training
  • Microchipping
  • Cremation and burial

Health supplements usually come with a maximum annual coverage or reimbursement limit for each category. For example, with Embrace pet insurance, you get $250 to $650 in benefits per year.

How does pet insurance work?

Unlike human health insurance plans, when you have a pet insurance policy, your insurer and veterinarian will not communicate directly. Instead, you will be responsible for paying the bill at the time of service and then filing a claim with your insurance company for reimbursement.

“Most pet insurance policies work on an indemnity model, which means you don’t have to worry about being in network,” Stier says. “You’ll pay a monthly or annual premium to maintain coverage, plus a deductible before your reimbursement rate starts.”

As Steere pointed out, pet insurance policies typically have a deductible. These policies also have a reimbursement rate, coverage limits and waiting period. Here’s what each of these means in the context of pet insurance.

  • The waiting period. The waiting period is the time between activating your pet insurance policy and becoming eligible for coverage. For example, for lemonade, the waiting period ranges from two days to six months, depending on the health condition. At Animalia, it’s only five days (or 30 for cancer coverage).
  • Decreasing. Your deductible is how much you are responsible for paying out of pocket before insurance pays anything. This usually ranges from $100 to $500.
  • Compensation rate. Here’s how much your insurer will pay out of each claim. For example, an 80% reimbursement rate would pay 80% of the insured service bill (after you meet your deductible).
  • Policy Limits/Amount of Coverage: Your policy limit is the maximum your insurer will pay for covered services during your entire coverage period (usually a calendar year). Some insurers have no coverage limits.

Since pet insurance policies are indemnity plans, you need to make sure you have some way to pay unexpected veterinary bills in advance, as there may be some time between filing your claim and receiving reimbursement.

“If clients are interested in pet insurance, I recommend that they find another financing option in addition to insurance, such as CareCredit or a pet-only credit card,” says Thomas Doak, director of Noah’s Animal Hospitals in Indiana. Director of Communications. .

“Then, if their pet has a serious illness or injury, they can use CareCredit or another card to pay the vet, [and] submit their claim for insurance,” says Doc. “In most cases, a reimbursement check is sent from the pet insurance company in time to pay off the credit card or CareCredit before interest starts to accrue.

Is pet insurance worth it?

Pet insurance can be expensive for many pet owners. The right choice and the right type of policy will largely depend on your emergency fund and budget. Do you have enough to cover unexpected veterinary expenses if your pet gets hurt or sick? Can you pay the bill for life-saving treatment if it becomes necessary? If not, pet insurance can offer a much-needed safety net.

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

“Having pet health insurance can help avoid decisions about whether someone can afford the treatment their dog or cat needs to live their best life,” says Shawn Burgess, Lemonade Chief Claims Officer.

Your pet’s breed, age, and general health should also factor into your decision to get pet insurance.

“Having the right pet insurance can provide valuable peace of mind, especially for animals whose breed is known to be prone to certain hereditary disorders,” Steer says. But it’s not meant to be a “last-minute reprieve from known upcoming expenses,” she adds, so if your pet is already sick or injured, it can help.

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