What Is Not Covered by Pet Insurance?

You might not have as much coverage as you think

Veterinarian with a dog



Pet insurance is designed to financially shield pet owners from paying sudden and costly veterinary bills. Insurers typically offer accident-only and accident-and-illness plans with optional preventive care, or wellness packages. There are no standard coverages across providers for each type of plan, and many pet owners are surprised at what’s typically left uncovered.

We’ll go over some of the most common exclusions and other out-of-pocket costs you may be responsible for, as well as different coverage levels to help decide if pet insurance is right for you.

Does Pet Insurance Cover Preexisting Conditions?

Pet insurance plans almost never cover a preexisting condition. Insurers typically have detailed definitions about what constitutes one, but in general, it’s a condition or illness your pet had before signing up or that appeared during the waiting period.

Some insurers will cover certain preexisting conditions if they were cured and your pet was symptom- and treatment-free for a specified period of time; in this case, it may no longer be considered a preexisting condition.

However, insurers might specify that certain conditions that developed before coverage began or during the waiting period are always considered preexisting and are therefore excluded from coverage. Examples may include cranial cruciate ligament (CCL; the animal equivalent of an ACL injury in humans) problems or other ligament issues.

Different Tiers Come With Different Levels of Coverage

The most basic pet insurance plan is typically an accident-only policy covering services and procedures for injuries and emergencies resulting from accidents, such as broken bones, cuts, and swallowed objects. The next step up is an accident-and-illness plan that adds coverage for minor and major illnesses such as diabetes, urinary tract infections (UTIs), heart disease, and other issues that wouldn’t otherwise be covered in an accident-only policy.

Not all providers include veterinary exam fees for accident-and-illness visits as part of the main plan, sometimes offering coverage instead as an optional add-on. Without this coverage, you’re responsible for exam and consultation fees for diagnosis and treatment of a covered claim.

You may also be able to add a basic or comprehensive preventive-care package to include routine teeth cleanings, wellness exams, shots, flea/tick/heartworm prevention medications, and more, up to the specified maximum annual benefit. Some pet owners prefer to skip this add-on—and thereby forgo wellness benefits—to save money on monthly premiums.

What Else Does Pet Insurance Not Cover?

While policy and company specifics vary, there are a few common limitations on coverage.

  • Annual, lifetime, and per-incident limits: Pet insurances won’t pay for any services and procedures beyond your plan’s annual, lifetime, and per-incident limits, regardless of which type of plan you choose. These are the maximum amounts the insurance pays out for a covered condition within a specified time frame or for that condition.
  • Elective procedures: Procedures that are considered elective, such as declawing and tail docking, are also nearly always excluded from coverage.
  • Age restrictions: Most pet insurance companies have age restrictions and won’t insure pets younger than around 8 weeks for accident-only or accident-and-illness policies or older than about 12 years for accident-and-illness plans.
  • Secondary conditions: Depending on your plan, secondary conditions arising from an uncovered condition, like heart problems resulting from periodontal disease, may be excluded.
  • Vaccinable illnesses: Diseases that could be prevented by a vaccine may not be covered depending on insurer.
  • Pregnancy and related birth costs: This is not a common coverage, but may be available as an add-on.

Restrictions by Policy Type

Basic accident-only and accident-and-illness plans won’t cover crucial preventive care such as dental cleanings, flea/tick/heartworm preventive medications, preventive vaccines, or essential procedures like spaying or neutering—although optional wellness packages typically do for an added fee.

Other things you typically won’t see in basic accident-and-illness plans are boarding or accommodations, transportation, and non-standard experimental or investigative treatments. And while your plan may cover prescription foods and supplements, it typically excludes those for weight loss and general maintenance or over-the-counter foods and supplies.

Bilateral Conditions

You’ll also want to read the fine print to see if bilateral conditions are included in your accident and illness policy. Two common ones pets may develop are hip dysplasia and CCL injuries. If your pet develops hip dysplasia on one side while insured, then later develops the condition on the other side, some insurers won’t pay for treatment on the second side.

They may also decline coverage if your pet had a bilateral issue on one side as a preexisting condition then developed it on the other side while insured.

What Else Should You Prepare For?

Pre-enrollment costs: A few pet insurance companies require a full medical exam and certain records before enrollment, which you’re responsible to pay for.

Breed-specific/hereditary conditions: Ask your veterinarian about conditions frequently occurring with your pet’s breed, and be alert to breed-specific limitations and exclusions across policies. For example, some insurers may cover hereditary conditions such as hip dysplasia, but only if you enroll your pet by a certain age. Others may not.

Review policies to compare coverage, limits, waiting periods, and exclusions. Don’t hesitate to contact customer service to clarify answers to your questions.

Pay attention to a policy’s per-incident limits, as you’ll use your own funds for expenses above those amounts, even if you haven’t reached your annual limit. Policies often have lifetime maximums, which differ depending on the plan, insurer, and coverage selected. Knowing what to look for will help you find the best pet insurance companies and level of coverage for your unique circumstances and pet.

Article Sources