What Does Pet Insurance Cover?

Pet insurance can help pay expensive pet bills, but it doesn’t cover everything.

Navigating the fine print can be a huge hurdle, and may explain why few pet owners see it as a must-have, as the cost of pet care rises.

A new study by Money and Healthy Paws Pet Insurance found that a vet bill of less than $1,000 can cause “significant stress” for nearly half of pet owners, and one in five would feel financially stressed at any amount. Yet only about 4% of US cats and dogs are insured, according to recent data from the North American Pet Health Insurance Association (NAPHIA).

However, the industry is growing rapidly, and there are more options available than ever. Here’s an explanation of what’s usually covered, what isn’t, and how to choose the right fit for your pet.

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What is covered under pet insurance?

Most pet insurance plans are designed to help cover unexpected pet bills related to accidents, injuries and illnesses. Costs for surgery, medications, X-rays, blood work and emergency care are usually included.

That said, coverage is not guaranteed for all veterinary buildings. Insurers may deny a claim if they can find a connection between the injury and the owner’s negligence. Certain diseases may be excluded if the animal does not receive proper preventive care.

Here is a breakdown of injuries and illnesses by many pet insurance providers the will cover:

What does pet insurance cover?

Premiums vary by insurance, but most pet insurance plans do not include:

Pre-existing conditions

Pre-existing conditions, or health problems that your pet had (or, in some cases, showed signs of) prior to vaccination are usually not covered. This exemption also applies to new medical conditions that may be linked to a pre-existing condition.

Some conditions – infections, allergies and bugs, for example – may eventually be covered, as long as your pet is symptom-free and considered cured for a period of time (usually 180 days). Every insurance policy has a different definition of what constitutes a pre-existing condition that is treatable, so be sure to dig into the details before purchasing a policy.

Routine care and prevention

Most standard pet insurance plans do not cover elective procedures such as grooming and nail trimming, or routine maintenance such as vaccinations and dental cleanings.

Damages and negligence caused by the owner

Pet insurance will not cover injuries or illnesses resulting from the owner’s actions, such as intentionally harming the pet or entering it into organized fights or races.

Pet liabilities related to breeding or problems related to breeding are also generally not covered in standard pet insurance policies.

What are the different types of pet insurance?

Most pet insurance companies offer two protection options: accident only and accident and illness coverage. Some companies also sell health supplements, but these plans usually include general care and are not considered pet insurance.

1. Accident and sickness plans

Accident and illness plans (also called “comprehensive policies”) cover many illnesses, from minor issues like vomiting and diarrhea – even if the cause is unknown – to more serious conditions like cancer.

Covered services typically include diagnostic tests (X-rays, MRIs and blood work), hospital stays, surgery, medications, chemotherapy and other treatments (acupuncture, laser and stem cell therapy.)

Cancer and specialty care coverage is common with many accident and illness plans. Here are a few other conditions these policies often include:

Coverage limits and limitations

Like other medical conditions, genetic and congenital conditions are usually only covered if they are diagnosed first after your policy takes effect. If a pet shows signs of one of these conditions prior to registration, insurers usually classify it as pre-existing and exclude it from coverage.

Some pet insurance policies only cover certain conditions after the waiting period is over. A policy can only cover hip dysplasia surgery if the condition is diagnosed at least six months after the policy takes effect, for example.

Age restrictions may apply as well. Treatment for congenital or acquired dental problems may be waived if you register a pet that is one year old, and hip dysplasia is generally not included if the pet is six years or older at the time of registration.

2. Accident plans only

As the name suggests, accident-only policies reimburse treatment for injuries caused by accidents. Coverage is limited compared to comprehensive plans but premiums are more affordable, you can enroll older pets, and waiting times are shorter. Unlike the usual two-week waiting period for accident and illness plans, accident-only plans are usually ready for use within 24 hours.

Anyway, Your first rate may be influenced by how prone your pet is to accidents. Labrador retrievers, for example, tend to have higher premiums because they are known to swallow things they shouldn’t.

Here’s a quick look at which risk-only premiums usually pay back – and which usually don’t:

3. Health plans

Health coverage, sometimes called preventive care, helps cover the cost of regular pet care and, in some cases, grooming, training and other services. This plan is usually offered as an add-on or “rider” to an accident and illness policy, although some insurers, veterinary hospitals and pet care stores offer it as a stand-alone plan.

In addition to health riders, pet insurance add-ons for things like end-of-life expenses, recovery of a lost or stolen pet, boarding the pet while the owner is in the hospital and liability coverage. Some insurance companies bundle this with health coverage, while others sell it separately.

Comparing pet insurance plans

The list below, while not exhaustive, can help you compare the benefits of each pet care plan and guide your choice.

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