Pet Insurance

Pet Coverage Details

1. We will reimburse you, subject to coinsurance requirements, for any allowable charges your pet receives in excess of the policy annual deductible and per incident co-pay amount, if elected, for medically necessary treatment(s) performed for conditions that showed signs, symptoms, or were diagnosed after the waiting period and during the policy term, which result from:
1. Accidents, including but not limited to, an automobile accident, ingestion of a foreign body, poisoning, animal bites, gastric torsion, and cruciate ligament rupture, as well as accidents resulting in dental trauma, burns, and fractures. Orthopedic accidents are subject to the Orthopedic Waiting Period;
2. Illnesses, including but not limited to, genetic conditions, acute conditions, and chronic conditions;
3. We will reimburse you for the cost of treatment your pet receives in the current term of insurance for an injury or illness that first showed clinical signs after the end of the waiting period and treatment required due to dental illness and injury, subject to policy limitations and exclusions. [To receive Dental Illness Coverage, you must follow your veterinarian’s advice regarding dental care, including but not limited to, an annual dental exam and any related treatment recommendations.]
4. If your pet incurs a life-threatening injury and requires immediate lifesaving treatment, we will waive your coinsurance, policy annual deductible and per incident co-pay, if elected. Normal waiting periods for injury apply. Coverage is up to the annual maximum benefit or covered incident limit, subject to any policy annual deductible, per incident co-pay, if elected, and coinsurance requirements, subject to policy limits and exclusions.
2. We will reimburse you for medically necessary treatment, for:
1. Surgery;
2. X-rays, ultrasounds, CT scans, and other diagnostic tests;
3. Professional services rendered by your veterinary provider, including costs or fees for telephone consultations if the optional Office Visit and Exam Fees Rider has been purchased;
4. Medical supplies required to perform covered procedures performed in the veterinarian’s office and other medical supplies, where deemed medically necessary by the veterinarian, such as an Elizabethan collar;
5. Laboratory tests required by your veterinary provider;
6. Hospitalization required by your veterinary provider to deliver professional services to your pet and post-procedure in-hospital care as is medically standard by our best estimation;
7. Medications your veterinarian dispenses for in-hospital treatment as part of your pet’s accident or illness treatment that started after the waiting period and during the policy term.
8. Endodontic treatment for dental injuries, such as extractions, root canals and crowns, where deemed medically necessary;
9. These treatments are subject to review and approval by our medical director;
10. Pet ambulance transportation, in the event of an emergency;
11. Euthanasia where necessary for humane reasons;
12. Orthodontic treatment that is medically necessary due to a covered illness or accident or illness.
13. All examinations performed by a veterinarian in the course of treating an otherwise eligible condition. This includes, but is not limited to, any exam, check-up, consultation, physical, physical consultation, health inspection, office visit, office call, after-hour fee, referral, or recheck.
3. Cost Shares. Once your policy annual deductible is reached, we will pay your claim subject to your coinsurance. The per incident co-pay is separate and distinct from the policy annual deductible and coinsurance for which you are responsible. The per incident co-pay is not applied toward satisfying the policy annual deductible. When the treatment dates of an injury or illness fall into two or more policy terms, you will be required to pay a policy annual deductible for each policy term.
4. Diminishing Deductible. For each year that you are claim-free while continuously covered by our policy, your current policy annual deductible will be reduced by $50.00 upon policy renewal until it results in a $0.00 policy annual deductible. If a claim is made and you receive payment, the policy annual deductible will be returned to its original policy annual deductible amount for the following renewal term and the process will start over. Coverage must be continuous for this rule to apply. This rule does not apply to claims for wellness.

Frequently Asked Questions

Does my pet need to have a veterinary exam before purchasing a pet policy? No, your pet doesn’t need a veterinary exam to be insured by us. However, we ask that you provide medical records showing your pet has been examined within 12 months of your policy’s effective date. Doing so will increase the efficiency of our claims process. If you’re unable to provide these records, we’ll use the first documented vet exam (after your policy’s effective date) to determine any pre-existing conditions. We strongly recommend that you have your pet examined annually. The notes your vet provides from annual exams — and other exams — will help when you file a claim.

What are the eligibility rules for my pet? We’ll insure any dog or cat. That said, there are pre-existing and other exclusions that may limit your coverage. Also, if you’re renewing a policy for a senior dog (8+ years) or cat (10+ years), we ask that you follow your veterinarian’s advice for senior wellness testing.

Does my pet have to be spayed or neutered to enroll? No, your pet doesn’t have to be spayed or neutered to be covered. Some, but not all, of our coverages may help cover the costs for this procedure. To see if your policy does, please refer to your policy documents.

What is a pre-existing condition? If your pet has (or had) an illness, injury or symptom before the end of your waiting period, they have a pre-existing condition. But that doesn’t mean your pet can’t be insured — they can! It just means their policy won’t cover the costs of treatment for the pre-existing condition. If the condition is cured or doesn’t present itself for 12 months, you can apply for coverage (for the condition) in case it reoccurs. This does not apply to knee or ligament conditions. We review up to 24 months of medical records to see if a claim is connected to a pre-existing condition. If not, we process the claim as usual. Pets tend to be their healthiest when they’re young. That’s why we recommend you buy pet insurance as soon as you can to cut the risk of pre-existing conditions. And, most importantly, keep it in place for the life of your pet.

What medical records are needed once I've purchased my pet's policy? In order to process any claim, we’ll need the last 24 months of medical records for your pet. When compiling your pet’s records, be sure to include records from all vets and visits within the past two years. If your pet is less than two years old (or has been in your family for less than 24 months), send all available records. If you adopted your pet, please include all records from the shelter or rescue organization. These include medical records, date of adoption and adoption certificate. Medical records include, but are not limited to, results from a veterinary visit, lab results, X-rays, physical exam and treatments. You’ll also need the detailed notes from your veterinarian and/or their staff about each of your pet’s visits. These notes are also referred to as Subjective, Objective, Assessment and Plan (SOAP) notes.

How is my policy premium calculated? We base your premium on factors such as:

• Type of pet. Dogs have different rates than cats.
• Background information. What breed and age is your pet? Where do you live?
• Policy information. These are things such as your annual policy limit, reimbursement limit and deductible amount.

Also, we take into account any discounts you’ve applied and are eligible for, as well as any optional coverages.

What if I don't know my pet's age? No worries! Simply make an estimate based on the documentation you have. This can be medical records or adoption paperwork. Once we have everything, we’ll work to validate your pet’s correct age.

How do you determine a pre-existing condition? Here’s how we determine pre-existing conditions for claims.

When you file a claim, we review your pet’s medical records for up to 24 months prior. We review any illness, injury or symptom your:

• vet provided medical advice for;
• pet received previous treatment for; or
• pet had signs or symptoms directly related to the condition for which the claim is being made.

If any of these apply prior to the end of your waiting period(s), we determine that your claim is subject to the pre-existing exclusion. If the condition is cured or doesn’t present itself for 12 months, you can apply for coverage (for the condition) in case it reoccurs. This does not apply to knee or ligament conditions. Lastly, if you can’t provide medical records showing your pet’s annual exam within the 12 months before your policy effective date, we’ll use the first documented vet exam to determine pre-existing conditions.

Is there a money-back guarantee with Pet Insurance? Yes! Your satisfaction is our number one priority. That’s why we gladly offer a money-back guarantee. Here’s how it works.

Based on your state of residence, you will have up to 15 days to review your policy to see if it fits your needs.

If you cancel within this review period and you:

• HAVE NOT filed any claims, you’ll receive a full refund.
• HAVE filed a claim, we’ll follow the cancellation provisions detailed in your policy.

If you cancel your policy after this review period:

• You’ll receive a pro-rated refund of the unused premium as of the date of cancellation. It’s that simple!