Why Insurance Coverage for Hereditary Conditions Is a Big Deal
Some pet owners who have investigated pet insurance have complained about what they felt were numerous exclusions or loopholes that would allow a pet insurance company to easily deny claims. This has led them to conclude that pet insurance isn’t worth it. One of the exclusions they frequently mention is coverage for hereditary conditions.
These are conditions that have a proven or suspected genetic basis or cause. Many times these conditions are commonly seen in certain breeds; for example, hip dysplasia in some large breed dogs, luxating patellas (dislocating kneecaps) in some small breed dogs, idiopathic epilepsy (seizures) in Beagles, polycystic kidneys in Persian cats, or cardiomyopathy in Ragdoll cats. (Here are a couple of websites that list hereditary conditions in dogs and cats.)
If you are considering the purchase of a policy from a company that doesn’t cover hereditary conditions, ask for a list of conditions that aren’t covered – preferably in a sample policy. Some companies will furnish you with a list of conditions they consider hereditary, and if it isn’t on the list, it’s covered. They may even offer limited coverage for the conditions on the list. Others may not have a list available for viewing and say they rely on lists of hereditary conditions in current veterinary textbooks, etc. You might be surprised how long some of these lists can be.
You should also inquire about whether congenital conditions are covered. These are problems that the pet was born with, such as a congenital heart defect or liver shunt. Some companies won’t cover congenital conditions (even if they cover hereditary conditions) because they consider them pre-existing, since they had the problem from birth — i.e., prior to your purchasing a policy. However, there are companies that will cover congenital problems as long as they weren’t known about or diagnosed by a veterinarian prior to the effective date of your policy.
For example, if you take your new puppy in for a wellness examination and vaccinations and on physical exam your veterinarian hears a heart murmur that the puppy has likely had since birth, it won’t be covered if you later purchase a policy. However, if you purchase a policy and several months later the puppy starts showing signs of illness and a liver shunt is diagnosed (which is congenital — the puppy was born with it), that would be covered because symptoms developed after you purchased the policy.
While coverage for hereditary conditions is a significant factor when selecting a policy for your pet, coverage for congenital problems is just a bonus because a pet is much more likely to develop a condition considered hereditary than it is to be born with a congenital problem.
From a veterinarian’s perspective, I believe coverage for hereditary conditions is essential. I have seen instances where the insurance company considered a condition hereditary and the veterinarian did not, but unfortunately the insurance company’s opinion is the one that counts and the claim was rejected. In order to avoid this situation, buy a policy from a company that covers hereditary conditions, preferably up to the full per-incident or annual maximum.
By reading a sample policy, you should be able to determine if hereditary conditions are covered and if there are any limits or restrictions on coverage.
Dr. Doug Kenney