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What to Ask When Choosing a Pet Health Insurance Plan?

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By Frances Wilkerson, DVM

 

There are several factors you need to consider when choosing a pet insurance plan. These factors will help you select a plan that fits your needs.

 

1. Does the plan have good medical coverage?

To get the most comprehensive coverage, you want to purchase a plan that covers accidents/injuries AND illnesses. The illness portion of the plan you select should have the following components:

 

a. Coverage for cancer

Cancer is very common in veterinary medicine. Coverage in this area is very important.

 

b. Coverage for chronic disease

Chronic diseases are illnesses that have long duration and generally slow progression, such as cancer, heart disease, chronic kidney disease, and chronic liver disease.

 

c. Continual coverage for chronic disease

If you do not get this coverage, the chronic disease will only be covered in the policy year it was diagnosed, after that, you will have to pay for any continuing medications or diagnostic monitoring yourself. Treatment for almost all chronic diseases will last beyond the first year of diagnosis.

 

d. Coverage for hereditary and congenital diseases

Some plans only cover hereditary medical conditions. Make sure your plan has both hereditary and congenital disease coverage. Examples of these types diseases include:

  • Hip Dysplasia, Patella Luxation, Entropion, Liver Shunt

   
e. Coverage for diseases that are common to your pet's breed and species

 

Examples of breed-related diseases:

  • Hypothyroidism and Hemangiosarcoma for Golden Retrievers
  • Bladder Stones, Diabetes Mellitus, and Cushing's Disease for Miniature Poodles

 

Examples of species-related diseases:

  • Older dogs are more likely to develop Osteoarthritis.
  • Older cats are more likely to develop Hyperthyroidism, Diabetes Mellitus, and Kidney Disease

 

2. What is the maximum payout?

The maximum payout is the maximum amount of money the company will reimburse you. The plan should have a maximum payout that covers the "Worst Case Scenario Costs" for your geographic location.

 

There are 5 different types of maximum payouts:

 

a. Maximum Payout Per Incident - This is the maximum amount of money the insurance company will reimburse you for each new illness or injury. Once you reach this limit, you will no longer receive money to cover that particular injury or illness

 

b. Maximum Annual Payout

This is the maximum amount of money the insurance company will reimburse you each policy year. Once you reach this limit, you will not receive any more money that policy year.

 

c. Maximum Lifetime Payout - This is the maximum amount of money the insurance company will reimburse you during the lifetime of your pet. Once you reach this limit, your pet will no longer be covered.

 

d. Maximum Payout Per Body System - This is the maximum amount of money the insurance company will reimburse for a body system, such as the digestive, musculoskeletal, and nervous systems. Once you reach this limit for a body system, you will not receive any more money for any injury or illness that relates to that body system.

 

e. Maximum Payout Based on a Predetermined Benefit Schedule - This is the maximum amount of money the insurance company will reimburse based on predetermined listed fee structure. This fee structure is available for your review.

 

Some pet insurance companies use only one type of maximum payout structure and some use a combination of payout structures. 

 

3. What are the exclusions and requirements?

Exclusions are medical conditions or situations that are not covered by the plan. Requirements are things you must do to remain insured (e.g. annual exams, submission of medical records, adherence to vaccination recommendations, and verification that the animal resides at the location listed on the policy).

 

Exclusions and requirements are written in the pet insurance company's terms and conditions. Most pet insurance companies allow you to download this document from their website. It is important that you read this document before you buy so that there are no surprises. You will also get a terms and conditions document after you purchase the plan. It is important that you read this document as well, as things may have changed.

 

4. What are the waiting periods?

The waiting period is the time you must wait before your coverage starts. If an injury or illness happens during the waiting period, that condition will not be covered by the policy. Each company handles waiting periods differently. There can be one waiting period for illnesses and a different one for injuries. There can also be separate waiting periods for certain medical conditions.

 


View next article: How Does a Pet Insurance Company Determine the Premium?

 

 

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