What to Ask When Choosing a Pet Health Insurance Provider?
By Frances Wilkerson, DVM
So now you are ready to choose a pet insurance provider. These are some factors which will help you select a provider that fits your needs.
1. How long has the company been in business?
The longer a pet insurance company has been in business, the more experience they will have in providing pet insurance policies.
2. How, when and by how much will your premium increase over time?
Pet insurance premiums will increase over time. It is very important to understand the insurance company's policy on premium increases so you can be financially prepared. Reasons for premium increases include, but are not limited to, the following: age, inflation, filing claims, moving to a new city, or a change of underwriters.
3. How attentive is their customer service?
The pet insurance company should have excellent customer service on all levels: phone, email, and Web. Slow or non-existent replies from customer service is not acceptable.
4. Are they licensed to sell pet insurance in your state?
Not all pet insurance companies are licensed to sell in all states. Before buying a pet plan, make sure the company sells plans in your state and any state you may be thinking of moving to. Also, make sure the coverage will be the same in the new state. If you have to switch pet insurance companies or pet insurance plans, any medical conditions your pet had under the old company/plan may be considered pre-existing.
5. How strong is the underwriter for your state?
The underwriter of a pet insurance policy decides whether to accept the risk and insure the pet. They also decide how much coverage the pet should receive. It is the underwriter's money that pays any insurance claims you have. Some companies have more than one underwriter. Make sure you check the underwriter for your state. You can use A.M. Best (www.ambest.com) to research the financial strength of the underwriter.
6. Does the company have a good reputation?
Research a company’s reputation by reading what others have to say about the company. You can also contact your State's Department of Insurance to see if any complaints have been filed. When checking with your Department of Insurance (DOI), make sure to use the underwriter's name and not the name of the pet insurance company. Also, let the DOI know you would like to look at the underwriter in reference to the underwriter's pet insurance program.
7. How long does it take to get reimbursed?
Since you are paying the veterinary bill up front it is important that the pet insurance company reimburse you in a timely fashion.
8. How is reimbursement determined?
Pet insurance companies use one of three structures to determine how much to pay you.
a. Actual Veterinary Bill
If a company uses the actual veterinary bill, you will be reimbursed based on what the veterinary bill states minus your deductible, co-payment, and medical expenses that are not covered.
b. Usual, Customary, and Reasonable (UCR)
Companies that use the UCR structure use compiled data that states what prices should be based on the procedure and the geographical location. Some companies have their own compiled data and some use the Veterinary Fee Reference published by the American Animal Hospital Association (AAHA). You will be reimbursed based on this pricing minus your deductible, co-payment, and medical expenses that are not covered.
c. Benefit Schedule
When an insurance company uses a Benefit Schedule to determine how much they will pay, they have predetermined amounts that they will pay for certain medical problems. These predetermined amounts are the same for everyone.
9. Do they offer a money back guarantee?
Most pet insurance companies offer a money back guarantee period. Use the money back guarantee period to review the terms and conditions of the policy they send you. If there is anything in the policy that you do not agree with, you can cancel the policy during this period. You will receive your money back as long as you have not filed a claim.
10. Do they offer a medical review?
A medical review will give you a list of the exclusions you can expect based on your pet's prior history. If you don't like what is on this list, you can cancel the policy within the money back guarantee period. Make sure that the pet insurance company will have this review done well before the money back guarantee expires so that you have adequate time to review it.
11. Can you choose your veterinarian or must you pick from a network?
It is important that you have the ability to choose any veterinarian you want.
12. Is there coverage when traveling out of state or to another country with your pet?
Most plans will cover your pet for eligible expenses if your pet must visit a veterinarian or specialist in another state. Some plans go further and cover eligible expenses for veterinary visits while you are traveling with your pet to certain countries.
13. Is there a surcharge for visiting an emergency clinic or specialist?
14. What is their bilateral conditions policy?
A bilateral condition is a medical condition that can happen on both sides of the body. Some companies have restrictions on how much they will cover for these types of conditions. Examples of bilateral conditions include but are not limited to: hip dysplasia and cruciate injuries.
Dr. Wilkerson is the author of Pet-Insurance-University.com. Her goal is to help pet owners make informed decisions regarding pet insurance. She believes that everyone can make great decisions when given good, reliable information.
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