What Does Pet Insurance Cover?

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Figuring out pet insurance can be overwhelming, especially when it comes to what it covers. What is included or excluded in pet insurance? 

The “right” coverage depends on your individual situation. One of the most basic questions you’ll have to answer as you shop for pet insurance is what your pet needs and whether the policies you’re considering provide that coverage.

Making this decision means having a good understanding the main types of pet insurance and what they usually do and don’t cover, what coverage your pet needs for their age and medical history, and how much of the bill a company will pay even for things that are covered.

Your vet can be a great resource to help understand pet insurance and which plan is right for you. Here are some insights on what pet insurance covers.

What's Usually Covered by Pet Insurance?

The exact coverage of your plan will depend on what type of plan you have. Pet insurance plans are not like human plans, where everything from your yearly physical to a sprain or rash falls under one plan.

In general, most pet insurance companies offer three main types that vary in what they will cover: accident-only, accident and illness plans, and wellness/preventive plans.

Accident-Only Insurance

As the name implies, an accident-only plan covers costs associated with accidents, including many emergency veterinary expenses. Often, there is the misconception that “everything emergency” is covered by an accident-only plan. However, it’s always a good idea to read the fine print on accident-only plans, because your idea of an accident and the insurance company’s idea of an accident might be very different.

For example, if you knock over the garbage can and your dog quickly scarfs down a chicken bone that results in emergency medical expenses, this might not be considered an accident. However, if someone leaves the front door open and your dog runs outside and gets hit by a car, that would likely be covered as an accident.

Accident-only plans tend to be less expensive, which makes sense, considering they have the most restrictive coverage. When pricing your plan, also make sure you understand the deductible and reimbursement percentages as well, because these will affect your out-of-pocket expenses if you need emergency coverage.

Accident and Illness Insurance

Accident and illness plans tend to be the most popular type among pet parents, because these often cover any nasty surprises you weren’t expecting.

These generally cover both accidents, like falling off the deck, and health conditions, from infections to chronic health conditions like diabetes, joint disease, and even cancers. The typical accident and illness plan will cover diagnostic and treatment expenses related to those types of vet visits (“sick pet” visits).

As with any plan, it’s always a good idea to read the fine print and ask questions. Search the company’s website for a list of conditions that are not covered. Some plans will have exemptions for congenital conditions (present at birth) and/or hereditary conditions based on your dog’s breed. For example, respiratory conditions among English Bulldogs may not be covered because they’re so common. 

Problems that develop during the “waiting period” (date from when you sign up until coverage kicks in) will also not be covered. Generally, if your pet is considered to have a “pre-existing condition” (such as a heart murmur diagnosed before you signed up), expenses related to this health condition will not be covered. 

Specific types of therapy, such as massage therapy, behavioral therapy, and non-mainstream treatments may or may not be covered. 

Accident and illness plans are more expensive than accident-only plans, but they have a wider range of coverage. Many policies will include deductibles and varying reimbursement percentages, which will further influence the cost of the plan and your out-of-pocket costs.

Wellness Plans

Pet wellness plans typically provide coverage for wellness and preventive care. They are often sold as add-ons to traditional accident-and-illness plans, or they can be purchased as standalone policies.

Wellness plans usually cover standard things such as routine vaccinations, annual checkups, senior checkups, heartworm testing, and parasite prevention medications for heartworms, fleas, and ticks.

The advantage of getting a wellness plan is spreading the expenses across a full year instead of paying them all at once when your pet needs routine care once or twice a year.

As always, read the fine print of the plan. For example, many wellness plans don’t cover dental care (you need a separate policy), or they might cover dental cleanings, but not tooth extraction.

How Much of the Vet Bill Will Pet Insurance Cover?

The amount you get reimbursed will depend on the type of plan, the level of deductible, the reimbursement percentage, and the annual cap.

Similar to human insurance, a deductible is a set amount that you pay the vet before coverage kicks in.

An annual deductible is the amount you will have to pay every year before your coverage kicks in, and it resets each year. Your dog may get hives and also be diagnosed with an ear infection on separate visits, and all approved costs will go toward the yearly deductible.

A per-incident deductible is one you have to pay for each type of incident. In this scenario, let’s say your dog is diagnosed with diabetes. You will be responsible for hitting the deductible before coverage kicks in. While these expenses can add up, the advantage is that, assuming you keep the policy year after year, you’ve already satisfied the deductible for diabetes-related expenses in the first year.

Also pay attention to the reimbursement percentage. This is the amount of coverage a plan provides after the deductible is met. For example, if the reimbursement percentage is 90%, you will be responsible for 10% of all expenses after the deductible. In this scenario, if you have a vet bill for $1,000 and have already met your deductible, you will still owe $100, or 10%, of the total bill.

Finally, many policies also have an annual reimbursement cap, meaning they will only pay so much in any given year. If your pet has an expensive year, you will be responsible for all costs above the total reimbursement cap.

When Will Pet Insurance Start Covering Incidents?

In most cases, pet insurance doesn’t kick in immediately. Most insurance companies have a waiting period between the time you buy the policy and the time the coverage actually starts. This is to make sure your pet doesn’t have an immediate and expensive health need that caused you to run out and buy insurance.

There may be one waiting period before illness are covered (such as 14-30 days), and a different waiting period (such as 48 hours) for accidents to be covered.

Pet insurance can be a great investment in your pet’s health, but to get the most from your insurance, make sure to weigh all the factors, including your pet’s life stage and health status, and all plan options. Your vet will always be a good resource for questions on pet insurance. A little bit of research up front can save a lot of extra expenses and misunderstanding later on.

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