Pet Insurance FAQs

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Pet Insurance FAQs

How do I know which vets accept pet insurance?

You don't have to worry about this! With pet insurance, you can go to any licensed veterinarian. You pay the veterinarian for services (as you normally would), then submit that bill with a claim form to the pet insurance company. Any reimbursement you're eligible for will be paid directly to you by the pet insurance company.

This is different from human health insurance, where the insurance company pays the doctor directly (not you). That's why for human health insurance, you need to confirm whether your doctor works with a particular insurance company. In this way, pet insurance is simpler than human health insurance.

What deductible should I get on my pet insurance policy?

You might be wondering which is better to get on your policy: a per-incident deductible or an annual deductible. The short answer is that neither is really better. They're both designed to share costs between you and the insurance company. The important thing is to choose a deductible amount that you're comfortable paying if the need arises. However, if you can predict the future:

  • And can see that your pet will have a lot of incidents requiring vet care over the next 12 months, then an annual deductible is probably better.
  • Or, if your pet will only have 1 or 2 incidents requiring vet care over the next 12 months, then a per-incident deductible is probably better.
  • One more important thing to remember about deductibles: if you want a low deductible, you'll pay for it with a higher premium. It also works the other way: if you're willing to accept a higher deductible, your premium will be lower. Neither is necessarily better—it just depends on your preference:
    • Do you want to pay less out of pocket when you actually seek vet treatment for your pet? Then get a lower deductible.
    • Do you want a lower fixed amount that you pay monthly, and are comfortable with a larger amount you're on the hook for when you go to the vet? Then get a higher deductible.

My pet insurance policy mentions a "reimbursement rate." What is that?

The reimbursement rate is the percentage rate at which the insurance company covers eligible expenses (after the deductible is applied). Most pet insurance policies have reimbursement rates that range from 70–90%. Higher reimbursement rates will cost you more in terms of monthly premium (just like low deductibles do). Here's an example of how it works if you have a policy with a $500 deductible and an 80% reimbursement rate:

Item Description Amount
Total claim submitted to insurance $3,000
Deductible you're responsible for - $500
Eligible expense for reimbursement $2,500
Reimbursement to you from your insurer X 80%
Total Paid by Insurance $2,000
Total Paid by You $1,100

A word of caution here: some pet insurance companies reimburse based on a fixed schedule of costs (you may see it referred to as the "usual and customary charges for the treatment"), rather than the actual vet bill you submit. We don't recommend that type of pet insurance policy; you'll be better off on reimbursements when they're based on your actual vet bills.

My pet insurance policy mentions a limit (or cap) on benefits. What does that mean?

Some pet insurance policies will limit the amount paid in claims for your pet. (There are also policies with no limits). Generally, there are five different types of limits on payouts:

  • Maximum payout per incident – This is the maximum amount the insurance company will pay out for each separate illness or injury. Once you hit that limit, the insurance company will not reimburse any additional expenses for that incident. For policies that have a maximum payout per incident, the limits can go up to $7,000.
  • Maximum payout per year – This is the maximum amount the insurance company will pay for each twelve-month period on your policy. Once you hit that limit, you're not eligible for any more money until the next year. For policies that have a maximum payout per year, the limits can go up to $20,000.
  • Maximum lifetime payout – This is the maximum amount the insurance company will pay during the lifetime of your pet. Once you hit that limit, you're not eligible for any more reimbursement and your policy will be terminated. For policies that have a maximum lifetime payout, the limits can go up to $200,000.
  • Maximum payout per body system - This is the maximum amount the insurance company will reimburse for a body system. Examples of body systems include: digestive system, musculoskeletal system, and nervous system. Once you hit that limit for a body system, you will not receive any more money for any injury or illness that relates to that body system.
  • Maximum payout based on a schedule of benefits – This is the maximum amount the insurance company will reimburse, based on a listing of allowances for health conditions. For example, the schedule might have a maximum allowance for asthma of $500. That's the maximum payout you'd be eligible for, per year, for any expenses related to your pet's asthma.

A word of caution here: some pet insurance companies reimburse based on a fixed schedule of costs (you may see it referred to as the "usual and customary charges for the treatment"), rather than the actual vet bill you submit. We don't recommend that type of pet insurance policy; you'll be better off on reimbursements when they're based on your actual vet bills.

We're also not fans of policies with maximum payouts per incident. An incident could be a single life-threatening event (e.g., cancer or a car accident) that requires expensive, lifesaving care. A per-incident limit is typically lower than an annual or lifetime limit, so the per-incident limit might actually defeat the purpose of pet insurance, which is to allow you to make decisions about lifesaving care without worrying about the cost.

On the other types of payout limits—annual and lifetime—we think they're totally fine as long as they're high enough to cover a worst case scenario (which can run upwards of $20,000 for certain conditions). There are also plans with no limits on payouts. These plans provide the greatest peace of mind (and are still reasonably priced).

What are congenital and hereditary conditions?

You'll probably see these terms referred to when you're shopping for pet insurance. What do they mean?

  • A hereditary condition is one that is linked to genetics, meaning it was passed down from your pet's parents. Example hereditary conditions include diabetes, cherry eye and hip dysplasia.
  • A congenital condition is not linked to genetics. It's related to things that happened while your pet was still developing in utero. Examples of congenital conditions include heart defects, cleft palate, and defects in other organs or limbs.

Some conditions might be both congenital and hereditary. The tricky thing about congenital and hereditary conditions is that they may not appear for years. So you wouldn't know your otherwise healthy pet has one until it shows up—and treatment is often expensive. For this reason, we encourage pet insurance buyers to consider only policies that cover congenital and hereditary conditions.

But wait—you might think that you don't need this coverage if your pet's breed isn't prone to these types of conditions. It's true that certain breeds have higher risks for these conditions; however, that doesn't mean that your pet, if not one of these breeds, is risk-free. Also, policies that exclude coverage for congenital and hereditary conditions give the insurance company more "wiggle room"—it gives them the ability to determine that a certain health condition, where the cause is unknown and difficult to determine, is congenital or hereditary. That means your claim would be denied.

To avoid these situations, and to make sure your pet is covered, we recommend getting a policy that covers congenital and hereditary conditions, without limit.

Why doesn't pet insurance cover pre-existing conditions?

Pre-existing conditions are any health conditions that first occurred before the pet insurance policy's start date (aka effective date). Anything that is documented on your pet's medical health record before you get pet insurance will likely be considered a pre-existing condition and will be excluded from coverage (meaning any claim you make on that condition will be denied).

We think this is a fair exclusion. Why do we think that? Because an insurance system that covers pre-existing conditions couldn't last for very long! That would allow people (or pet owners) to wait until they get sick before they got insurance—and then cancel it after they recover. If everybody did that, no insurance company could afford to exist. Insurance works because not everybody needs it at the same time (this is because of the "law of large numbers"). Sick pets (and wrecked cars and damaged homes) can be covered by insurance because people with healthy pets and no car accidents and undamaged homes are also paying into the insurance pool.

Because pre-existing conditions are always excluded, you should get pet insurance as soon as possible for your pet. The longer you wait, the greater the chance your pet experiences a health issue that would be excluded from coverage.

How do I get reimbursed for a vet bill?

If your pet needs to go to the vet for medical treatment, then you'll make a claim for reimbursement of eligible expenses. Here's what you should know about the claims process:

  1. You can go to any licensed veterinarian. Unlike health insurance, pet insurance doesn't require you to stick to a network.
  2. You have to pay all vet bills upfront. Unlike health insurance, the vet doesn't bill the insurance company. You pay first, then file a claim with the pet insurance company.
  3. Your pet insurance company will have a simple form for you to fill out and submit (via fax, mail or email), along with the itemized invoice from your vet. The form usually asks for your information about: your vet, the diagnosis and the treatment provided for your pet. It's a simple, one-page form.
  4. If it's your first claim, you'll have to submit your pet's complete medical records, along with the claim form.
  5. Then you wait on the decision from the company. If you've been a careful shopper, and read through the policy when you bought it, you should not be surprised by the claim reimbursement. This check will usually arrive in the mail (processing times will vary).

Last updated on Nov 17th 2017