These things usually aren’t covered by pet insurance. And that’s ok. We consider these exclusions fair—they don’t shortchange the pet insurance policyholder. But you should be aware of them so you’re not surprised.
These 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.
Why is this fair? 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! The only way it would work to cover pre-existing conditions is if everyone is required to have insurance (which is how human health insurance now works).
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 will experience a health issue that would be excluded from coverage.
Routine care & wellness
This refers to all vet care and procedures to prevent illness and keep your pet healthy. This usually includes: spaying and neutering, annual checkups, vaccinations, flea & tick control, heartworm medication, teeth cleaning, ear cleaning, and microchipping. These are almost always excluded from pet insurance coverage. However, many plans will allow you to add wellness coverage for an additional cost.
Why is this fair? These are the types of costs you should expect as a responsible pet owner. They’re predictable (meaning you can budget for them) and are usually not outrageously expensive.
Many pet insurance companies offer an optional policy add-on, usually called a wellness policy rider, to cover a portion of these costs. However, we think your money is better spent on getting a more robust policy for unpredictable illnesses and injuries. Instead of a wellness option, we’d choose: a higher reimbursement rate, a lower deductible or a higher payout limit.
Office visits & exam fees
Most vets charge a flat fee whenever you bring your pet in for a consultation or exam. That fee is usually in addition to whatever diagnostic test or treatment your vet might perform. (Your regular doctor probably charges for office visits too.) Pet insurance plans with payout limits (for example: a $5,000 annual limit on reimbursements) will cover this fee. However, pet insurance plans that don’t have limits on payouts will not cover this fee. This is important to know so you're not surprised! But this exclusion on unlimited plans is fair.
Why is this fair? Because it’s reasonable cost-sharing between you, as a responsible pet owner, and the insurance company, which wants to offer plans at affordable premiums. By making the pet owner responsible for the exam/consultation fee, it encourages pet owners to take their pets to the vet only when it’s reasonable to seek vet care. Not every little sniffle or sneeze requires you to see the doctor; it’s the same with your pet. But if vet office visits were covered on plans without limits, some anxious owners might be inclined to take their pet to the vet even when it’s unnecessary. This would drive up the cost of insurance for everybody!
If you didn’t read the previous section about what to make sure your policy includes, here’s a reminder:
accidents & illnesses
congenital and hereditary conditions
cancer and chronic diseases
Make sure these are included in your policy’s coverage.
Also, make sure you read a sample policy of any pet insurance plan you’re thinking about buying. These should be available online. Read through the list of exclusions carefully to make sure you fully understand what’s not covered. You don’t want to be surprised by an exclusion when your pet needs expensive care.