Compare Pet Insurance Plans

Compare pet insurance plans

Common Insurance Terms

Insurance plans and rate quotes can be quite confusing. Below are explanations for some of the most commonly-used pet insurance terms. It is important to understand what your plan includes before paying for it!

 


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Age limit
Your pet's age may need to be confirmed by a veterinarian. Most plans will only cover pets older than 8 weeks. Some insurers will not cover any pets above a certain age or will only cover older pets with a limited “senior pet” policy. As older pets generally need more medical attention, your premium and deductible will increase as your pet ages.

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Allowable Charges
Certain pet insurance companies will only reimburse according to their allowable covered charges. Allowable charges are medical costs considered reasonable for your geographic area. The insurance company will determine on its own what it considers a reasonable charge. If your veterinarian charges more than their determined amount, you will not be reimbursed for the difference.

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Benefit Schedule
Some pet insurance providers pay claims based on a benefits schedule, which is a list of diagnoses and corresponding reimbursement amounts. If your insurer only reimburses according to a benefit schedule, it is important to review it before purchasing a plan. That way you will know what medical services are covered and can anticipate how much you will be reimbursed for each one. You will not be reimbursed for any medical condition or veterinary service that is not listed on the benefit schedule.

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Breed Surcharge
Insurers will often increase premiums, restrict coverage or not insure certain high-risk breeds. Some breeds are more susceptible to certain illnesses and medical conditions. Aggressive breeds may be also restricted as they are at a higher risk for injuries.

Premiums may be higher for these breeds: American Staffordshire Terriers, Basset Hounds, Basenjis, Boxers, Bulldogs, All Bull Terriers, Dalmatians, Deerhounds, Doberman Pinschers, all German Shepherds, all Greyhounds, Great Danes, Irish Wolfhounds, Leonbergers, all Mastiff breeds, All Mountain Terriers/Dogs, Newfoundlands, Old English Sheepdogs, Peruvian Inca Orchid, Pharaoh Hounds, Pit Bull Terriers, Rottweilers, St. Bernards, Staffordshire Bull Terriers, Wheaten Terriers.

Chinese Shar-pei and Wolf breeds are often not covered at all.

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Claim
After your pet receives treatment, you will need to fill out a claim form and submit it to your insurer. Your insurance provider will review your claim and determine if you are eligible for coverage. If you are eligible, your insurance provider will approve your claim and mail a reimbursement check.

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Coinsurance/Co-pays
Coinsurance is the percentage of the total bill that your pet health insurance company will pay. Co-payment ("co-pay") is the amount of money you have to pay for a specific treatment or veterinarian visit besides insurance.

Example: 75% coinsurance - On a $100 vet bill, the insurance company will pay $75 and you will need to pay the remaining $25.

Example: $20 co-pay per office visit - You must pay $20 out of pocket before your insurance covers anything.

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Congenital conditions
A congenital condition is a condition that is considered a birth defect or a defect in growth development. Congenital conditions do not only present themselves at birth. Your pet can show symptoms of a congenital condition at any time. Congenital conditions are common pet insurance exclusions. Most pet insurance providers do not cover these conditions or any problems directly related to them.

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Coverage Limits/Benefit Limits
Coverage and benefit limits are the maximum amount the insurance company will pay for a duration of time, usually the life of your pet or annually. Coverage limits may also apply to specific treatments or conditions.

Example: $10,000 annual coverage limit - If your pet incurs $12,000 of expenses that year, insurance will only cover $10,000.

Example: $3,000 accident coverage limit - If your pet is in an accident, the pet insurance company will only pay up to $3,000 for that specific incident.

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Deductibles
Deductible is the amount of money that you have to pay out of pocket before your pet health insurance company will begin paying anything.

Deductibles can be per incident, lifetime or annual. A per-incident deductable means you have to a certain amount for each visit or treatment before insurance kicks in. An annual deductable applies to all services and treatments performed in one year. A lifetime deductable applies to all services and treatments performed while your pet is covered under that insurance plan. Your insurance will not pay anything until you pay the deductible amount.

Example: $1,000 annual deductible - If your pet has a surgery that costs $2,500, you would need to pay $1,000 out of pocket before your pet insurance will cover the remaining $1,500 according to your regular plan. For the rest of the year, all procedures will be covered under your regular plan.

Example: $100 per incident deductible - If your pet has a $2,500 surgery, you will need to pay the $100 per incident deductible before insurance kicks in for the remaining $2,400.

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Elective procedures
An elective procedure is any procedure performed by your veterinarian that your insurance provider does not deem medically necessary. An elective procedure is one that is chosen by the patient or veterinarian and includes both cosmetic and preventative surgeries. Most pet insurance providers do not cover elective procedures.

Examples include: spay and neuter, de-clawing, dew claw removal, anal sac removal, ear cropping, tail docking, skin folds removal and nail trimming.

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Exclusions
An exclusion is any situation, event or medical condition that is not covered by your policy. The most common exclusions are those related to pre-existing conditions, hereditary or congenital conditions and elective procedures.

Exclusions also include non-insurance related costs such grooming and feeding. It is important to research your insurance provider’s list of exclusions. Excluded procedures are often common and expensive procedures.

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Genetic conditions
A genetic condition is a condition that is passed down through a pet's genes. Genetic conditions can show symptoms any time during a pet's life. Most pet insurance providers do not cover any genetic conditions or problems directly related to them.

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Hereditary conditions
A hereditary condition is any condition that may have been passed down from an animal's parents or through its breed. Hereditary conditions can show symptoms any time during a pet's life. Most pet insurance providers do not cover any hereditary conditions or problems directly related to them.

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Network
A network is a group of veterinarians or facilities that you must visit in order for your pet insurance to cover the veterinary services. If your vet is "non-network" (i.e., not in the network) you may get no coverage or smaller level of coverage. Always confirm that a vet is in your insurance company's network before scheduling an appointment. Most insurance companies that limit you to a network will list their network veterinarians online. Make sure there are enough quality veterinarians in your area.

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Pre-existing conditions
A pre-existing condition is any illness or injury of which your pet displayed symptoms before your insurance plan’s effective date. Pre-existing conditions include conditions that were not already diagnosed or treated. It also can include a condition or illness that happens within the first 30 days of having a new plan. Most pet insurance providers do not cover any pre-existing conditions or problems directly related to them.

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Reimbursement
The amount of money paid for a claim. You insurer will review your claim to determine eligibility. If your claim is approved, you will be reimbursed for your expenses, less any coinsurance and deductibles.

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Waiting Period
Even after your policy goes into affect, your insurance company may impose a waiting period. Your plan will not cover any costs incurred during that period. Most insurance plans include a 2 to 14 day waiting period for accidents and a 14 to 30 day waiting period for illnesses. If your pet gets injured a day after your policy goes into affect, you will have to pay all the costs out of pocket.

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Wellness Coverage
Wellness coverage includes routine preventive treatments, like vaccinations, annual check-ups, and dental cleanings. Many providers do not offer coverage for routine wellness care. It can often be purchased as an addition to your regular illness and injury insurance plan. A plan with wellness coverage will insure everyday vet expenses and may cover vaccinations, teeth cleanings, office visits, spaying or neutering and heartworm testing.

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