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What Does Pet Insurance Cover?
By Ingrid Case MONEY RESEARCH COLLECTIVE
Pet insurance offers coverage for accidents, illnesses, and routine exams. We guide you through what each plan type includes and excludes.
Pet insurance can help offset expensive vet bills, but it doesn’t cover everything.
Navigating the fine print can be a major hurdle, and may contribute to why so few pet owners see it as a must-have. Currently, only about 4% of U.S. cats and dogs are insured, according to the latest data from the North American Pet Health Insurance Association (NAPHIA).
Still, the industry is growing rapidly, and there are more options available than ever. Here’s a breakdown of what’s typically covered, what’s not, and how to choose the right fit for your pet.
What is covered by pet insurance?
Most pet insurance plans are designed to help pay for unexpected vet bills related to accidents, injuries and illnesses. Costs for surgery, medication, X-rays, blood work and emergency care are typically included.
That said, coverage isn’t guaranteed for every vet bill. A claim may be denied if the pet insurer can establish a connection between the injury and the owner’s negligence. Certain illnesses may also be excluded if the animal hasn’t received proper preventative care.
Here’s a breakdown of the injuries and illnesses most pet insurance providers will cover:
What pet insurance usually doesn’t cover
Coverage varies by insurer, but most pet insurance plans don’t cover:
Pre-existing conditions
Pre-existing conditions, or health issues your pet had (or, in some cases, showed symptoms of) before coverage began typically aren’t covered. This exclusion also applies to new medical complications that can be linked to a pre-existing issue.
Some conditions — infections, allergic reactions and stomach bugs, for example — may eventually be covered, provided your pet is symptom-free and deemed to be cured for a certain length of time (often 180 days). Every insurer has a different definition of what constitutes a curable pre-existing condition, so make sure to dig into the details before you buy a policy.
Routine and preventative care
Most standard pet insurance plans don’t cover routine care, such as vaccinations and teeth cleaning, or elective procedures like grooming and nail trimming.
Owner-caused injuries and neglect
Pet insurance won’t cover injuries or illnesses that result from the owner’s own actions, such as intentionally harming a pet or subjecting them to organized fighting or racing.
Veterinary bills related to breeding or breeding-related complications are also generally excluded from standard pet insurance policies.
Types of pet insurance plans
Most pet insurance policies offer two main coverage options: accident-only and accident and illness coverage. Some companies also sell wellness add-ons, but these plans typically cover routine care and aren’t considered pet insurance.
Your premium will vary based on the type of plan you choose, among other factors.
1. Accident and illness coverage
Accident and illness plans (also called “comprehensive policies”) cover a wide range of illnesses, from minor issues like vomiting and diarrhea — even if the cause is unknown — to serious conditions like cancer.
Covered services typically include diagnostic testing (X-rays, MRIs and blood work), hospital stays, surgery, medications, chemotherapy and alternative therapies (acupuncture, laser and stem cell treatment.)
Coverage for cancer and specialty care is standard with most accident and illness plans. Here are a few other conditions these policies typically cover:
Common coverage restrictions
As with most other treatments, hereditary and congenital conditions are covered only if a vet identifies the issue after the policy is in place. If a pet showed signs of one of these conditions before enrollment, insurers usually classify it as pre-existing and exclude it from coverage.
Some pet insurance policies only cover specific conditions after a waiting period has elapsed. A policy may only cover surgery for hip dysplasia if the condition is diagnosed at least six months after the policy takes effect, for example.
Age-based restrictions can apply as well. Treatment for congenital or hereditary dental issues may be excluded if you enroll a pet that’s already one year old, and hip dysplasia is often excluded from coverage if the pet is six years or older at the time of enrollment.
2. Accident-only coverage
What accident-only plans typically cover
As the name suggests, accident-only policies reimburse treatment for injuries caused by accidents. Filing a claim under this type of policy won’t increase your monthly premium. Still, your initial rate may be influenced by how accident-prone your pet’s breed is. Labrador retrievers, for instance, often have higher premiums because they’re known for swallowing things they shouldn’t.
Here’s a quick look at what accident-only coverage typically reimburses — and what it usually doesn’t:
3. Wellness coverage
What wellness coverage typically covers — and doesn’t
Wellness coverage, sometimes called preventative care coverage, is usually offered as an add-on or “rider” to an accident and illness policy, though some insurance companies offer it as a standalone plan. It helps cover the cost of routine veterinary care and, in some cases, grooming, training and other services.
In addition to wellness riders, pet insurers may offer add-ons for things like end-of-life expenses, lost or stolen pet recovery, pet boarding while the owner is hospitalized and liability coverage. Some insurance companies bundle these with wellness coverage, while others sell them separately.
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Summary of Money’s What Does Pet Insurance Cover?
Pet health care plans cover the cost of treating unexpected accidents and illnesses. This includes surgery, medication, tests, emergency care and long-term treatment plans.
The details of your pet insurance policy will depend on the type of coverage and the provider you choose. There are two main pet insurance coverage options:
- Accident and illness coverage will cover accidents and vet-diagnosed sickness or disease, including congenital and hereditary conditions.
- Accident-only coverage will cover only treatment for accidental injuries such as fractures, bite wounds and poisonings.
You can also add preventive care riders to cover services like routine care, end-of-life expenses, alternative therapies and behavioral modification.