Pet Insurance Guide

Lesson 7:
5 Points of Coverage Your Pet Insurance Plan Must Have

(Not All Pet Insurance Plans Are Created Equal)


Having pet insurance can give you a peace of mind that you are covered for the worst case scenario...but the keyword is "covered".

If you are going to spend the money on pet insurance, you need to make sure you are getting good coverage.

The last thing I want to see happen is the scenario where you have been paying monthly premiums for 10 years and your pet gets a disease that is not covered. The plan you pick, must provide good coverage.

Let me start out by saying that you want to purchase a plan that covers accidents/injuries AND illnesses.



note    If your pet is older or has pre-existing conditions the type of coverage available to you may be limited. You may have to use alternatives to help pay for conditions that are not covered.



All pet insurance companies offer plans that cover accidents/injuries and illnesses. The differences lie in the types of medical conditions that are covered.

There are 5 components of medical coverage that, if possible, must be part the insurance plan you pick. Getting a pet insurance plan without them will leave you unprotected.

  • Some pet insurance companies have these components included in their policies.
  • Some companies offer these components as additional add-ons that you must purchase.
  • Some companies do not offer some of these components at all.

If you do not have these 5 components of coverage, you are literally throwing your money away because you will not be covered for common, core diseases.

The 5 components are:

  1. Coverage for Cancer
  2. Coverage for Chronic Disease
  3. Continual Coverage for Chronic Diseases
  4. Coverage for Hereditary & Congenital Diseases
  5. Coverage for Medical Conditions Common to your Pet's Breed & Species



COVERAGE FOR CANCER

Cancer is common in veterinary medicine and treatment can get very expensive. Make sure you have coverage in this area. Most pet insurance plans provide coverage in this area.

Some plans, however, have a limit on the amount of money you can be reimbursed for cancer.

I believe there should be no limit on how you can use your Maximum Payout. You do not know in advance what diseases your pet will get or how much it will cost therefore you should be able to use your Maximum Payout for whatever comes up. Avoid plans where the payout for cancer is less than the "Worst Case Scenario Cost" you picked in Lesson 6.

If you can't avoid these plans, then make sure you have a clear understanding of what your payout limit will be and how it will affect you.

note    If you pet is older or has pre-existing conditions they may not be eligible for full cancer coverage. Call the insurance company to see what your coverage limitations may be.




COVERAGE FOR CHRONIC DISEASES

Chronic diseases are illnesses that have long duration and generally slow progression. Chronic diseases are usually not curable. Examples include: Heart Disease, Chronic Kidney Disease, and Chronic Liver Disease.

Do not get a plan that excludes chronic diseases. These types of diseases usually show up in middle aged to older dogs and cats.

There is one company that excludes some very common chronic diseases. These exclusions include: Chronic Kidney Failure (common disease in older cats and dogs), Osteoarthritis (common disease in older dogs), and Diabetes Mellitus (common disease in middle aged to older cats).

Insurance plans that do not cover these common diseases, isn't acceptable in my book. You could end up paying premiums for 10 years and then have a pet come down with one of these common diseases and not get reimbursed.

Who is the winner of that game....definitely not the owner or the pet


Some plans may also have monetary limits on the amount you can be reimbursed for chronic diseases.

I believe there should be no limit on how you can use your Maximum Payout. You do not know in advance what diseases your pet will get or how much it will cost therefore you should be able to use your Maximum Payout for whatever comes up. Avoid plans where the payout for chronic diseases is less than the "Worst Case Scenario Cost" you picked in Lesson 6.

If you can't avoid these plans, then make sure you have a clear understanding of what your payout limit will be and how it will affect you.

note    If your pet is older or has pre-existing conditions, they may not be eligible for full chronic disease coverage. Call the insurance company to see what your coverage limitations may be.




CONTINUAL COVERAGE FOR CHRONIC DISEASES

Chronic diseases will continue to need treatments & diagnostic monitoring long after the diagnosis is made.

Make sure your plan includes continual coverage for chronic diseases.

You may have to purchase an additional add-on to get this coverage.

If you do not get this coverage, the chronic disease will only be covered in the policy year it was diagnosed, after that, you will have to pay for any continuing medications or diagnostic monitoring yourself.

It doesn't make sense to me to be covered the first year a chronic disease develops but not be covered for this condition in subsequent years.

Any chronic condition is going to have ongoing costs for the life of the patient not just the first year in which it happens.

...If you don't get this coverage you are just wasting your money.


Some companies have continual coverage for chronic conditions but at a reduced percentage of the Maximum Payout.

I believe there should be no limit on how you can use your Maximum Payout. You do not know in advance what diseases your pet will get or how much it will cost therefore you should be able to use your Maximum Payout for whatever comes up. Avoid plans that place limits on the continual coverage payout.

If you can't avoid these plans, then make sure you have a clear understanding of what your payout limit will be and how it will affect you.

note    If your pet is older or has pre-existing conditions, they may not be eligible for continual coverage on certain chronic diseases. Call the insurance company to see what your coverage limitations may be.




COVERAGE FOR HEREDITARY & CONGENITAL DISEASES

Your plan should include coverage for hereditary & congenital conditions. These types of conditions can be present at birth or develop later in life.

Some hereditary & congenital conditions in veterinary medicine are rare - (e.g. Von Willebrand Disease , Liver Shunt).

Some are more common - (e.g. Hip Dysplasia, Patella Luxation, Entropion).

These sites can give you an idea of the type of hereditary & congenital diseases common to your pet's breed or mix of breeds:

Dogs: Cats:

You might think you can forgo this coverage because the your pet's breed does not have a lot of hereditary or congenital issues listed. The problems is that some diseases (e.g. patella luxation) don't always have a hereditary or congenital cause. In these cases, even if the exact origin is not known, the underwriter of an insurance company that does not cover hereditary & congenital conditions, may call it hereditary or congenital anyway and deny your claim. Also, some cancers may be considered hereditary by the underwriter.

Remember the underwriter of the pet insurance company has the final say on the cause of a diagnosis not the veterinarian in charge of the case.

...put the odds of being reimbursed in your favor. Get coverage in this area.




What about companies that provide one type of coverage but not the other?...

Some companies will cover hereditary conditions but not congenital conditions.

These companies state that congenital conditions are deemed to be pre-existing conditions because they are present at birth. For conditions like Cleft Palate, this may be true. But some congenital conditions do not show signs until later in life. Patella Luxation is one of many examples.

In addition, some congenital diseases are also considered to be hereditary.

This creates a fuzzy, fine line that can get very confusing. The more confusing and restrictive a plan is, the higher the chances are that you will not be fully covered. Make sure your plan covers both hereditary and congenital conditions.




What about companies that limit the payout for hereditary & congenital conditions?...

Some companies will have a payout limit for hereditary & congenital conditions. I believe there should be no limit on how you can use your Maximum Payout. You do not know in advance what diseases your pet will get or how much it will cost therefore you should be able to use your Maximum Payout for whatever comes up. Avoid plans where the payout for hereditary & congenital conditions is less than the "Worst Case Scenario Cost" you picked in Lesson 6.

If you can't avoid these plans, then make sure you have a clear understanding of what your payout limit will be and how it will affect you.




Hip Dysplasia Coverage...

Some companies separate hip dysplasia coverage (a hereditary disease) from general congenital/hereditary coverage and offer it as a separate add-on that you must purchase. If you have a dog whose breed is predisposed to hip dysplasia, you want this coverage. Don't get an insurance plan without it.

note    Even if you find plans that cover hereditary & congenital conditions, each pet insurance company can set their own definitions of what these terms means. Before you buy a policy, make sure you have a clear understanding of what their hereditary & congenital policy is. Call the company and read their policy. Make sure there aren't any "weird" exclusions. If you find medical terminology that is confusing ask your veterinarian to help you clarify it or email me I will see if I can help.

note    If your pet is older or has pre-existing conditions, they may not be eligible for coverage on certain hereditary & congenital conditions. Call the insurance company to see what your coverage limitations may be.




COVERAGE FOR MEDICAL CONDITIONS COMMON TO YOUR PET'S BREED & SPECIES

Most breeds/species have medical conditions that are more likely to occur in that breed/species compared to other breeds/species.

A few breed-related examples:

A few species-related examples:

Make sure that the plan you pick includes coverage for problems that could arise for your pet's breed and species. Ask your veterinarian to help you create a list.

note    If your pet is older or has pre-existing conditions, they may not be eligible for coverage on certain medical conditions. Call the insurance company to see what your coverage limitations may be.




... In Summary

Many people sign up for pet insurance without knowing what they are covered for. Many think the coverage is similar to human health insurance. This is not the case.

With pet insurance, things like cancer, chronic conditions, hereditary, and congenital disorders may not be covered or may have limited coverage. Also, the monetary payout for these conditions may be limited as well. These are categories of common pet conditions...do not run the risk of not getting reimbursed by omitting these items.

Remember...put the odds in your favor...



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