- Read the Policy Before You Buy.
(Make sure you understand all exclusions and requirements)
Exclusions are medical conditions that are not covered by
Requirements are things you must do to remain insured (e.g.
annual exams, animal must reside a place of residence listed on policy,
submission of medical records, and adherence to the vaccination recommendations).
Even if you use the comparison
sheets on this website to help you make a decision about your
pet insurance purchase, it is still very important that you
read a sample policy of the plan before you buy. The written policy
contains the terms and conditions of the plan you are buying.
The written policy is where all the hidden exclusions and requirements
YOU MUST READ THIS DOCUMENT before you buy so that you are
fully aware of what is not covered by the plan and what is required
of you to maintain coverage. I've found some very surprising
exclusions and requirements that are not listed in the marketing materials.
Some companies have sample policies available online. For those that
don't, you can request one via email.
In addition to reading the sample policy before you buy, it is equally
important that you read the actual policy you receive after
you purchase the policy as things may be different after you apply.
The underwriter may choose
not to cover you for certain things after they receive your application.
Use the company's "Money Back Guarantee" period (if present)
to review the actual policy they send you. If there is anything in
the policy that you do not agree with, you can cancel the policy during
this "Money Back Guarantee" period. You will get your money back,
provided you did not file a claim.
If a sample policy is not available for your review prior to purchase,
I'd be a little concerned about buying this policy...But in this case
you could still protect yourself using the "Money Back Guarantee"
period (if present) to review the policy they send you after you buy.
Be wary of vaguely worded exclusions or limitations which
could pose a problem later. Make sure all oral promises are put in
- Ask for a list of exclusions based on your pet's past medical history and breed.
Usually you have to purchase the policy first to receive this type of review and you will have to submit medical records. Also,
not all pet insurance companies offer this option....but if they do, it will give you a list of the exclusions you can expect based
on your pet's prior history. If you don't like what is on this list, you can cancel the policy within the money back guarantee
Just make sure that the pet insurance company will have this review done well before the money back guarantee expires so
that you have adequate time to review it.
- Pet Insurance Companies are Businesses
As businesses, their top priority is to make a profit for their stakeholders
(e.g. investors/shareholders). They can and may change your rates
and terms to meet that top priority. A change of business ownership
or underwriters can also be a catalyst for changes in your rates and
When you purchase pet insurance, make sure you have a realistic understanding of this and how it can affect you.
- Know Which States are Covered
Not all pet insurance companies are licensed to sell insurance in
all states...Therefore, before buying a pet insurance plan, make sure
the company sells plans in your state and any state you may be thinking
of moving to. Also, make sure the coverage will be the same in the
Let's say you have a pet insurance plan and you move to different
state. If your current pet insurance company is not licensed in the
state you are moving to, you may not be able to keep your current
If you apply to another pet insurance company (one that is licensed
in your new state) and your pet has diseases that were covered by
the old plan, these diseases may not be covered by the new insurance
company as they will be deemed pre-existing
by the new company.
The bottom line - try to do as much pre-planning as you can.
- Get Pet Insurance as Early as Possible
As stated in Lesson 7,
there are core pieces of coverage that you must have in your
pet insurance policy to get the most for your money. If your pet is
older or has pre-existing conditions you may not be eligible for full
- Know Who the Underwriter Is
The underwriter is responsible
for paying claims, so it is important for the underwriter to be as
financially healthy as possible.
Research a underwriter's financial health by using A.M. Best's
Rating Center. A.M. Best is the largest and longest established
insurance rating and information agency.
When doing this research, make sure you use the underwriter's name
not the name of the insurance company. Be aware that some pet insurance
companies are their own underwriters, in these cases you may be typing
in the name of the company. The underwriter's names are listed on
the comparison sheets or
can be requested from the pet insurance company.
- Use the information in the comparison
- Go to A.M.
Enter the name of the underwriter in the box labeled 'Text'
and click the 'Search Now' button at the bottom of the page.
Once you are on the ratings page, make sure you click on the
name of the underwriter to get the full ratings report.
Once you are at the ratings report, you want to look at the underwriter's
Financial Strength Rating (eg. A++, A, A-, B++, etc) and the
Outlook (e.g. Positive, Negative, Stable)
For an explanation of what the Financial Strength Rating means,
For an explanation of what the Outlook means, go to:
- Know the Year the Company Started in the
I say in the US because pet insurance is relatively new in the United
States compared to other countries.
Even if a company has a successful business in other countries, it
doesn't necessarily mean they will be successful here.
If they do not make enough money their underwriters can pull out.
The longer they have been in business the more experience they have
providing policies in the US.
- Know the Enrollment Age Range
This is the age range a pet must be to sign up for a new policy.
There is usually a low end and a high end. There can
be one range for dogs and one range for cats. There can be ranges
for certain breeds.
Check to make sure the plan covers the current age of your pet.
Even if your pet is too old for the high end of the age range, they
still may be able to get limited coverage.
- Know the Waiting Period
The Waiting Period is the time you have to wait before coverage starts.
If something happens to your pet during the waiting period, that condition
will not be covered by your policy.
There can be one waiting period for accidents/injuries and another
for illnesses. There can also be waiting periods for specific injuries
or illnesses like Cruciate
Ligament Injuries and Intervertebral
If you purchase a pet insurance policy and your pet gets sick during
the waiting period, do not wait until after the waiting period to
seek treatment and subsequent reimbursement because:
- This is detrimental to your pet
- It is considered insurance fraud
Make sure you have a clear understanding of the waiting periods for
the policy you purchase.
- Is There Coverage When You Travel Out Of
If you travel with your pet, this is a factor you may want to pay
Most plans will cover your pet for eligible expenses if your pet
must visit a veterinarian in another state.
Some plans go further and cover eligible expenses for veterinary
visits while you are traveling with your pet to certain countries.
This coverage is for vacations or if you need to see a specialist
in another state/country. If the pet insurance company gets the impression
you are living there your claim may not be covered.
Some companies have a maximum number of days your pet can be in another
state/country. If you go over this maximum number of days, coverage
will be denied
Make sure you get a clear understanding of what the out-of-state/country
- Will the Price Increase as Your Pet Ages?
For most plans, the price of your premium
will increase as your pet ages.
These increases can be annually or occur at certain ages
Make sure you ask what the price increases will be and when they
will happen. Make sure you understand when and how much your premium
will increase as your pet ages.
- Can the Price of your Premium Increase
if you File a Claim?
Ask if filing a claim will increase your premium.
- Can the Price of your Premium Increase for other Reasons?
Pet insurance companies can increase the premium for your pet for reasons other than the ones mentioned above.
These additional reasons include but are not limited to: inflation, you moving to another city (even a city within the same state), change of underwriter, and the
company's need increase their bottom
Before buying, make sure you fully understand how, when and by how much your premium will increase over time
and make sure you are prepared for those increases.
- Do you Get to Choose the Veterinarian you
Want to Use?
Most plans allow you to choose the veterinarian you want to use in
the US. Some plans will allow you to use choose a veterinarian in
- Does the Company Offer a Money Back Guarantee?
Plans with money back guarantees are helpful because they allow you
to review the terms and conditions of the policy to make sure there
are no hidden or unexpected exclusions
- Is There a Surcharge for Visiting an Emergency
Clinic or a Specialist?
Some companies may charge an extra fee for these types of veterinary
visits. While some will increase the co-pay you must pay.
Make sure you understand the surcharge policy for these types of
services before you buy.
- What is the Pre-existing Conditions Policy?
Pre-existing conditions are illnesses or accidents/injuries that
occur before you apply for a policy or that happen during the waiting
Any illness or injury that occurs during this time will not be covered
by your plan.
Some plans have additional conditions in their pre-existing conditions
- Symptoms can be used to label something pre-existing. If your pet had a cough before you applied for pet insurance and this
cough was discussed and written in the pet's medical record, there is the possibility that all future
cough conditions, no matter what the cause, would be considered pre-existing - even if there was no treatment given.
- If you change plan levels, there is a possibility that all medical conditions that you filed a claim for in the old
plan will be considered pre-existing in the new plan.
...So make sure you fully understand the company's pre-existing conditions
policy before you buy it. If think your pet may have a pre-existing
condition, call the company and ask how it will be handled.
- What is their Bilateral Conditions Policy?
A Bilateral Condition is any condition that can happen on both sides
of the body.
The condition does not have to happen on both sides at the same time.
One side could develop the condition, and the other side could develop
the condition years later or not at all.
If the condition happens on both sides of the body, some pet insurance
companies will bundle it into one incident. Even if it happened at
two different times.
The most common examples of bilateral conditions given by pet insurance
companies include but are not limited to - Hip
Dysplasia (could happen in both hips) and Cruciate
Injuries (could happen in both knees).
"Bilateral Conditions" is a term that is specific to the pet
insurance industry and how companies handle these conditions can be
Let's say a pet has a cruciate injury on his left knee that
is pre-existing, if that same
pet gets a cruciate injury on the right knee years later, some
companies will bundle this right knee injury with the left knee injury
and call it pre-existing as well. Because it is considered pre-existing,
it will not be covered.
Also, for some companies, bilateral conditions share the same Maximum
Let's say a pet is diagnosed with a cruciate injury on the left
knee during the first year of the insurance policy. He then gets
a cruciate injury on the right knee two years later. If the
company uses a Maximum Payout
Per-Incident structure, the amount of money reimbursed to the
owner for the right knee will be whatever is left over from the left
knee injury because they are bundled as one incident.
Try to get as clear as you can on the company's bilateral condition
policy. I had a very hard time getting some companies to be clear
with me about their bilateral conditions policy. I don't think they
were trying to hide anything, I just think it is a complex topic that
is not clearly defined.
I would like to see pet insurance companies clearly define their
bilateral conditions policy. I would like the insurance companies
to list all the diseases and injuries that will be consider a bilateral
condition. I would also like them to clearly state what the terms
and conditions are for these conditions.
Are ear infections considered bilateral condition? They can happen
on both sides. There are a lot of diseases and injuries that can happen
on both sides of the body. Will these be treated as bilateral under
the bilateral conditions policy as well?
In my opinion this is a confusing, gray area.
- What is their "Preventable Diseases" Policy?
Many companies have a clause in their policy that states they will not cover diseases that are preventable
by vaccines (Parvo, Bordetella, etc) and prophylactic treatments (heartworm, fleas, whipworm, etc)
Most of these clauses are vague and leave a lot of unanswered questions.
For example, some pets can get sick from bordetella even if vaccinated,
will their diseases be covered by the policy? What if your pet has
allergic reactions to vaccines and you and your vet decide to minimize
the number of vaccines your pet receives, what happens in these cases?
Make sure you have a clear understanding of the company's stance on this subject.
- How is Reimbursement Determined?
Many people think that the amount of money they will get back from
their pet insurance company is based solely on the medical costs they
submit with their claim.
This isn't always true. There are three structures a pet insurance
company can use to determine how much they will pay you:
- The Actual Veterinary Bill
- Usual, Customary, and Reasonable (UCR)
- Benefit Schedule
Pros: This is the best structure because your reimbursement
is based on what you paid.
Cons: Because the amount of money that a company pays out
tends to be higher, companies that use this method tend to have higher
When a company is using UCR they are using compiled data that states
what prices should be based on the procedure and the geographical
location. Some companies have their own compiled data and some use
the Veterinary Fee Reference published by the American Animal
Hospital Association (AAHA)
Pros: There is a higher chance that a company using UCR with
the Veterinary Fee Reference by AAHA is more likely to be closer to
the fee you actually paid than a company that uses a benefit schedule,
but a company utilizing UCR is not required to use the Veterinary
Fee Reference by AAHA and can use any compiled data.
Cons: Because the amount of money that a company using the
compiled data from the Veterinary Fee Reference pays out tends to
be higher, companies that use this method tend to have higher premiums.
When an insurance company uses a Benefit Schedule to determine how
much they will pay, they have predetermined amounts that they will
pay for certain medical problems. These are usually set in stone and
usually do not take into account geographical location.
Pros: You can get an idea of what your reimbursement will
be before you go in.
Cons: Benefit schedules break the reimbursement down by the
amount of money you get back for diagnostics and/or treatment of a
certain disease or injury. In these cases, you need a medical degree
to piece everything together to get an idea of what you will be reimbursed.
I have found that some companies will say they use
the actual vet bill (on their websites or via their customer support
rep), but the sample or actual written policy states UCR.
It is the written policy that governs. If the phrase UCR (or some
variation of it - "usual and customary", "customary") is used in
the written terms and conditions of the policy, it can be implemented
at any time despite what someone tells you.
These same companies may also tell you that they do not use UCR
unless the fees are outrageous compared to other prices in the area.
This is an "internal" policy (a policy that the company has adopted
that allows for leniency in the written terms and conditions in
the policy). This "internal" policy may be true at this time, but
it doesn't guarantee that it will be true in the future. If this
"internal" policy is not written in the terms and conditions, it
could change at any time.
- How Long Does Reimbursement Take?
Because you pay the vet upfront and then get reimbursed by the pet insurance company, it is important that you know just how long
that reimbursement will take.
- What are other people saying about the
pet insurance company?
It's important that you get unbiased information regarding
the pet insurance company you are thinking of using.
Good places are:
- The Better Business Bureau (BBB)
- Your State's Department of Insurance Regulation
- Google - Search Phrase
- Your Veterinarian
Do not rely on one source to help you make a decision, review at
least 2 or 3 of the above sources.
A website with pet insurance reviews by customers. This is very helpful
because it gives you an idea of the experience you can expect from
the pet insurance company after you buy. When using reviews, look for consistent reasons for dissatisfaction and/or satisfaction.
Use this information to check for consumer complaints against the
company. You can also use the website to file a complaint.
Each state has an insurance department whose task it is to regulate
Contact information for each state's insurance department can be
found here (Click on the picture of the state and you will be taken to their website)
Use this information to see if there have been any problems with
the insurance company in your state.
You can also use your state's insurance department to file a complaint.
You can use Google to search additional reviews about each pet insurance company by using the search phrase - 'Name of Company' + Pet Insurance + Reviews.
(e.g. Acme Pet Insurance Reviews). When using reviews, look for consistent reasons for dissatisfaction and/or satisfaction.
Some veterinarians are well versed in pet insurance and some are not. The best way to use your veterinarian
is to ask them their experience with specific pet insurance companies.