A Vet's Review of Nationwide Pet Insurance
2023

by Frances Wilkerson, DVM

This review discusses the 5 important pieces of coverage and payout structure.

To get the most from this review, please read the Guide to Pet Insurance first.
For a detailed look at Nationwide, see Nationwide's Comparison Sheet.



Overview
Nationwide acquired VPI in 2015. VPI was started in 1982.

This review refers to the following dog and cat plans: Modular Pet Insurance Plan, Whole Pet and Major Medical.


Coverage Overview

In general, the Modular, Whole Pet and Major Medical plans cover examinations, diagnostics and lab tests, surgery, treatments, hospitalization, and prescription medications for accidents/injuries and illnesses as long as the condition is not pre-existing, has not occurred during the waiting period, and you have not reached your maximum payout.

The way the Modular Pet Insurance Plan is structured, illness coverage is optional.

Dental coverage for accidents and illnesses is limited for both plans.


Coverage For Chronic Diseases & Continual Coverage For Chronic Diseases

Modular Pet Insurance Plan
The Modular Plan offers chronic diseases coverage and continual coverage for chronic conditions as long as the condition is not pre-existing, has not occurred during the waiting period, and you have not reached your maximum payout.

You must purchase accident AND illness coverage to get this coverage. The way this plan is structured, illness coverage is optional.

Whole Pet Plan
The Whole Pet Plan offers chronic diseases coverage and continual coverage for chronic conditions as part of the base policy as long as the condition is not pre-existing, has not occurred during the waiting period, and you have not reached your maximum payout.

Major Medical Plan
For the Major Medical Plan, chronic diseases listed in the benefit schedule are covered, as long as the condition is not pre-existing, has not occurred during the waiting period, and you have not gone over the maximum benefit allowance for the diagnosis/treatment for the year.

Unfortunately, the benefit schedule structure makes it too difficult to determine how comprehensive the chronic disease coverage will be. It would take too much time to check the benefit schedule against every known chronic disease. It would be much easier for the consumer if Nationwide stated which medical conditions are not covered.

The Major Medical Plan offers continual coverage for chronic diseases. Coverage for chronic conditions in subsequent years is available up to the benefit allowance for the diagnosis/treatment. Benefit schedule allowances are reset every policy year.



Hereditary & Congenital Coverage

Modular Pet Insurance Plan
The Modular Pet Insurance Plan covers hereditary and congenital conditions as long as the condition is not pre-existing, has not occurred during the waiting period, and you have not reached your maximum payout.

You must purchase accident AND illness coverage to get Hereditary and Congenital coverage. The way this plan is structured, illness coverage is optional. Illness coverage comes with removable Hereditary and Congenital coverage.

Hereditary and Congenital conditions (including hip dysplasia) will only be covered up to $5,000/year.

Whole Pet Plan
The Whole Pet Plan covers hereditary conditions as long as the condition is not pre-existing, has not occurred during the waiting period, and you have not reached your maximum payout.

It is unclear if congenital conditions are covered. It is not explicitly stated on the website or in the sample policy at the time of this writing.

Major Medical Plan
Monetary and medical coverage for hereditary and congenital conditions is low for the Major Medical Plan

The Major Medical Plan does not cover congenital conditions and has limited coverage for hereditary conditions.

With the Major Medical Plan, coverage for a certain number of specified hereditary conditions becomes available after you've had the plan for one year. The monetary limits on this coverage are $275 per policy period toward diagnosis or medical treatment and $550 per policy period for surgical treatment. Hip dysplasia is one of these covered conditions.

Hereditary and congenital is one of the important pieces of coverage that must be part of any pet insurance plan you purchase. (See: 5 Points of Coverage Your Pet Insurance Plan Must Have)



Cancer Coverage

Modular Pet Insurance Plan
The Modular Pet Insurance Plan covers cancer conditions as long as the condition is not pre-existing, has not occurred during the waiting period, and you have not reached your maximum payout.

You must purchase accident AND illness coverage to get this coverage. The way this plan is structured, illness coverage is optional.

Also make sure the illness coverage has hereditary and congenital coverage selected as well otherwise cancers deemed hereditary/congenital in nature will not be covered.

Whole Pet Plan
The Whole Pet Plan covers cancer conditions as long as the condition is not pre-existing, has not occurred during the waiting period, and you have not reached your maximum payout.

Major Medical Plan
Cancers listed in the benefit schedule are covered, as long as the condition is not pre-existing, has not occurred during the waiting period, and you have not gone over the maximum benefit allowance for the diagnosis/treatment for the year.

Again, the benefit schedule structure makes it too difficult to determine how comprehensive the cancer coverage will be. It would be much easier for the consumer if Nationwide stated which cancer conditions are not covered.

If a cancer is shown to be due to hereditary/genetic reasons, there is a possibility that it will not be covered.



Coverage For Breed Specific Conditions

Modular Pet Insurance Plan
The Modular Pet Insurance Plan covers breed specific medical conditions as long as the condition is not pre-existing, has not occurred during the waiting period, and you have not reached your maximum payout.

You must purchase accident AND illness coverage to get this coverage. The way this plan is structured, illness coverage is optional.

Since, many Breed Specific conditions can occur as Hereditary/Congenital, make sure the illness coverage has hereditary and congenital coverage selected as well.

Whole Pet Plan
The Whole Pet Plan covers breed specific medical conditions as long as the condition is not pre-existing, has not occurred during the waiting period, and you have not reached your maximum payout.

However, it is unclear whether or not Breed Specific Conditions that are Congenital in nature are covered. It is not explicitly stated on the website or in the sample policy at the time of this writing.

Major Medical Plan
Breed specific medical conditions often occur as hereditary/congenital issues. The Major Medical Plan does not cover congenital conditions and has limited coverage for hereditary conditions, therefore coverage for breed specific conditions is low.



Maximum Payout Structure

Whole Pet Plan
Modular Pet Insurance Plan
The Modular Pet Insurance Plan has a $5,000 or Unlimited annual maximum payout. In either case, Hereditary and Congenital conditions will only be covered up to $5,000/year.

Whole Pet Plan
The Whole Pet Plan has an annual maximum payout structure of $10,000. This maximum payout structure will meet the needs of those whose calculated "Worst Case Scenario Costs" are $10,000 or less. (See: Picking the Right Maximum Payout)

Major Medical Plan
The Major Medical Plan has a benefit allowance structure. This means there is a benefit allowance that will limit what you will receive for the medical condition's diagnosis and treatment each year. The benefit allowance may be too low for those with high calculated "Worst Case Scenario Costs". (See: Picking the Right Maximum Payout)



Summary of Coverage and Payout Structure

Limitations

Modular Pet Insurance Plan
  • The way this plan is structured, illness coverage is optional.
  • 12 month waiting period for cruciate and meniscal damage or rupture. After 12 months has passed, you must remember to call the company and apply for this coverage as it is not automatically attached to the base plan. (May vary by state)
  • Bilateral Conditions Policy is not clear (See 'Concerns' section below)
  • Hereditary and Congenital conditions (including hip dysplasia) will only be covered up to $5,000/year.
  • Dental coverage for accidents and illness is unclear
Whole Pet Plan
  • 12 month waiting period for cruciate and meniscal damage or rupture (May vary by state)
  • Bilateral Conditions Policy is not clear (See 'Concerns' section below)
  • It is unclear whether congenital conditions are covered
  • Dental coverage for accidents and illness is unclear
Major Medical Plan
  • No congenital coverage
  • Limited hereditary coverage
  • 12 month waiting period for cruciate and meniscal damage or rupture (May vary by state)
  • 12 month waiting period for hip dysplasia (May vary by state)
  • Bilateral Conditions Policy is not clear (See 'Concerns' section below)
  • If a cancer condition is shown to be hereditary or genetic, there is a possibility it will not be covered
  • The payout structure for the Major Medical Plan may be to low for those with high calculated "Worst Case Scenario Costs".
  • Calculating the amount you will be reimbursed using the benefit schedule can be confusing
  • Dental coverage for accidents and illness is limited


Good Points

  • Strong Underwriters
  • You can use any licensed vet worldwide


Concerns

  • It is not clear if the reimbursements are calculated by taking the deductible first or the reimbursement percentage first.
  • The wording "whether or not the condition was ... diagnosed" in their pre-existing conditions policy may leave the door open for signs and symptoms to be used as reason to deny claims even when these previous sign or symptom is not directly related to the disease or condition currently in question.
  • The way the Modular Pet Insurance Plan is structured, illness coverage is optional. This can lead to the consumer getting inadequate coverage. What the consumer feels should fall under the category of accidents and injuries isn't always how the insurance company sees it. (e.g. cruciate ligament injuries fall under the category of illness, not accident/injury)
  • The Modular Pet Insurance Plan appears to use a utilization level factor when calculating initial/renewal premium pricing. Does this mean that premiums can increase based on the number of claims and dollar amount of claims filed?
  • For the Whole Pet Plan, the website explicitly states that Hereditary conditions are covered. However, it is not explicitly stated on their website or sample policy that Congenital conditions are covered. I have concerns that by it not being explicitly stated it could be used to deem a condition pre-existing.
  • Another concern I have is in regards to Nationwide's claim that they are the ones that issued the first pet insurance policy in 1982 to the dog playing Lassie at the time. The way they word it makes it seem as if they created the policy and issued it. It was actually the leadership of VPI that created and issued this policy. Nationwide acquired VPI in 2015, but that is not the same as being the company that actually issued the policy. I truly hope that this is an honest mistake on the marketing department's side and not a form of marketing spin, as marketing spin breeds a lack of trust.

    m.facebook.com/NationwidePet/photos/a.230393421318/10157721220216319/

    www.linkedin.com/posts/heidisirota_nationwide-celebrates-40-years-of-pet-insurance-activity-6918204460527734784-s6zi?trk=public_profile_like_view



Additional Comments Regarding All Pet Insurance Companies:

  • Make sure you research what customers are saying about the company. A company may have the 5 components that should be part of a pet insurance plan, but the company may not be a hit with customers. Sites to check include but are not limited to BBB.org, Yelp.com and PetInsuranceReview.com. Things to look for include but are not limited to: How fast are payments paid?, What are customers saying about the pre-existing conditions policy?, How often are claims denied and for what reason?, What is the customer service experience like?, Are there issues with premium increases?
  • Check with your state's Department of Insurance to see if any complaints have been filed for the company you are interested in.
  • Make sure you understand what the waiting periods are.
  • Make sure you understand their bilateral conditions policy.
  • Make sure you understand any requirements that you must adhere to to maintain coverage.
  • Make sure you read the terms and conditions to get a thorough understanding of all exclusions.
  • Make sure you understand when and by how much your premium can increase.
  • If you change plan levels, there is a possibility that all medical conditions present under the old plan will be considered pre-existing in the new plan. Make sure you ask the company if this is the case.
  • For some companies, pre-existing conditions can be based on signs and symptoms alone, a diagnosis is not needed. For example, 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. Make sure you ask the company if this is the case.
  • Pet insurance companies are businesses. The top priority of any business is to make a profit for their stakeholders. Pet insurance companies 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 terms.

    When you purchase pet insurance make sure you have a realistic understanding of this and how it can affect you.


Additional Reviews:

24PetProtect | AKC | ASPCA | Bivvy | Companion Protect | Doggo | Embrace | Fetch | Figo | Hartville | Healthy Paws | Lemonade | ManyPets | MetLife | Nationwide | Odie | Petco | Pet Partners | Pets Best | Physicians Mutual | Prudent Pet | Pumpkin | Spot | Toto | Trupanion | Wagmo


**Disclaimer: This review is meant to supplement, not replace your own due diligence. Terms and conditions can vary from state to state. Before buying a pet insurance plan, confirm all information by contacting the company or reading the most current policy for your state. We will not be held liable for errors or omissions. If you see something that is incorrect or needs clarifying, please let me know.

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