A Vet's Review of PetFirst Pet Insurance

by Frances Wilkerson, DVM

This review discusses coverage and payout structure

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



Overview

PetFirst has offered pet insurance since 2004. This review refers to the following plans: Standard and Lifetime


Coverage Overview

In general, PetFirst Pet Insurance covers 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.

Non-routine dental coverage is limited.


Coverage For Chronic Diseases & Continual Coverage For Chronic Diseases

If you do not purchase the Lifetime Plan or the 'Hereditary/Chronic/Congenital' add-on and your pet acquires a chronic disease, that medical condition will only be covered the first year it is diagnosed.

Pet owners who do not have a medical background may not understand the importance of this type of coverage and not purchase it.



Hereditary & Congenital Coverage

In order to get hereditary/congenital coverage, you must purchase the Lifetime Plan or the 'Hereditary/Chronic/Congenital' add-on.

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

If you leave this coverage out you are putting the odds too heavily in favor of the pet insurance company.



Cancer Coverage

PetFirst pet insurance offers cancer coverage but...
  1. If you do not purchase the Lifetime Plan or the 'Hereditary/Chronic/Congenital' add-on and your pet acquires cancer, that cancer condition will only be covered the first year it is diagnosed.
  2. If you do not purchase the Lifetime Plan or the 'Hereditary/Chronic/Congenital' add-on and your pet acquires cancer and that cancer is shown to be due to hereditary/genetic reasons, it may not be covered.



Coverage For Breed Specific Conditions

Breed Specific Medical Conditions occur as hereditary and congenital issues and as recurring chronic medical diseases.

In order to get coverage for breed specific conditions with PetFirst, you will need to purchase the Lifetime Plan or the 'Hereditary/Chronic/Congenital' add-on. Otherwise your coverage for breed specific conditions will be minimal.

Also, if you do not purchase the Lifetime Plan or the 'Hereditary/Chronic/Congenital' add-on, conditions like hip dysplasia will not be covered.


Maximum Payout Structure

PetFirst Pet Insurance Standard Plan has a per-incident maximum payout structure combined with an annual maximum payout structure. So, there is a maximum you will receive per-incident depending on the plan you purchase.

This per-incident maximum payout may work for people whose calculated "Worst Case Scenario Costs" are on the low end. But if your calculated "Worst Case Scenario Costs" are higher, the payout will not meet your needs.

The Lifetime Plan has an annual maximum payout structure. The highest annual maximum payout is generous and will work for people whose "Worst Case Scenario Costs" are less than $20,000. (See: Picking the Right Maximum Payout)



The Hereditary/Chronic/Congenital add-on has two payout options:
  1. Payment for these conditions up to 25% of the plan's per incident limit.
  2. Payment of these conditions up to 100% of the plan's per incident limit.
The first option (payout up to 25% of the plan's per-incident limit) limits the amount of payout you can receive on hereditary/congenital and ongoing chronic diseases. This payout limit may not be enough to cover conditions in this category.

Your full maximum payout amount should be available for use on whatever comes up for your pet. There should be no percentage limits or cut off points.



Summary of Coverage and Payout Structure

Gotchas

  • You must remember to purchase the Lifetime Plan or the 'Hereditary/Chronic/Congenital' add-on to get continual coverage for chronic conditions, including cancer
  • You must remember to purchase he Lifetime Plan or the 'Hereditary/Chronic/Congenital' add-on to get coverage for hereditary/congenital issues
  • If you do not purchase he Lifetime Plan or the 'Hereditary/Chronic/Congenital' add-on and your pet acquires cancer and that cancer is shown to be due to hereditary/genetic reasons, there is a possibility that it may not be covered.
  • The per-incident payout structure of the Standard Plan may not be enough for those with high "Worst Case Scenario Costs"
  • Non-routine dental coverage is limited



Good Points

  • Strong underwriter



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, 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?
  • 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 how and when 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 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:

AKC | ASPCA | Embrace | Figo | Healthy Paws | PetFirst | PetPlan | Pets Best | Trupanion | VPI | 24 Pet Watch


**Disclaimer:This review is meant to supplement not replace your own due diligence. Please read all terms and conditions of the pet insurance plan before you buy.

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