What doesn't pet insurance cover?

Exclusions vary between policies, but standard accident-and-illness pet insurance commonly doesn't cover some or all of the following:

• Pre-existing conditions
• Routine wellness and preventive care
• Vaccinations
• Spaying and neutering
• Routine dental cleaning
• Grooming
• Elective or cosmetic procedures
• Breeding and pregnancy-related costs
• Treatment arising during applicable waiting periods
• Expenses specifically excluded by the policy

Some of these expenses may be available through optional wellness coverage or other add-ons.

Pre-existing conditions are one of the most important exclusions to understand.

Pet insurance generally won't cover an illness or injury that existed before your coverage became effective or that arose during an applicable waiting period.

And a condition doesn't necessarily need to have been formally diagnosed to be considered pre-existing.

For example, if your dog showed signs of persistent limping before you purchased insurance and was later diagnosed with an orthopedic condition, treatment related to that condition could potentially be excluded.

Some insurers may reconsider certain curable pre-existing conditions after a specified symptom- and treatment-free period. Definitions and rules vary considerably, so check the individual policy.

Standard accident-and-illness insurance is primarily designed for unexpected medical problems, rather than predictable everyday veterinary expenses.

That means routine care such as:

• Annual wellness exams
• Vaccinations
• Flea and tick prevention
• Heartworm prevention
• Routine bloodwork
• Routine dental cleaning

may not be included.

Some insurers offer optional wellness or preventive-care packages that can help pay for these expenses.

Spaying and neutering generally aren't covered by standard accident-and-illness policies because they're planned procedures rather than treatment for an unexpected illness or injury.

However, some wellness or preventive-care plans may provide an allowance toward these procedures.

If you have a new puppy or kitten and want help with routine first-year veterinary expenses, it's worth comparing wellness benefits separately from core insurance coverage.

This is an area where it's particularly important to read the details.

Routine dental cleaning is commonly excluded from standard accident-and-illness coverage.

However, some policies can cover eligible treatment for dental injuries or illnesses, such as damaged teeth or certain dental diseases.

Dental coverage can vary significantly between insurers, including requirements around preventive dental care.

If dental coverage matters to you, compare the policy wording rather than assuming all plans treat dental conditions the same way.

Not necessarily.

Many accident-and-illness policies can cover eligible hereditary and congenital conditions, provided the condition wasn't pre-existing and isn't otherwise excluded.

This can be especially important for breeds that are predisposed to expensive medical problems.

However, insurers can differ in how they handle conditions such as hip dysplasia, cruciate ligament problems and other orthopedic disorders.

Check for breed-specific, hereditary, congenital and bilateral-condition exclusions when comparing plans.

Pet insurance policies typically have waiting periods between enrollment and when some or all coverage becomes effective.

If your pet develops signs of an illness or injury during an applicable waiting period, expenses associated with that condition may not be covered.

Depending on the policy, the condition could also potentially be considered pre-existing for future claims.

Waiting periods vary between insurers, so they're an important factor to compare—particularly if you're buying coverage for the first time.

No.

You might assume that if treatment for an illness is covered, the veterinarian's examination or consultation fee is covered too.

That's not necessarily the case.

Some policies include eligible exam fees, some offer them as an additional benefit, and others may exclude them.

On a single claim the difference might seem relatively small, but repeated exam or specialist consultation fees can add up.

Prescription medications used to treat an eligible accident or illness are covered by many comprehensive policies, but not necessarily every medication or expense.

Coverage can vary for:

• Prescription medications
• Prescription diets and food
• Supplements
• Compounded medications
• Preventive medications

Check the policy if your pet requires—or is likely to require—ongoing medication.

A condition being generally covered doesn't necessarily mean every dollar on the veterinary bill will be reimbursed.

Your claim could be affected by:

Your deductible

You may need to satisfy a deductible before reimbursement applies.

Your reimbursement rate

A policy might reimburse 70%, 80% or 90% of eligible expenses rather than 100%.

Your coverage limit

The policy may have an annual or other applicable maximum.

Excluded expenses

Some items on the same veterinary bill may be eligible while others aren't.

Policy requirements

The claim must meet the terms and conditions of your specific policy.

That's why it's important to compare the details rather than focusing only on a headline such as “90% reimbursement.”

Imagine your pet needs emergency surgery and the total veterinary bill is $8,000.

Even if the underlying condition is covered, that doesn't necessarily mean the entire $8,000 is eligible for reimbursement.

The bill could contain:

Whether each expense is covered depends on the policy.

Then your deductible, reimbursement percentage and coverage limits can determine how much of the eligible amount is ultimately reimbursed.

Before choosing pet insurance, look beyond the list of benefits and pay close attention to the exclusions.

Ask:

How are pre-existing conditions defined?

Are exam fees covered?

Are hereditary and congenital conditions covered?

Are there breed-specific exclusions?

How are bilateral conditions handled?

What are the waiting periods?

Is dental illness covered?

Are prescription medications covered?

Are there annual or other coverage limits?

Are there additional exclusions that matter for your pet?

Two policies with similar premiums and reimbursement percentages can provide very different protection.

The cheapest pet insurance isn't necessarily the best value.

A policy that costs a few dollars less each month could potentially have exclusions that matter when your pet needs expensive veterinary treatment.

Comparing plans side by side can help you understand what's covered, what's excluded and what you could actually pay out of pocket before you choose.