What qualifies as a pre-existing condition can vary among pet insurance companies, but in general, it’s any medical condition “that existed before the pet was enrolled for coverage,” according to Kristen Lynch, executive director of the North American Pet Health Insurance Association.
Let’s take a closer look at pre-existing conditions, how they impact pet insurance, and what coverage options exist. That way, you can protect your pet (and your wallet) despite its medical history.
Does Pet Insurance Cover Pre-Existing Conditions?
Understanding the limitations of pet insurance, particularly regarding pre-existing conditions, is crucial for pet owners. This section explores common exclusions, waiting periods, and real-life scenarios to clarify how pre-existing conditions impact coverage.
Common Exclusions in Pet Insurance
Pet insurance has many common exclusions. Policies generally don’t cover expenses related to breeding, grooming, or elective procedures. Likewise, coverage for pre-existing conditions is relatively rare, and it’s not just diseases that are often exempt from coverage.
Pre-Existing Conditions
For example, if your dog was diagnosed with a torn ligament before you purchased pet insurance, you couldn’t file a claim for any medical treatments. The exclusion of pre-existing conditions also applies to your policy’s waiting period. For instance, if your cat gets diagnosed with diabetes during that time, treatments like dialysis won’t be covered. Insurers impose a waiting period to prevent pet owners from signing up for coverage when they already know of (or suspect) a medical concern.
Waiting Periods
The average waiting periods on pet insurance policies typically range from one to 14 days for injuries and 14 to 30 days for illnesses. “This is not as straightforward as it might seem because our pets can't speak to us, and even in human health, we often have the precursors of medical conditions long before they manifest and are diagnosed and treated,” Lynch says. “Like us, lack of a 'medical history' does not mean the pet doesn't have a medical condition that is going to show up in different ways and worsen over time."
Example Scenario
Kristen Lynch offered an example of a common scenario to help explain the issue of pre-existing conditions:
"Your 3-year-old dog develops a limp. You decide not to conduct a lot of medical tests as they've never limped before. Your vet advises to rest the leg for a few weeks, and [they] prescribe some anti-inflammatory meds,” Lynch says. “Over the next few weeks, your pet's condition improves. Then, six months later, Max plays rambunctiously at doggy daycare and comes home limping. Again, you think he's just aggravated it, so you treat it like the last time. Max's occurrences continue with increasing frequency and include longer recovery periods, more medication, and increasingly complex diagnostic tests until he is ultimately diagnosed with ligament disease and needs surgery."
Coverage Implications
Would this scenario be covered? If Max was already enrolled in coverage, Lynch says, the answer is yes. "However, if you enrolled Max at some point along the way before he was fully diagnosed, he had a pre-existing condition which would be excluded from coverage (and ineligible to claim for),” she adds.
Disclosure of Symptoms
Moreover, in the eyes of insurers, your pet doesn’t even need to be seen by a veterinarian to have a pre-existing condition. If you observe symptoms in your cat or dog, you must disclose them when purchasing coverage. The insurance company will decide whether or not your pet has an excluded pre-existing condition.
Types of Pre-Existing Conditions
There are two types of pre-existing conditions: curable and incurable. Here’s how they compare:
| Curable | Incurable | |
|---|---|---|
| Definition | An isolated medical issue that hasn’t required treatment or resulted in symptoms for a set period (often six-12 months) and isn’t likely to recur | A chronic medical issue that requires regular or continuous treatment |
| Coverage Eligibility | Sometimes covered since the insurer’s financial risk is relatively low | Never covered due to the insurer’s guaranteed financial obligation |
| Examples |
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If you're considering getting pet insurance, you should also be aware of bilateral conditions, which can impact both sides of the body. A common bilateral condition is hip dysplasia.
If your pup is diagnosed with dysplasia on its left side before you purchase pet insurance or during the waiting period, typically, neither hip would be covered even if the right hip displayed no signs of dysplasia when the policy is purchased.
Pet Insurance Enrollment Requirements
Every pet insurance company has its own enrollment criteria your pet must meet to be eligible for coverage. However, you can generally expect to encounter requirements such as:
Species restrictions. Most pet insurance policies only cover cats or dogs.Age limitations. Insurers often won’t cover animals if they’re under 8 weeks or over 14 years old.
Health status checks. Typically, you’ll need to submit veterinary records or have your pet undergo a medical exam to identify pre-existing conditions.
“Some companies may necessitate an initial and subsequent annual health exam, while others may only require medical records from the past 12 months," says Raman Singh, certified financial planner and pet insurance advocate. "Alternatively, certain insurers may not mandate any exams or pet records, but their rates are typically higher than those with enrollment requirements.”
How to Choose the Right Pet Insurance for Pre-Existing Conditions
As you evaluate pet insurance policies, you’ll want to understand how the insurer handles pre-existing conditions. This information will help you gauge if the plan’s coverage is a good fit for your pet. Here’s how to do it:
Before you apply for a policy, you should review your pet’s medical records to determine what an insurance company may deem a pre-existing condition. That way, you won’t be surprised when the insurer gives you a list of exclusions.
As you research different plans, find out if curable pre-existing conditions are covered. If so, note how long your pet must be symptom- and treatment-free before the policy will pay for related care. You may be able to get coverage for injuries and ailments your cat or dog experienced (and recovered from) months ago.
It’s important to note that obtaining pet insurance early allows you to transfer potential financial risks to the insurance company. The earlier you secure coverage, the lower the likelihood of the insurer adding exclusions to your policy.
Medical History Review Process
Insurance companies typically request your pet's records from your current veterinarian, considering factors such as the pet's age and breed type. These records may span up to two years in history. This practice enables insurers to assess the probability of claims and accurately calculate your monthly premium based on the evaluated risks.
As noted, if your pet has pre-existing conditions, your insurer may exclude them from your policy, especially if they’re incurable. The insurance company may also charge you a higher rate for coverage if your pet is older or is a breed that often develops expensive medical issues.
Finally, note that some insurers require a medical history review before you enroll in coverage, while others need it before you file your first claim.
How to Choose the Right Pet Insurance for Pre-Existing Conditions
There are several factors you should consider when choosing the best insurance for your pet, including:
Coverage. Is the plan robust, covering a wide range of medical concerns? Will the policy cover curable pre-existing conditions?
Cost. How much will you pay to cover the premium, deductible, and co-insurance each month or year? Is it a good value when you consider the benefits offered?
Claims experience. How long does the insurer take to pay out on claims? Is the filing process straightforward?
Customer service. Can you easily reach someone at the insurance company? Do representatives seem knowledgeable and friendly?
Company reputation. What do online reviewers have to say about their experience? Has the insurance company been sued or sanctioned by a governing body?
While you can find most of the information online (or by calling the insurer), there’s no substitute for a personal recommendation from someone you trust. Ask your friends and family what pet insurance company they use – particularly if their pets had pre-existing conditions at the time of enrollment.
Pet Insurance Companies That Cover Curable Pre-Existing Conditions
Some of the best pet insurance companies have started offering coverage for curable pre-existing conditions. Here are three insurers who currently do so:
Embrace
Embrace may cover a curable pre-existing condition if your pet has been symptom-free for 12 months. The company will determine your pet’s pre-existing conditions by reviewing its medical records for the previous year. The company’s full-coverage policy also pays for dental issues, congenital or genetic conditions, and alternative treatments such as acupuncture.
ASPCA Pet Health Insurance
The insurer states that any injury or illness that hasn’t required treatment or resulted in symptoms in the last 180 days is not a pre-existing condition and may be eligible for coverage. Exceptions, such as ligament issues, may apply. Full coverage from ASPCA provides protection for a broad scope of concerns, including behavioral problems.
Figo Pet Insurance
The insurance company may cover curable pre-existing conditions if your pet has been treated and symptom-free for the past 12 months. The insurer closes most claims within three business days and doesn’t impose per-condition caps on coverage.
But what if your pet has an incurable pre-existing condition? Unfortunately, pet insurance companies won’t pay for claims associated with that issue. However, several alternatives to traditional pet insurance can help you afford your pet’s necessary care.
Alternatives to Traditional Pet Insurance
It’s recommended that all pet owners plan for costly health issues their dog or cat might need to experience in the future. This is especially true if owners don't plan to pay for pet insurance or if doing so is not an option.
While no one knows about a pre-existing condition before it shows up, preparing for one is never a bad idea. Here are some ways you can plan for future costly veterinary treatment:
Plan ahead for the cost. “Consider setting aside monthly savings, akin to how you might save for your child's college education fund,” says Singh.
Research low-cost clinics or medical non-profit organizations. You can secure discounted veterinary care.
Ask for help online. Community pools or crowdfunding platforms provide newer alternatives to consider.
While these alternatives may have fewer restrictions on pre-existing conditions, their benefits are typically limited or capped at a certain dollar amount. Ideally, combining savings, pet insurance, or community funding sources offers the most comprehensive approach.
Bottom Line
Finding the right pet insurance for pre-existing conditions can be complex, making you navigate many exclusions and requirements. While some insurers offer coverage for curable pre-existing conditions, incurable ones are generally not covered.
Understanding your pet’s medical history and carefully reviewing policy details before enrolling is crucial. Planning ahead, researching low-cost care options, and considering alternative funding can help manage costs. By taking these steps, you can provide the best possible care for your pet, regardless of its medical history.
