Pet Insurance and Pre-existing Conditions
Pet Insurance and Pre-existing Conditions
Pet insurance plans usually do not cover pre-existing conditions. These are injuries or illnesses that come up or show symptoms before your plan goes into effect or during a waiting period. Here are a few examples:
- If your dog tumbled down the steps and fractured a paw before you enrolled in pet insurance, expenses for X-rays and other treatments related to the break would not be covered. Also, future related expenses for the same condition would not be covered unless the condition becomes eligible for coverage as a cured condition.
- Pet insurance providers may define and handle pre-existing conditions differently. Please read the policy carefully so you know what to expect.
- For example, an ASPCA Pet Health Insurance plan states that a condition will no longer be considered pre-existing if it's cured and free of symptoms and treatments for 180 days, with the exception of knee and ligament conditions. If a knee or ligament condition occurs before the coverage effective date or during a waiting period, any future ones won’t be covered.
What if a condition hasn’t been diagnosed yet?
Conditions that have not been diagnosed or treated yet can still be considered pre-existing conditions. For instance, imagine your dog starts limping in March before you sign up for pet insurance. You take your dog to the veterinarian, but they are not sure what is causing your pooch to limp. If you enroll in pet insurance in April and your dog starts limping again, any treatments that might now be needed related to this issue would not be covered because symptoms occurred before the plan went into effect.
Does my pet need to be examined before enrolling?
To help identify pre-existing conditions and assess the overall health of your pet, some providers may require proof that your pet has had a full medical exam prior to enrolling in their pet insurance. They may also ask for past veterinary records. The ASPCA Pet Health Insurance program does not require a veterinary exam or any medical records for enrollment.
Can a pre-existing condition be covered in the future?
Pet insurance providers may define and handle pre-existing conditions differently, so it depends on the plan. Our policy states that a condition will no longer be considered pre-existing if it's cured and free of symptoms and treatments for 180 days, with the exception of knee and ligament conditions. If a knee or ligament condition occurs before the coverage effective date or during a waiting period, any future ones won’t be covered.
So, if your cat had an upper respiratory infection (URI) when you enrolled, treatment for it would not be covered. However, if your cat came down with another URI 180 days after the first one was cured and treatment free, it would be eligible for coverage.
Why aren’t they covered?
When you think about the purpose of most insurance, it makes sense that pre-existing conditions typically aren’t covered by pet insurance. Insurance is generally intended to protect you for things that might happen in the future, not the past. For instance, if you purchased home insurance today, you would not be able to get reimbursed for repairs due to a flood that happened a few months ago.
How can I avoid a pre-existing condition?
There’s no way to guarantee that your pet won’t have a pre-existing condition, but it can help to enroll in a pet insurance plan sooner rather than later. Our curious, energetic, and playful pets can get injured when you least expect it or get sick out of the blue. The longer you put off enrolling, the more time there is when something could happen to your pet. That injury or illness would then be considered a pre-existing condition and not eligible for coverage.
Should I cover a pet with a pre-existing condition?
Pets with a pre-existing condition are still eligible for pet insurance and that condition should not stop you from considering coverage. While you may not be able to get reimbursed for treatments related to that particular condition, you can receive payouts for future injuries or illnesses. Complete CoverageSM also covers congenital and hereditary conditions, alternative therapies, and behavioral conditions. In addition, the pre-existing condition may be covered in the future depending on your plan.
Can I get reimbursed for past wellness services?
Past wellness treatments are similar to pre-existing conditions in that they are not covered. For instance, if your pet had an annual exam along with vaccines and a dental cleaning a few weeks before you enrolled, these services would not be covered.
However, there is no waiting period for our preventive care coverage. It starts as soon as your plan takes effect. That means you can enroll in this coverage on Monday, take your pet in for their annual check-up on Tuesday, and get reimbursed for covered services.
It’s easy to enroll in preventive care coverage. Simply get a free quote and choose your base plan. Then you will be able to add it to your plan at a low additional cost. We have two preventive care coverage options, which have different lists of covered services and payouts. There is no deductible or reimbursement percentage with this coverage.
Still have questions about pre-existing conditions?
You can review a sample policy to see all of the details related to our coverage. Our friendly representatives can also answer any questions or help you choose a plan and customize it to fit your budget and coverage needs. They are available at 1-888-716-1203 during the following hours:
- Monday to Friday between 8:00 am and 9:00 pm EST
- Saturday 9:00 am to 5:00 pm EST
- Sunday 11:00 am to 3:00 pm EST
If you call after hours, you can leave us a message and we will return your call as soon as possible.
Ready to get started? See the options and pricing available for your pet with a free quote.