Like all pet insurance policies, our plans have exclusions, which are treatments that are
not covered. Our exclusions help us offer affordable plans that are consistent with the
beliefs of the ASPCA (The American Society for the Prevention of Cruelty to Animals).
Inhumane Treatments
Some of our exclusions support the standards of the ASPCA for the humane treatment of
animals. For instance, we do not cover elective procedures the ASPCA opposes like tail
docking, ear cropping, and the removal of dewclaws.
Congenital and Hereditary Disorders
Our plans do not offer coverage for congenital or hereditary disorders. That's because
covering these disorders would require higher premiums for all of our insured pets.
Pre-existing and Ongoing Conditions
Pre-existing conditions are illnesses or injuries that show symptoms, which may or may not
have been diagnosed or treated, prior to a plan's effective date. Like plans from other pet
health insurers, all our plans exclude these conditions.
Ongoing conditions are illnesses or injuries that show symptoms or have been treated in one
plan period, and need care in subsequent plan periods. To prevent the high premiums that
result from runaway treatment costs, most pet health insurance plans limit the coverage of
ongoing conditions. Examples of these coverage limitations include imposing incident caps,
permanently excluding certain chronic conditions, or canceling coverage completely.
We offer two different approaches to ongoing conditions. First, while our
N/A
Basic,
Plus,
and Platinum
Plans do not cover these types of conditions, unless 180 days have passed since cure
and last treatment. This keeps the premiums for these plans lower, and also means that ongoing
conditions can be covered again in the future after this waiting period.
Second, we developed the Plan, which does
not cover pre-existing conditions, but does offer uninterrupted coverage for ongoing conditions.
While we've found that our other plans provide enough coverage to satisfy most of our customers'
needs, the Platinumg Plan gives pet parents who are
especially concerned about ongoing conditions
another choice.
Treatments Without Clear Standards
We also exclude treatments that do not have agreed-upon standards for practice or costs
in the veterinary community. For example, our plans do not cover acupuncture, chiropractic
or rehabilitative therapies, vaccine antibody titers, treatments for behavioral problems,
experimental procedures, organ transplants, or holistic, homeopathic, and herbal
supplies and treatments.
Other Exclusions
Our plans do not cover the costs of breeding or pregnancy, boarding, time and travel to a veterinary
clinic, health certificates or vaccination tags, special diets or food, grooming or supplies,
pre-anesthesia tests except prior to eligible dental cleaning, or multiple incidents of foreign
object ingestion in a 12-month period. Also, while we work hard to make our wellness care payouts
for dental cleanings as generous as possible, we only offer coverage for dental extractions associated
with abscessed, diseased, or broken teeth, but not gingivitis, periodontal disease, or deciduous teeth.
Waiting Periods
In addition to exclusions, there are waiting periods for certain treatments. For example, there is a 30-day
waiting period for illness coverage to begin on a new plan (this waiting period does not apply in all states).
Any illness that shows symptoms or is treated during this waiting period will be considered a pre-existing
condition. There is also a 12-month waiting period before the diagnosis, treatment, or surgery related to
Anterior Cruciate Ligament (ACL) or Cranial Cruciate Ligament (CCL) damage is covered on a new plan.
Fees Exceeding Reasonable Costs
Reasonable costs are the customary fees charged for specific treatments or procedures within a particular
geographic area. Like all pet health insurers, we set our premiums based on prevailing norms for typical
costs of veterinary treatments associated with various conditions. To keep our premiums affordable, we may
question billed costs that significantly exceed reasonable costs for treatment in a given area.
We use our own internal claims data as well as available industry information to determine our proprietary
reasonable costs. Our plans reimburse 80% of reasonable costs, which means that any portion of a submitted
charge that exceeds reasonable costs is excluded.
Please note that this is not a complete description of all coverage terms, conditions, and exclusions.
See the coverage terms in your plan for full details.