Navigating the world of pet insurance can be complex, especially when considering coverage for pre-existing conditions. As a loving pet owner, ensuring your furry friend has access to the best veterinary care is paramount. Pet insurance is designed to help manage unexpected healthcare costs, but it’s crucial to understand what policies typically cover—and, importantly, what they usually don’t. A common concern for pet parents is whether pet insurance will cover conditions their pet already has before enrollment. Let’s delve into the specifics of pre-existing conditions and pet insurance to clarify what you can expect.
What Constitutes a Pre-Existing Condition in Pet Insurance?
In pet insurance terms, a pre-existing condition is any illness, injury, or symptom that your pet experienced or was diagnosed with before your insurance coverage started. This definition is broad and includes conditions that were apparent or for which your pet received treatment prior to the effective date of your policy. To better understand the scope, pre-existing conditions are often categorized into several types: curable, incurable, bilateral, and hereditary or congenital conditions.
Curable Pre-Existing Conditions: Temporary Setbacks
Curable pre-existing conditions are temporary illnesses or injuries from which a pet can fully recover. Many pet insurance providers offer a glimmer of hope for these conditions. If a curable pre-existing condition, such as a simple infection, remains symptom-free and requires no treatment for a defined period, often 180 days to a year, some insurers will then cover it as a new condition should it recur after this waiting period.
Examples of curable pre-existing conditions include:
- Bladder infections
- Diarrhea
- Ear infections
- Kennel cough
- Respiratory infections
- Urinary tract infections
- Vomiting
It’s important to note that the specific waiting period and conditions for curable pre-existing condition coverage can vary significantly between insurance companies. Always review policy details carefully to understand the terms.
Incurable Pre-Existing Conditions: Permanent Exclusions
Incurable pre-existing conditions represent chronic or lifelong health issues that, unfortunately, are typically not covered by pet insurance. If your pet has been diagnosed with an incurable condition before you enroll in a pet insurance plan, any future veterinary costs associated with that condition will likely be excluded from coverage. This is a standard practice across the pet insurance industry, as these conditions often require ongoing and costly care.
Examples of incurable pre-existing conditions include:
- Allergies
- Arthritis
- Cancer
- Cataracts
- Chronic kidney disease
- Diabetes
- Epilepsy
- Glaucoma
- Heart disease
- Hip dysplasia
- Inflammatory bowel disease (IBD)
- Liver disease
- Orthopedic conditions (like cruciate ligament issues)
- Thyroid imbalances
Understanding this distinction is vital when choosing a pet insurance policy. If your pet has any known incurable conditions, insurance will primarily be beneficial for new accidents and illnesses that are unrelated.
Bilateral Pre-Existing Conditions: Considering Both Sides
Bilateral conditions are those that can affect both sides of a pet’s body, such as hip dysplasia or cruciate ligament tears. If your pet had an issue on one side of the body before coverage began, many pet insurance policies will exclude coverage for the same condition on the opposite side. This is because if a condition has manifested in one limb or organ system, there’s an increased risk of it developing in the corresponding part of the body.
However, if a bilateral condition arises for the first time after your pet insurance policy is active and the waiting periods have passed, it will generally be covered according to the terms of your policy.
Hereditary and Congenital Conditions: Genetic and Birth-Related Issues
Hereditary conditions are genetically passed down from parents to offspring and may not be apparent until later in life. Congenital conditions are present at birth and may or may not be genetic. Pet insurance companies generally approach these conditions differently from typical pre-existing conditions.
Examples of hereditary conditions:
- Brachycephalic Obstructive Airway Syndrome (BOAS)
- Dilated cardiomyopathy (DCM)
- Elbow dysplasia
- Hip dysplasia
- Intervertebral disc disease (IVDD)
Examples of congenital conditions:
- Congenital heart defects
- Portosystemic shunt
- Umbilical hernias
While true pre-existing conditions are excluded, many pet insurance providers do offer coverage for hereditary and congenital conditions, provided that the symptoms first appear after the policy’s waiting period. This is a crucial distinction, as many breeds are predisposed to specific hereditary issues, and congenital conditions can be costly to treat.
A veterinarian carefully examines a dog’s ear during a check-up. Regular vet visits are important for early detection and management of pet health.
Pet Insurance Companies and Their Stance on Pre-Existing Conditions
It’s essential to shop around and compare different pet insurance companies, especially regarding their policies on pre-existing conditions. While no company broadly covers incurable pre-existing conditions, some offer more flexibility with curable conditions.
Below is a table summarizing how various pet insurance companies handle pre-existing conditions, specifically curable ones:
| Company | Pre-Existing Condition Coverage Details |
|---|---|
| ASPCA Pet Health Insurance | Curable pre-existing conditions (excluding knee and ligament conditions) are covered if the pet is symptom-free and treatment-free for 180 days. |
| Chewy Pet Insurance (Plans through Lemonade) | Curable pre-existing conditions resolved for at least 12 months may be covered. Plans through Trupanion do not cover curable pre-existing conditions. |
| Embrace Pet Insurance | Curable pre-existing conditions are covered if the pet is symptom and treatment-free for 12 months. |
| Felix Pet Insurance | Pre-existing conditions may be eligible for coverage after a 365-day waiting period, but only for treatment after this period. |
| Fetch Pet Insurance | Curable pre-existing conditions are covered if the pet shows no symptoms within 12 months from policy purchase. |
| Figo Pet Insurance | Case-by-case review for curable pre-existing conditions symptom-free for 12 months post-treatment. Contact customer service for specific cases. |
| Hartville Pet Insurance | Curable pre-existing conditions are covered if symptom and treatment-free for 180 days. |
| Healthy Paws Pet Insurance | Does not cover curable pre-existing conditions. |
| Lemonade Pet Insurance | Pre-existing conditions cured and resolved for at least 12 months may be covered. Eligibility varies by state. |
| MetLife Pet Insurance | Pre-existing conditions previously covered under a MetLife group policy will continue to be covered when switching to an individual MetLife Pet policy. |
| Nationwide Pet Insurance | Review of cured pre-existing conditions possible, with potential exceptions added to policies. |
| Pets Best Pet Insurance | Curable pre-existing conditions (excluding knee and ligament conditions) covered if symptom and treatment-free for 180 days. |
| Prudent Pet Insurance | One-time incidents that resolve may be covered if symptom and treatment-free for 365 days. |
| Pumpkin Pet Insurance | Curable conditions (excluding knee and ligament conditions) covered if treatment and symptom-free for 180 days. |
| Spot Pet Insurance | Curable conditions covered if symptom and professional treatment-free for 180 days (except for knee and ligament conditions). |
| Trupanion Pet Insurance | Does not cover any pre-existing conditions. |
Note: Always verify the latest policy details directly with the insurance provider as terms and conditions can change.
Veterinary Exams and Medical History: What to Expect
When you enroll your pet in an insurance plan, you might wonder if a veterinary exam is required upfront. Some companies, like Embrace, may request a medical history review after you apply to identify pre-existing conditions. This allows them to assess your pet’s health status and determine any exclusions from coverage. After review, you typically have the option to adjust or cancel the policy if it doesn’t meet your expectations.
However, not all insurers mandate a veterinary exam before you purchase a policy. For example, ASPCA Pet Health Insurance and Spot Pet Insurance do not require upfront medical records or exams.
Regardless of initial requirements, most pet insurance companies reserve the right to request veterinary records when you file a claim. Companies like Pets Best may request these records to verify whether the condition being claimed is pre-existing.
It’s also important to be aware that symptoms observed before your policy starts can be considered pre-existing, even without a formal diagnosis. For instance, if your dog showed signs of a limp before you bought insurance, and it’s later diagnosed as hip dysplasia, related claims could be denied.
A veterinarian carefully reviews a pet’s medical chart, which is crucial for understanding a pet’s health history and pre-existing conditions when considering insurance coverage.
Expert Advice on Pet Insurance and Pre-Existing Conditions
To provide further guidance, here are some expert tips to consider when looking for pet insurance, especially if you’re concerned about pre-existing conditions:
Enroll Early
Jason Metz, Insurance Lead Editor, recommends: “I encourage you to buy a plan before your pet develops any health issues, like diabetes or orthopedic conditions. If you wait until after your pet develops health problems, you won’t be covered for vet bills related to those issues.” Enrolling while your pet is young and healthy is the best way to ensure comprehensive coverage before any conditions arise.
Be Proactive About Pet Health
Ashlee Valentine, Insurance Editor, advises: “I would urge pet owners to be proactive with their pet’s health care. Address any injuries and illnesses so they don’t worsen and stay current on your pet’s vaccinations to help reduce the chances of developing an incurable condition.” Preventative care and prompt treatment of new issues can help minimize the chances of developing conditions that could become pre-existing in the future.
Consider Waiting Periods
Amy Danise, Insurance Managing Editor, suggests: “I suggest you take special waiting periods into consideration. For example, some pet insurance companies have special waiting periods of six to 12 months for orthopedic issues. If your pet develops an orthopedic condition during the waiting period, it will be considered a pre-existing condition.” Be aware of all waiting periods, especially for specific conditions like orthopedic issues, as these can impact what’s considered pre-existing.
No Vet Exam Policies
Michelle Megna, Insurance Lead Editor, notes: “If you want to skip the veterinary exam before buying a policy, I recommend looking for a company that doesn’t require it, such as ASPCA pet insurance.” If you prefer to avoid an initial veterinary exam for insurance purposes, some companies offer policies without this requirement.
Frequently Asked Questions About Pet Insurance and Pre-Existing Conditions
How do pet insurance companies find out about pre-existing conditions?
Pet insurance companies discover pre-existing conditions primarily through veterinary records. Some, like Lemonade, request these records upon policy purchase. Others, such as Pets Best, may request them when a claim is filed. Any symptoms or treatments documented before your policy’s start date or during the waiting period are typically considered pre-existing.
Can symptoms be considered pre-existing conditions?
Yes, symptoms can be deemed pre-existing, even without a formal diagnosis. If veterinary notes document symptoms of an incurable condition before coverage begins, treatment for the underlying condition will likely be excluded. For example, symptoms of diabetes noted before policy inception could lead to diabetes-related claims being denied.
Is it possible to get pet insurance if my pet has pre-existing conditions?
Absolutely. You can still obtain pet insurance for a pet with pre-existing conditions. While incurable pre-existing conditions like diabetes or heart disease won’t be covered, many insurers will cover new accidents and illnesses unrelated to the pre-existing condition. Additionally, as discussed, some companies offer coverage for curable pre-existing conditions after a waiting period of being symptom and treatment-free.
Will my premium increase if my pet has a pre-existing condition?
No, your pet insurance premium is not increased due to pre-existing conditions. Premiums are generally based on factors like your pet’s species, breed, age, and location, as well as the coverage level you select. However, it’s crucial to remember that while your premium isn’t affected, the lack of coverage for incurable pre-existing conditions means you’ll be financially responsible for their care.
Making Informed Decisions About Pet Insurance
Understanding how pet insurance handles pre-existing conditions is crucial for making the right choice for your pet and your budget. While pet insurance won’t typically cover ongoing issues your pet already faces, it can still provide significant financial safety net for unexpected new illnesses and injuries. By choosing a policy that best fits your pet’s current health status and future needs, you can ensure they receive the care they deserve without unexpected financial strain. Always read the fine print, compare policies, and ask questions to ensure you’re fully informed about what is and isn’t covered.
Disclaimer: This article is for informational purposes only and does not constitute financial or veterinary advice. Always consult with a qualified professional for personalized advice.
