If My Dog Was Sick Before I Got Insurance, is He Covered?

Veterinary care for your dog can be expensive, even prohibitively so. For most pet parents, their furry companion is like a family member, and having to face a medical crisis without the means to cover the cost of pet insurance, treatment, and preventative care is a nightmarish situation. Nobody wants to face the decision, if care can not be afforded, of what to do: go in debt beyond your means or consider euthanasia. 

Many pet parents obtain medical insurance for their dogs in the expectation they will not have to face such a difficult decision. But is it that simple? Does pet health insurance cover pre-existing conditions? As with human health insurance, pet health insurance is pretty limited, and often does not cover pre-existing conditions--and a variety of other situations you may be unaware of. For a better understanding of what pet health insurance covers, what it does not, and some notable exceptions, read on.

A pre-existing health condition is a medical condition, disease, or disorder your dog suffered from prior to your obtaining health insurance. The vast majority of pet health insurance plans do not cover medical expenses to address pre-existing conditions--and there is more. Most insurance plans also have a waiting period after you begin your policy. The waiting period may be several weeks or months, during which time any medical condition that manifests is considered to have been pre-existing, and is not covered by your newly obtained insurance. This waiting period is implemented because medical conditions that manifest slowly could exist prior to coverage being obtained, but are not discovered until weeks or months later. Your new coverage does not apply to medical conditions in your dog that were believed present, but undetected prior to coverage being obtained.

Also, newly developed bilateral conditions may not be covered for your dog. For example, if your dog was previously diagnosed as having hip dysplasia in one hip, that is a pre-existing condition not covered by newly obtained pet insurance. If the other hip later develops hip dysplasia, even though your dog did not have it there before, because of the dysplasia in the previous hip, the new hip is classified as a pre-existing condition. Limitations like this are something for pet parents to be aware of when they take out pet health insurance for their dog if their dog has experienced orthopedic conditions or disease on one side of the body and not the other.

Also, symptoms that have manifested before coverage that were not diagnosed or treated in your dog, or symptoms in one area of the body that manifest again in the same region, may be ruled as pre-existing, and medical expenses for these will not be covered under an insurance policy. For example, an injury to your dog's shoulder that later results in orthopedic strain in the same limb, or a gastrointestinal symptom that is dismissed as resolved without treatment, and later your dog develops a gastrointestinal disorder that the previous symptom is linked to, may be considered as indications of a pre-existing disorder and not covered. 

Other expenses that are generally not covered by pet health insurance include:

■ Regular vet check-ups
■ Expenses around breeding and having puppies, as this is considered an optional decision
■ Injury caused by your abuse, altercations with other animals or people in your home, or neglect on your part are considered your responsibility
■ Injury caused by strenuous activities you choose to partake in with your dog, such as racing or sporting competitions
■ Cosmetic procedures

Some companies will cover a pre-existing condition if it was “curable” and was successfully resolved prior to insurance being obtained. In this case, if the condition occurs again, it may be covered. An example might be an eye infection that was successfully treated and resolved. After pet insurance has been obtained, and an appropriate time period has gone by, if your dog gets another eye infection, it may be covered and treated as a separate incident, not a pre-existing one. You will need to carefully examine the policy you are purchasing to determine if this is the case and if this is a concern for you and your dog.

As our dogs age, more and more conditions will become classified as pre-existing, so getting coverage earlier, rather than later, may be advisable. Some plans cover routine medical care, while some are for accidental injury or illness only. The cost of these plans varies. What is and isn't covered varies between companies and plans, so doing research on what coverage best suits you and your pet's needs is recommended.

Some insurance plans do or do not cover the following conditions:

■ Serious disorders with poor prognosis such as cancer or heart conditions
■ Orthopedic conditions and arthritis
■ Allergies
■ Diabetes and other endocrine conditions
■ Hereditary disorders