By Mel Lee-Smith
Published: 09/08/2021, edited: 09/10/2021
Deductibles, coinsurance, waiting periods — pet insurance jargon can confuse even the most experienced pet parents. If you’re a first-time pet parent or you’ve never applied for pet insurance before, you’ve likely got a ton of questions. We’ve answered 10 of the most common questions about pet insurance and included some handy resources to help you make the most informed decision for your pet.
Just like human health insurance protects you from financial hardship due to emergency healthcare expenses, pet insurance protects your companion animals.
The average pet insurance plan covers between 70% and 90% of vet costs. Most pet insurance companies reimburse pet parents for vet costs instead of paying them directly. Currently, the only exception is Trupanion, which offers software for veterinary clinics that allows them to receive direct payments.
How does pet insurance work? There are 4 key pet insurance terms you need to know:
Deductible: The amount the pet parent must pay toward vet costs per year or condition before coverage takes effect.
Payout limit: Also called a coverage limit, this is the maximum amount of expenses your pet insurance policy will cover per claim, per year, per condition, or throughout your pet's lifetime.
Reimbursement rate: The percentage of veterinary expenses covered by your plan. (You'll need to cover the remaining percentage out of pocket.)
Coinsurance: The percentage of veterinary expenses you're responsible for paying out of pocket. (Your insurance provider will reimburse you for the rest once you've met your deductible.)
Seems simple enough on paper. But how does all that work in a real-life scenario? Here's a quick rundown of what the process might look like with your own pet.
You take your time comparing pet insurance providers to find the right fit for your pet.
Once you've found the right match, you apply for a policy and start paying your monthly premium. Your annual deductible is $250, your reimbursement rate is 80%, and your coinsurance is 20%.
You take your dog to the vet when they get sick or injured. The condition and treatment are covered by your insurer.
The bill comes out to $1,000. You pay the whole bill upfront.
You submit a claim to your insurance provider within the time limit specified by your policy (typically within 30 days of treatment).
You're responsible for paying your annual deductible of $250, plus 20% coinsurance ($150), which equals $400 in out-of-pocket costs.
Your claim is either approved or denied depending on your pet insurance company's terms and conditions.
If your claim is approved, you'll be reimbursed for $600 via mail or direct deposit.
If your claim is denied, you'll usually get a chance to appeal the decision. You can work with your vet to provide supporting documentation.
New to pet health insurance? Check out our guide for a walkthrough of the pet insurance application process.
That depends on the plan and provider you select. The most common types of plans include:
Accident-only: As the name suggests, this plan covers only emergency vet costs associated with accidents.
Accident and illness: The most "pawpular" pet insurance plan, accident and illness policies cover certain conditions as well as emergency treatment.
Most pet health insurance plans cover accidents and illnesses that didn't occur or weren't diagnosed during the waiting period. (We'll talk more about waiting periods in the next section.)
Common conditions and procedures covered:
Prescription medication and food
Dental injuries and illnesses
Cosmetic or elective surgeries
Routine veterinary exams
For a more detailed breakdown of which conditions and procedures are covered under pet insurance, check out our guide on everything you need to know about pet insurance.
Waiting periods help prevent insurance fraud from pet parents who apply for a policy knowing their pet is already sick or showing symptoms of a serious condition.
Waiting periods go into effect after you sign up for your pet insurance policy. Different waiting periods usually apply for accidents and illnesses. For example, PetPremium's waiting period for illnesses is 14 days after the policy start date. Accident coverage activates immediately.
Certain conditions are subject to special waiting periods. For example, a 6-month waiting period commonly applies for cruciate ligament conditions.
Are there any pet insurance plans without a waiting period? Read our guide to find out!
This is the golden question, but unfortunately, there's no one-size-fits-all answer. Your monthly premium amount will vary depending on a wide variety of factors, including:
your pet's species, breed, age, and health history
the number of pets you're insuring (many providers offer multi-pet discounts)
the cost of vet care in your location
the type of plan you choose
your deductible, coverage limit, and reimbursement rate (some providers let you adjust these figures)
whether you sign up for wellness add-ons
Monthly premiums generally range from $10 to $100 per month. On average, you can expect to pay $28 to $47 a month for an accident and illness pet insurance policy. Most pet insurance providers let you get a quote before committing to a plan. Keep in mind that your monthly premium may increase along with vet costs in your area.
Check out our guide on how much pet insurance costs for more information.
You might think the indoor cat who snoozes on your bed for 18 hours a day doesn't really need pet insurance. And sure, an indoor kitty has a much lower risk of injury compared to an active working dog or an outdoor cat. But that doesn't mean they won't ever get sick or need emergency vet care.
So yes, investing in pet insurance is a good idea, even for indoor pets. Still not convinced? Head over to our guide on why indoor pets need pet insurance.
Pets with pre-existing conditions can absolutely get pet insurance. But any conditions or symptoms that were present before you got insurance won't be covered under your plan.
This restriction can be a little confusing for bilateral conditions that affect both sides of the body, like hip dysplasia. Let's say your dog was diagnosed with hip dysplasia in their right hip before you applied for pet insurance. What happens if they get the same condition in their left hip after coverage goes into effect? Usually, the same condition in the left hip won't be covered since bilateral conditions are often considered pre-existing.
You may also have to work a bit harder to prove any newly diagnosed conditions aren't related to or caused by pre-existing ones. Anecdotal reports from pet parents online claim that pet insurance providers often reject claims for new conditions diagnosed in pets with pre-existing conditions.
Claims processing times, upfront payments, and lack of clarity on deductibles, coinsurance, and coverage limits are 3 common challenges in pet insurance.
Most pet insurance providers reimburse eligible vet expenses quickly, sometimes within 24 hours. But some claims may take up to 60 days to process before being approved.
Paying vet bills upfront can be difficult for pet parents who are facing financial hardship or don't have a pet savings account.
Pet parents should also read the fine print to learn how deductibles and coinsurance work, and ask questions before committing to a policy.
Again, this depends on the plan and provider you choose. Many pet insurance providers won't accept new policies for pets over a certain age. For some providers, the maximum age is as young as 6 years for dogs, but it averages out at 10 years for dogs and 15 years for cats.
Fortunately, most providers won't end coverage after your pet turns a certain age. These restrictions usually apply to new policies, not existing ones. But the sooner you apply for coverage, the more you and your pet will benefit.
If you've read the questions above, you probably know the answer to this one: it depends on your pet's age, breed, and health needs. (Not to mention your budget.)
But if we had to narrow it down to the top 5 pet insurance plans, here are the ones we'd pick:
All pet insurance plans by Healthy Paws
All pet insurance plans by Trupanion
Nose to Tail Plan by Embrace
Ultimate Plan by Figo
BestBenefit Plan by PetsBest
To learn more about each pet insurance company's policies, coverage, and exclusions, click the links above to read our reviews.
Now that you’ve got answers to your other pet insurance questions, you might still be wondering, “Is pet insurance really worth it?”
We here at Wag! believe pet insurance is always worth the investment.
Pet insurance is a safety net that protects your fur-babies from the unexpected. Paying a $30 monthly premium is a lot more manageable than footing a $5,000 emergency vet bill out of pocket. And even though you'll usually need to pay vet costs upfront, getting reimbursed for up to 90% of the bill is just one of the many benefits of having pet insurance.
Still got questions about pet insurance? Check out our pet insurance comparison tool to get answers. Brought to you in partnership with Pet Insurer, Wag! Wellness lets you see coverage, exclusions, deductibles, and more from leading pet insurance companies like Spot and ASPCA.
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