Common Exclusions in Pet Health Insurance

Thinking about getting pet insurance for your furry friend? There are a lot of choices out there, and a lot of details to sort through. While it is important to ensure that your pet can get medical care when it needs it most, trying to choose a policy means figuring out what is actually covered. And as you dig deeper into the details, often what you find is a heap of what isn’t. 

Knowing just what a company excludes from their policies can make all the difference in deciding which one could be right for you and your pet. Here’s a list of common, and some uncommon, exclusions that can be the decision maker or breaker in your search for the best health care solution.

Pre-existing, Hereditary, and Chronic Conditions

There are no insurance companies that cover pre-existing conditions, but what a company defines as a pre-existing condition can determine if your pet qualifies for the policy. For most companies, a pre-existing condition is one that is present before the policy begins, or before the end of the waiting period, a set time after the beginning of the policy when most things will not be covered. These conditions can range from allergies to cancer, and can even include an injury to one side of the body excluding the future coverage of the same injury on the opposite side, such as in the case of cruciate ligament problems.

Hereditary and congenital conditions are inherited, and are also often excluded from coverage. However, many companies allow for extra coverage for these types of conditions that can be added on to a main policy. If your pet is a purebred, you may want to research what kinds of breed specific conditions he may be at risk for and ask the company if it can be covered.

Chronic conditions, also referred to as incurable, are those diseases and illness that are with your animal for life, such as allergies or diabetes. Insurance policies will usually not continue to pay for conditions that need continued, lifelong care.

Things We Wish Were Covered, But Aren’t

Dental coverage will vary from company to company, but most will only cover dental work resulting from an accident. Any cosmetic or aesthetic work is not covered, nor are routine cleanings, removal of deciduous teeth, endodontics, caps, crowns, fillings, root canals, or planing. There are policies which offer an add-on to allow for more dental work to be covered, but this is by no means universal.  

Preventative and routine care are standard for any pet, and the insurance companies do not cover them based on the idea that these are expenses a pet owner expects and should have planned for. Like dental coverage, there are add-ons that can cover some of these types of care, so ask what can be covered under one of these. 

Treatments that are usually not covered include:

  • Diagnostics, laboratory procedures, and physical exams, including annual check-ups
  • Vaccinations and vaccination tags 
  • Medications, supplements, or vitamins, even if prescribed by your veterinarian
  • Prescription foods, diets, or treats
  • Parasite testing, treatment, or prevention, including those for fleas, ticks, lice, ear mites, scabies, heartworms, hookworms, roundworms, tapeworms, coccidia, or giardia
  • Spaying and neutering procedures
  • Complications due to breeding, pregnancy, whelping, or nursing
  • Prosthetic limbs or organ transplants
  • Herbal, holistic, or homeopathic treatments, including acupuncture, hydrotherapy, laser therapy, physical therapy, and chiropractic care
  • Veterinary fees not related to treatments, such as medical record expenses, waste disposal fees, and administration fees
  • Injuries that are incurred from a specific or repetitive activity that have already occurred once, such as swallowing foreign objects or toxins
  • Eating disorders, including poop eating

Things We Expect Would Not Be Covered

There are things that probably shouldn’t be covered under insurance, so it is no surprise that they aren’t. These include:

  • Cosmetic or elective surgeries, including tail docking, ear cropping, skin fold removal, anal gland expression or removal, dewclaw removal, and feline declawing
  • Grooming procedures, such as nail trimming, ear cleanings, and medicated baths
  • Microchipping
  • Injuries that were intentional, such as those from abuse or neglect
  • Injuries received from racing, fighting, coursing, or personal protection and guarding
  • Expenses incurred while traveling to or from a veterinary clinic
  • Boarding expenses
  • Pet training and behavioral modification therapy
  • Experimental procedures, including DNA testing, cloning, stem cell therapy, or medical drug trials
  • Treatments performed by someone other than a licensed veterinarian
  • Obesity that is not from a medical condition
  • Autopsy expenses

A Few Odds and Ends

The lists above seem standard. But what about the out of the ordinary? While we expect our insurance to be there when the very worst happens, some policies make it explicitly clear that they cannot help us in certain situations, including: 

  • Avian Flu 
  • Attacks by armed forces
  • Illegal acts
  • Insurrection, invasion, rebellion, or revolt
  • Civil, chemical, biological, or nuclear war 
  • Quarantine

While there seems to be a lot that pet insurance just won’t cover, there may be circumstances when it can be the right choice. Arm yourself with a list of what you and your pet may need help with as you navigate the many pet insurance policies vying for your business, and ask questions to be sure the policy you choose is the right one for you.

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