- The pros and cons of pet insurance
- 4 types of pet health insurance
- Components and provisions of pet insurance and what they mean to you
- Pet insurance reviews by plan type and company (on a separate page)
The Pros and Cons of Pet Health Insurance
| Pros | Cons |
|---|---|
| There is no need to decide what to do if and when your pet becomes sick – you automatically have coverage. | If your dog never gets sick or hurt, you still have to pay the monthly or annual premiums. |
| It allows you to take your focus off of the cost of pet care and put it on to the treatment that is best for your dog. | If you don’t do the necessary research, you could end up with:
|
| Accidents and illness can cost thousands of dollars. Could you pay if something bad should happen? Pet health insurance helps to remove this concern. | |
| If you know where to look, there are plans available that allow you to only pay for what you need or can afford (don’t worry, we’ll help). |
To us, the pros greatly outweigh the cons, especially considering that:
- Advances in the field of animal medicine have been exponential in past decades allowing veterinarians to successfully treat conditions that were previously considered untreatable. With these advances comes an escalating cost of veterinary care.
- It is estimated that North American pet guardians now spend over $10 billion a year on healthcare for their pets.
- One in three pets need emergency veterinary treatment each year.
- Two out of every three pets experience a significant health problem during their lifetime.
Types of Pet Health Insurance
Your first step towards deciding the best pet health insurance for you is to understand the different types of plans available. This section will cover…
- 4 types of pet health insurance
- An example that compares them
- Points to keep in mind when deciding which is right for you
4 Types of Pet Health Insurance
- Traditional Health Insurance – this is probably what you had in mind when you started your research. With traditional pet insurance, you choose a particular plan and pay a premium every month to the insurance company. When your pet receives treatment, your insurance company will pay part or all of the bill depending on the plan. Traditional plans can cover accidents, illnesses and sometimes even preventive care such as immunizations.
- Customizable Health Insurance is just like traditional pet insurance, except you are allowed to choose the levels of coverage and in some cases what is actually included under the plan.
- Accident Only Plans are also just like the traditional plans, except only accidents are covered. There will be no coverage for anything else, including illnesses or preventive treatment.
- Discount Plans – with this kind of plan you pay a fee to have access to a network of veterinarians. As long as your pet is treated at a vet on the insurance company’s list, your bill will be discounted by a set percentage. If your vet is not on the list, you can usually ask them to join.
Click here for the pet insurance reviews and recommendations for each plan type.
Example: Comparing the 4 Types of Pet Health Insurance
To give you as close of an apples to apples – or should we say “milkbones to milkbones” – comparison as possible, following is a sample scenario and what your out of pocket costs might be for each type of plan…
Sample Scenario: Your vet charges you $2,000 for treating your dog for a specific illness.
Following are some sample plan provisions by plan type and your would-be out of pocket expenses for each (definitions of the terms used can be found in the next section)…
| Tradi-tional | Custom-izable | Accident Only | Discount | |
|---|---|---|---|---|
| Plan Design | $100 Deductible 80% Coinsurance | $100 Deductible 80% Coinsurance | $100 Deductible 80% Coinsurance | 25% Discount at Participating Vets |
| Vet Bill | $2,000 | $2,000 | $2,000 | $2,000 |
| Deductible – You Pay | $100 | $100 | Bill not covered because vet care was for an illness. Coverage is only for accidents. | n/a |
| Remaining Balance After Deductible | $1,900 | $1,900 | $2,000 | |
| Coinsurance – Insurance Company Pays | 80% of Remaining Balance ($1,520) | 80% of Remaining Balance ($1,520) | n/a | |
| Discount off of billed charges | n/a | n/a | 25% ($2,000 X .25 = $500 discount) | |
| Your Net Out of Pocket Costs | $380 ($1,900 – $1,520) | $380 ($1,900 – $1,520) | $2,000 | $1,500 |
Points to Keep in Mind About Each Pet Health Insurance Type
- For the Traditional plan, you choose from a list of “cookie cutter” plans where all of the plan provisions are set.
- For the Customizable plan, you choose the plan provisions such as the deductible and coinsurance levels.
- For the Accident Only plan, if the vet bill had been for an accident, your net out of pocket costs would have been the same as the traditional and customizable plans.
- For the Discount plan, while you will typically pay more at the vet, you will probably pay a much lower premium per month to the insurance company. If your pet does not qualify for the other kinds of insurance (i.e. for a pre-existing condition, your dog’s age or breed makes them ineligible for coverage, etc.) this will still give you an opportunity you to reduce your vet bills.
If you already know the ropes when it comes to insurance terminology, you’re way ahead of the curve! To find the best pet health insurance for you, click here to go straight to the pet insurance reviews for each plan type.
If insurance terminology is like another language to you, you’re not alone. By the time you finish the next section, you’ll be throwing insurance terms around with the best of ’em…
Components & Provisions of Pet Health Insurance and What They Mean to You
The increasing popularity of pet health insurance has led to more companies touting the “best value,” which often means the most fine print.
And this can lead to unsuspecting buyers owning a policy that may not cover…
- A condition that your dog already has
- Older dogs
- Certain breeds
- Services received at your local veterinarian
- Vet bills over a certain amount
Much of the fine print included in the insurance contracts is there to give you a lower rate. While that can be good for your monthly expenses, it can be a nightmare if something bad happens and you find out afterwards that your dog is not covered.
Let’s cover some insurance terminology and how the words affect you. Either click the words in the chart to jump straight to the definition/examples or review this section from top to bottom…
While all of the terminology below will affect you, the bolded words are especially important to understand to ensure that you don’t get blind-sided with a big bill you thought would be covered…
- Accidental Death – pays you should your pet die from injuries as a result of an untreated accident.
- Age Restriction or Age Limit – if either of these are included in the plan, your dog will either not be covered or have less coverage if he falls within a specific age range identified in the fine print.
- Boarding Kennel Fee Reimbursement – Should you become hospitalized for more than a certain amount of time and are unable to care for your pet, plan will pay for boarding or home care up to a maximum amount.
- Breed Surcharge – additional fees added to your bill to cover certain breeds due to those breeds having a higher risk of certain medical conditions.
- Coinsurance or Co-pay Percentage – the percentage of the total bill that your pet health insurance company will pay after all deductibles and co-payments are paid.
Example – 80% coinsurance/co-pay percentage – for a $100 vet bill, the insurance company will pay $80 (80%) and you pay the remaining $20 (20%).
- Co-payment (“co-pay”) dollar amount – similar to a per incident deductible defined below, a co-pay is the amount of money you have to pay for a specific treatment or veterinarian visit before insurance begins. Depending on your plan, coinsurance may also apply after your co-pay.
Example – $20 co-pay per veterinarian office visit – you must pay the first $20 of the veterinarian office visit bill before any other pet health insurance payments begin.
- Coverage Amount – the maximum amount that the insurance company will pay for a specific treatment, condition or specific duration of time (i.e. annually or for the entire lifetime of your pet). Sometimes called “maximum benefit” or “benefit limit.”
Example – $3,000 coverage amount per accident – if your dog gets hurt in an accident, the insurance company will only pay up to $3,000 for that specific accident. If another accident occurs, you will have up to another $3,000 of insurance.
- Deductible (per incident or annual) – the deductible is the amount of money that you have to pay before your pet health insurance company will start paying anything. Your insurance coverage does not begin until you pay the deductible amount.
Deductibles can apply to all treatment for the year (nothing is covered until you pay the deductible amount), to specific incidents (you have to pay a deductible amount for a certain condition or treatment before insurance kicks in) or both (you pay your deductible for the year, then the deductible for the incident, then insurance coverage begins).
A per incident deductible is just like a co-pay, whereas a per year deductible only applies once for the entire year.
Example Scenario:
- $500 annual deductible, $100 per incident deductible, 100% coverage after deductibles
- Policy goes into affect January
- On February 12th, your dog has surgery that costs $2,000
- You pay $500 to satisfy the annual deductible plus $100 for the per incident deductible, then your insurance pays for some or all of the remaining $1,400 depending on your plan’s coinsurance percentage
- If your dog has a second surgery in August, you only pay the $100 per incident deductible before insurance begins since the $500 annual deductible was already satisfied
Let’s look at that in a chart to make it easier to understand (what you pay is bolded)…
| February 12th Surgery | $2,000 |
| $500 Annual Deductible (you pay) | -$500 |
| $100 Per Incident Deductible (you pay) | -$100 |
| Remainder (since 100% coverage after deductibles in this example scenario, insurance company pays this entire amount) | $1,400 |
| August Surgery | $2,000 |
| $100 Per Incident Deductible only (you pay) since you already “satisfied” the $500 Annual Deductible. | -$100 |
| Remainder (since 100% coverage after deductibles in this example scenario, insurance company pays this entire amount) | $1,900 |
| Total out of pocket for you Total out of pocket for insurance company | $700 $3,300 |
- Elective procedures and cosmetic surgeries – treatments that are deemed as not “medically necessary” by the pet health insurance company. Examples include tail docking, declawing, skin folds removal, nail trimming and cropping of ears.
- Euthanasia – plan pays to have your pet put to sleep should they suffer from a condition that can not be cured.
- Exclusions – events or items that you will be 100% liable for after you purchase the insurance plan. This is usually a big part of the fine print. Before you buy a plan, make sure that you completely understand everything that excluded from (not covered by) the plan. The following are common exclusions found in some pet health insurance plans. If you see an exclusion that you want covered on the plan you are evaluating, look for another plan:
- Behavioral problems, training, or therapy are covered only with Preferred and Basic plans.
- Breeding or conditions related to breeding
- Congenital or hereditary defects or diseases
- Continuous coverage of chronic and long-term conditions that manifest in a previous policy year
- Diagnostic test(s) and treatment(s) for conditions excluded or limited by this policy and complications of conditions excluded or limited by this policy
- During the first 12 calendar months in which your policy is in effect, no coverage will be extended for the diagnosis, medical management, or surgical correction of anterior cruciate ligament (ACL) or cranial cruciate ligament (CCL) damage or rupture. During the first six calendar months in which your policy is in effect, no coverage will be extended for the diagnosis, medical management, or surgical correction of intervertebral disc(s), regardless of the procuring cause.
- Elective procedures and cosmetic surgeries
- Expression or removal of anal glands or anal sacculitis
- Illness or injury that arises out of racing, coursing, commercial guarding, or organized fighting of your pet
- Orthodontics, endodontics and removal of deciduous teeth
- Pre-existing conditions
- Preventative treatments and diagnostics for, or conditions relating to, preventable parasites, including heartworms, are covered only with Preferred and Basic plans.
- Routine examinations, routine tests or screens, and vaccines are covered only with Preferred and Basic plans.
- Spaying/neutering
- Special diets, pet food, vitamins, mineral supplements, grooming costs and bathing
- Teeth cleaning or polishing are covered only with the Preferred plan.
- Time and travel expenses to the veterinarian’s premises or the hospital
- Treatment of external parasites such as fleas, lice, ticks and preventable internal parasites such as heartworms, hookworms, roundworms, tapeworms and whipworms
- Maximum Benefit or Benefit Limit – the maximum amount that the insurance company will pay for a specific treatment, condition or specific duration of time (annual or lifetime). Same as “coverage amount”.
- Medically Necessary – any treatment that will improve the health of your pet or prevent future health issues. Typical treatments that are considered NOT medically necessary include elective procedures and cosmetic surgery.
- Network – a group of veterinarians or facilities that the pet health insurance company has contracted with for lower fees. If you take your pet to an “in-network” veterinarian, your insurance will pay for a higher percentage (or even all) of your bill. If your vet is “non-network” you may get no coverage or smaller level of coverage.
Always make sure that your vet is in your insurance company’s network before you schedule a visit. Note that not all insurance companies have networks. Double check with your insurance company to be sure, but if there is no network it usually means any licensed veterinarian will be covered.
You should also make sure you understand how emergency services are covered and whether you receive the same deal at all vet emergency centers. If you have a pet emergency, be ready to take them to the closest in-network emergency center if applicable!
- Owner Bequest – money provided to the guardian of your pet should you predecease your pet.
- Pre-existing conditions – Any illness or injury that your dog either shows signs of or has been treated for before you buy the pet health insurance plan. It also can include a condition or illness that happens within the first 30 days of having a new plan. This would include conditions that have not yet been clearly diagnosed or are being treated with medication.
Worst case – you pay a lot of money out of your own pocket to have your dog treated, then you ask your insurance company to pay you back. Your insurance company researches the claim, finds out that your dog showed signs of suffering from the condition before you bought the insurance (by contacting your veterinarian and reviewing their records, for example) and therefore denies your claim.
- Recovery Costs – plan will pay for advertising or to offer a reward should your pet go missing.
- Trip Cancellation – covers the cost of canceling a trip should your pet require life-saving medical treatment up to a certain amount of time before or during your trip.
- Waiting Period – the amount of time it takes for your insurance to “kick in” after your policy goes into effect. Most pet health insurance plans have between a 2 and 14 day waiting period for accidents and between 14 and 30 days for illnesses.
Example: If your policy has a 2 day waiting period for accidents and 14 day waiting period for illnesses and your coverage begins on January 1st, all costs for an accident before January 3 and all costs for an illness before January 15th will come out of your pocket. Waiting periods are in place to make sure that people do not buy insurance after their dog becomes sick or ill.
While they can sound scary and unfair, waiting periods actually benefit most people by keeping the monthly rates lower. A few bad apples out there have caused this by taking advantage of pet health insurance companies.
They signed up for coverage, paid one month’s worth of premiums to the insurance company (at a low rate of $30, for example), immediately file a claim for thousands of dollars for a problem that either already happened or they already knew about, received reimbursement from the insurance company, then terminated their coverage. In this scenario the insurance company would lose thousands of dollars and have to raise everyone else’s rates to cover the difference.
Worst case – your dog gets hurt in an accident the day after your coverage goes into affect and you have to pay all treatment costs.
- Wellness Plan – insurance will pay for annual wellness costs which may include annual physical exams, spaying or neutering, heartworm testing, teeth cleaning and vaccinations.
Also see…
- Pet insurance reviews by plan type and insurance company
- Dog Vet Care to learn how to pick a good vet in your area
- My Online Vet to ask the veterinarian your specific question