Haris Ashley
When you take out pet insurance, the company will want to check your pet's medical history to see if they have any pre-existing conditions. This is because pet insurance usually doesn't cover pre-existing conditions, and a company will want to exclude any costs that relate to ailments in your pet's medical history. When you file your first claim, the insurance company will request your pet's medical records, and a claims specialist will review them to assess whether a condition is pre-existing or not. Some companies may also request a medical exam when you buy a policy.
| Characteristics | Values |
|---|---|
| How do pet insurance companies check for pre-existing conditions? | Requesting medical records, performing a medical exam, or reviewing the pet's medical history. |
| What are pre-existing conditions in pet insurance? | Any health issue, illness, injury, or symptom that was present or diagnosed before the start of the pet's insurance policy. |
| Are pre-existing conditions covered by pet insurance? | Typically, pre-existing conditions are not covered by pet insurance, but there may be exceptions for curable pre-existing conditions if the pet remains symptom-free for a specified period. |
| How do pre-existing conditions affect pet insurance coverage? | Pre-existing conditions may be temporarily or permanently excluded from future coverage. They can impact the pet's eligibility for specific coverages and affect the cost of the insurance plan. |
| Examples of pre-existing conditions that may be covered | Kennel cough, bladder infections, ear infections, urinary tract infections, vomiting, diarrhea |
| Examples of pre-existing conditions that are typically not covered | Allergies, arthritis, bladder crystals, cancer, diabetes, epilepsy, heart disease, hip dysplasia, kidney disease |
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What You'll Learn
Medical exams and records
Insurers will request medical records when you submit your first claim, or when you enrol in a new plan. They will typically request records for at least six months to a year, or longer for older pets. A claims specialist will then review your pet's medical history to assess whether a condition is pre-existing or not. For example, if your pet had a bout of vomiting a few months before enrolling, and it recurs, insurers may exclude coverage for diagnostics or treatments, assuming it is due to an undiagnosed pre-existing condition.
Insurers may also request medical records following a claim to see if a pre-existing condition exists. For example, if your pet has a pre-existing condition, you can still buy coverage, but the company may require that the pet is symptom-free for a period before covering the condition.
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Diagnoses and symptoms
Pet insurance companies often request medical records when a policy is purchased or after a claim is filed to review a pet's medical history and identify any pre-existing conditions. They may look for any diseases, symptoms, or veterinary care noted in these records. For example, if a pet showed symptoms of an illness, such as vomiting, before enrolling in insurance, and the same symptoms recur after enrolling, the insurance company may exclude coverage. This is because they may assume that the vomiting is due to an undiagnosed pre-existing condition.
Incurable or chronic pre-existing conditions, such as joint deterioration, hip dysplasia, or chronic kidney disease, are typically excluded from coverage. These conditions are defined as those that a pet will have for a lifetime, with no known cure. On the other hand, some companies may cover curable pre-existing conditions if the pet remains symptom-free for a certain period, such as 6 or 12 months. For example, a respiratory infection or minor injury may be covered if the pet shows no symptoms or requires no treatment for an extended period.
It is important to note that pet insurance providers may define and handle pre-existing conditions differently, so it is essential to carefully read the policy to understand their specific criteria and coverage. While pre-existing conditions may impact eligibility for specific coverages, they should not necessarily prevent pet owners from considering insurance. Even with pre-existing conditions, pets can still receive coverage for other accidents, illnesses, and routine expenses through add-on wellness coverage.
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Chronic conditions
Most pet insurance companies do not cover pre-existing chronic conditions, as they are considered high-risk. However, some companies, such as Healthy Paws, offer coverage for new chronic conditions that manifest after enrollment and the completion of a waiting period. It is important to note that this does not include pre-existing chronic conditions.
Some insurers, like Embrace, may provide coverage for curable pre-existing conditions if your pet remains symptom-free and treatment-free for a specified period, typically a year. AKC Pet Insurance is another option, as they offer coverage for both curable and incurable pre-existing conditions after 365 days of continuous coverage.
When enrolling in pet insurance, it is essential to carefully review the policy's terms and conditions. Some companies may require a medical exam or request medical records to check for pre-existing chronic conditions. Others, like ASPCA pet insurance, do not demand a vet exam or medical records when purchasing a policy.
It is worth noting that even without coverage for a specific chronic condition, pet insurance can still provide benefits. Policies may cover accidents, illnesses, and prescriptions unrelated to the pre-existing condition. Additionally, add-on wellness coverage can help with routine expenses, such as annual exams and vaccinations.
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Curable conditions
Pet insurance companies generally do not cover pre-existing conditions, which are injuries or illnesses that show symptoms before a plan goes into effect or during a waiting period. However, some providers cover curable pre-existing conditions, such as kennel cough, ear infections, and bladder infections, as long as the pet has remained symptom-free for a certain period, typically 180 days. For example, ASPCA's Pet Health Insurance covers curable pre-existing issues if the pet is symptom-free for 180 days, except for knee and ligament conditions. Similarly, Nationwide covers curable illnesses after six months without symptoms.
AKC Pet Insurance is the only brand that covers curable and incurable pre-existing conditions after 365 days of continuous coverage. This means that even if your pet has been diagnosed with an incurable condition, pet insurance is still an option. You may get coverage for other issues like accidents, illnesses, and prescriptions. You can also buy add-on wellness coverage, which pays for routine expenses like annual wellness exams and vaccinations.
Pet insurance providers may define and handle pre-existing conditions differently, so it is important to read the policy carefully. A condition will no longer be considered pre-existing if it is curable, cured, and free of symptoms and treatments for a certain period, typically 180 days, except for knee and ligament issues. For example, if your cat had an upper respiratory infection (URI) when you enrolled, treatment for it would not be covered. However, if your cat caught another URI 180 days after the first one was cured and treatment-free, it would be eligible for coverage.
Pre-existing conditions should not deter you from considering pet insurance coverage. While you may not be reimbursed for treatments related to a particular condition, you can still receive payouts for future injuries or illnesses.
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Insurer definitions
Insurers define pre-existing conditions as any health issue, illness, or injury with visible signs and symptoms in a pet before insurance coverage takes effect, including during applicable waiting periods. This includes any condition for which veterinary care was sought, even if it responded to treatment or did not warrant a full investigation of the underlying causes.
Insurers may also consider symptoms without a diagnosis as a pre-existing condition. For example, if your pet was limping before enrolling in insurance and started limping again after enrolling, insurers may consider this a pre-existing condition and deny coverage for any necessary future treatments.
When enrolling in a new plan or submitting your first claim, insurers will typically request past medical records for at least six months to a year, or longer for older pets. They may also require a recent vet check-up to establish a baseline of your pet's health and identify any potential pre-existing conditions.
Insurers may define and handle pre-existing conditions differently, so it is important to carefully read the policy. Some insurers distinguish between curable and incurable pre-existing conditions. Curable pre-existing conditions, such as kennel cough or a respiratory infection, may be covered if your pet remains symptom-free for a specified period, typically 180 days or one year. Incurable pre-existing conditions, such as chronic kidney disease or hip dysplasia, are typically excluded from coverage for the pet's lifetime.
It is important to note that pre-existing conditions do not necessarily prevent pets from enrolling in insurance. While coverage for the specific pre-existing condition may be excluded, pets can still receive payouts for future injuries or illnesses and coverage for other accidents, illnesses, and prescriptions.
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Frequently asked questions
A pre-existing condition is any health issue, illness, injury, or symptom noted in your pet's medical records before their insurance plan enrollment. This includes any condition for which veterinary care was sought, even if there was no official diagnosis.
Insurance companies may request a medical exam or medical records when you buy a policy or after you file a claim. They will review your pet's medical history to assess whether a condition is pre-existing.
Pet insurance companies typically do not cover pre-existing conditions. However, some companies may cover curable pre-existing conditions like kennel cough or a respiratory infection if your pet remains symptom-free for a specified period, usually 6 or 12 months. Incurable or chronic conditions are generally not covered.
