Our best pet insurance companies can help you pay for planned and unexpected vet bills. However, it won’t cover everything. To ensure you receive the coverage you need and prevent unwanted financial surprises, it’s important to familiarize yourself with common exclusions.
Below, we’ll dive deeper into pet insurance exclusions and provide useful tips on how to zero in on the ideal plan for your furry friend.
What Is a Pet Insurance Exclusion — and How Do They Work?
A pet insurance exclusion refers to specific conditions or situations that are not covered by the insurance policy. “These exclusions are outlined in the policy documents and can vary depending on the insurance provider and plan,” explains Rachel Hinder, director of claims and registered veterinary technician at Embrace.
The purpose of exclusions is to limit the risk of an insurance company. They usually apply to predictable and preventable issues, such as pre-existing conditions and routine care.
“For example, if your dog has a history of hip dysplasia diagnosed before enrollment, any future treatment for that condition will likely be excluded,” says Dr. Sabrina Kong, veterinarian at We Love Doodles.
Standard Pet Insurance: What’s Commonly Excluded?
Each pet insurance policy has its own unique list of exclusions. However, the following exclusions are widely seen among most pet insurance companies:
- Pre-existing conditions: Any health abnormalities that existed before the policy start date or in the policy waiting periods are excluded from coverage. These are known as pre-existing conditions and include arthritis, diabetes, or cancer.
- Routine and preventive care: "Vaccinations, dental cleanings, wellness exams, and other routine care are not covered in a standard pet insurance plan," explains Hinder. You'll need to invest in wellness coverage to offset the cost of routine or preventive care services.
- Elective procedures: Cosmetic procedures or treatments that are not medically necessary may be excluded. A few examples of common elective procedures are spay and neuter surgery, declawing, tail docking, and ear cropping.
- Pregnancy and breeding: "Costs arising from breeding or accidental pregnancy of the insured pet are not usually covered," says Hinder. In most cases, you'll need to pay for these expenses out of pocket.
- Hereditary conditions: "Many policies also exclude hereditary conditions in certain breeds, such as heart disease in Cavaliers," explains Dr. Kong. You might be able to buy an add-on or rider to cover hereditary conditions.
- Dental care: Usually, dental coverage in standard pet insurance plans is fairly basic. Anything beyond extractions due to injury will likely be excluded.
- Alternative therapies: Some pet insurers won't pay non-conventional treatments. These may include acupuncture, chiropractic care, massage, and stem cell therapy.
Pet Wellness Plans: What's Commonly Excluded?
Pet wellness plans are often offered as an add-on to a standard pet insurance policy, such as an accident-only or accident and illness plan. You'll find that wellness coverage varies, but most plans include these exclusions:
- Illness coverage: Wellness plans typically focus on preventive care and don't cover treatment for illnesses or injuries. You'll need a standard plan to reimburse you for allergies, broken bones, diagnostic exams, pet surgeries, hospitalizations, and other unexpected vet bills.
- Emergency care: "Typically, wellness policies don't include emergency veterinary visits or treatments for accidents," explains Hinder. This is because you can't plan for them in advance like you can for routine care services.
- Grooming: Grooming can be considered preventive care. However, most pet insurers exclude it from their wellness plans.
- Non-routine dental services: Sometimes, routine dental work, such as exams and cleanings, is included in wellness coverage. Non-routine dental services, like extractions, on the other hand, are usually out-of-pocket expenses.
- Pre-existing conditions: In general, pet insurance companies won't include pre-existing conditions in their coverage. Whether you buy a wellness plan or a standard accident-only or accident and illness plan, you can expect it to be excluded.
Picking Pet Insurance: How to Get the Coverage You Need
These tips can make it easier to find the best pet insurance plan for your particular budget, pet, and personal preferences.
1. Review Exclusions
“Request a sample policy from the insurer and look for breed-specific or age-related exclusions,” recommends Dr. Kong. For example, some plans exclude cruciate ligament repairs in large breeds. Depending on your pet, this might be a deal breaker.
2. Consult Your Vet
Don’t be afraid to use your veterinarian as a resource when you shop for pet insurance coverage. “Discuss genetic predispositions, such as IVDD in Dachshunds and ensure your policy covers them,” says Dr. Kong.
The last thing you want is a pet insurance plan that excludes the services that are most important to your breed.
3. Reach Out to Insurance Companies
If an exclusion is unclear, contact the pet insurance company for clarity. “Purchase from an insurer that has staff readily available to help answer your questions and assist in the purchasing process,’ explains Hinder.
4. Consider Your Pet’s Age and Lifestyle
Every pet has their own unique needs. “Senior pets need coverage for chronic conditions; adventure pets may require injury-focused plans,” says Dr. Kong. Take the time to think about the inclusion your specific pet could benefit from the most and use that information to lock in the best plan.
5. Compare Waiting Periods
Pet insurance waiting periods refer to the periods of time that must pass before your pet insurance policy can kick in and reimburse you for a covered service. “
Some insurers impose 6–12 month waits for orthopedic conditions, which could leave you uncovered during critical times,” explains Dr. Kong. Pay attention to waiting periods as they can help you make a more informed decision.
6. Read Customer Reviews
Reviews from current and former policyholders are important as you look for pet insurance coverage. “Check social media for patterns of denied claims related to vague exclusions,” recommends Dr. Kong. Third-party review sites like TrustPilot and Better Business Bureau (BBB) may also come in handy.
7. Plan for the Future
Look beyond your pet’s current needs. “Anticipate potential pet health issues or conditions that may arise in the future and ensure your policy provides adequate coverage,” says Hinder. Being proactive can save you time, money, and hassle down the road.
8. Review Coverage Annually
Pet insurance plans aren’t set in stone. “Regularly review your pet insurance policy to make sure it still meets your pet's needs and adjust coverage as necessary,” says Hinder. You might find that the policy you initially purchased no longer suits you and your pet.
Bottom Line
While no pet insurance policy covers everything, knowing common exclusions helps you make an informed decision. Compare policies carefully, consider add-on coverage for gaps that matter to you, and always read the terms before signing up.
Frequently Asked Questions
Does pet insurance pay for everything?
No, pet insurance doesn't cover all veterinary care services. Almost every plan has a list of exclusions, which explains what situations or conditions aren't covered.
What is a disadvantage of pet insurance?
While pet insurance is a smart investment for many pet parents, there are exclusions. Depending on your pet's needs and the policy you choose, it may not cover the services that are important to you and your pet.
