Pet insurance coverage ranges widely by provider and plan, and some of the omissions may surprise you – beginning with the fact that standard coverage typically doesn’t include checkups, vaccinations and other routine care.
Buying the right coverage for your pet involves understanding the general types of policy and what they include. But it’s also wise to dig into the details of comparable policies at competing providers, since they differ in what is and isn’t covered and when.
This guide breaks down what is and isn’t covered by most pet insurance policies. If you want to know which companies offer the best pet insurance coverage options, check out our picks for the best pet insurance companies.
What is covered by pet insurance?
In general, most pet insurance plans cover unexpected injuries/accidents, unexpected illnesses, surgery, medication, tests/diagnostics, and emergency care and exam fees. But not every expense in those categories is customarily eligible for reimbursement.
In short, the details of your pet insurance policy will depend on the type of coverage and the provider you choose.
Types of pet insurance coverage
Insurers typically offer three main coverage options: accident-only coverage, accident and illness coverage, and wellness coverage.
Specific benefits and restrictions for each option differ by company, which is why we cover pet insurance costs separately.
For instance, although all the companies we’ve researched cover hip dysplasia, some impose an age limit on treatment (between 10 and 14 years of age). Others have no restrictions for the same condition.
1. Accident and illness coverage
- Covers injuries from accidents
- Covers vet-diagnosed sickness or disease
- Good fit for breeds that commonly experience health problems
- May include optional wellness rider for an extra fee
- Monthly premiums are higher than for accident-only coverage
- Often won’t cover routine care, like check-ups and teeth cleanings
- Reimbursements are capped per accident and per illness
What is covered by accident and illness insurance
Although some insurers sell stand-alone illness coverage, it’s far more common to see it bundled with accident coverage. Accident & illness policies (also typically known as “comprehensive policies”) cover a gamut of illnesses, from the minor — such as vomiting and diarrhea, even if due to unidentified causes — to the serious, like cancer. They can also cover all veterinary examination and consultation fees, hospitalization, treatments, surgery costs and prescription medications.
Most of these insurance policies also cover hereditary and congenital conditions that are breed-specific, like torn ligaments. However, this is only true so long as your vet identifies the problem after the policy is in place. If your dog suffered any of these conditions before enrollment, they will be considered “pre-existing” and won’t be covered.
Some policies also cover specific conditions, but only after a waiting period elapses. For example, an insurance company might pay for surgery to alleviate hip dysplasia, but only if treatment happens at least six months after the policy takes effect.
Unfortunately, some policies omit certain types of prescriptions — such as those for behavioral problems — and put the pet owner on the hook for exam fees.
Other serious illnesses that are usually covered
Virtually every pet accident & illness policy covers cancer and specialty care of any kind. Here are other specific conditions, both chronic and inherited, for dogs and cats that you can typically expect coverage for — although not every insurer may cover every condition.
|• Hepatitis||• Polycystic Kidney Disease (PKD)|
|• Arthritis||• Skin allergies|
|• Inflammatory Bowel Disease||• Hip dysplasia|
|• Hyperthyroidism||• Elbow dysplasia|
|• Diabetes mellitus||• Hypothyroidism|
|• Type II diabetes (linked to obesity)|
Comprehensive plus wellness coverage
Some comprehensive (that is, accident and illness) plans are available bundled with wellness coverage. As we cover below, wellness coverage can include alternative therapies, and a whole host of additional covered treatments, from behavioral therapy, acupuncture, and chiropractic care, to laser therapy and hydrotherapy. Some plans also cover specific dietary supplements and foods needed to treat your pet’s health condition.
2. Accident-only coverage
- More affordable monthly premiums
- Best for young, healthy pets unlikely to develop a hereditary condition
- Covers only injuries from an accident
- Illness treatment and routine care are still out-of-pocket expenses
What is covered by accident-only insurance
Accident-only policies reimburse the cost of treating injuries or illnesses caused by mishaps, whether they’re self-inflicted by the animal or the fault of the owner.
While claims for accidents stemming from such behaviors won’t increase your monthly premiums, breed disposition to accidents may affect the cost of accident insurance – and of comprehensive plans that include the coverage. For example, premiums are high for Labrador Retrievers in part because of the breed’s tendency to swallow foreign objects.
What isn’t covered by accident-only insurance
Accidents that can be traced back to the pet owner — such as intentional injuries or those that result from the use of the pet in organized fighting or racing — will not be covered, and neither will any accident that results from a pre-existing condition.
Accidents: What is and isn’t reimbursed
|Covered||May not be covered|
|• Motor-vehicle accidents||• Poisoning|
|• Ingesting foreign bodies||• Intentional harm to the animal|
|• Sprains and lacerations||• Injuries in organized fights or races|
|• Broken Bones|
|• MRIs and x-rays for diagnostic|
How you buy pet insurance will depend on a variety of factors. For instance, not all policies cover poisoning and flea or tick bites, since those perils are often the result of owner negligence. As with any type of coverage, read the fine print to verify what is and isn’t covered.
3. Wellness coverage
- Reimburses for preventative (routine) care
- Usually has a zero deductible
- Usually isn’t a standalone policy, but an add-on or rider
What is covered by wellness insurance
Often referred to as “preventive care” coverage, wellness coverage is available as an add-on or “rider” to a broader policy or, with some carriers, as a separate stand-alone policy.
Many routine veterinary care procedures are typically included. Other services like grooming and training can sometimes also be included.
Wellness: What is and isn’t reimbursed
|Covered||May not be covered|
|• Vaccination||• Pregnancy or other breeding/whelping expenses|
|• Flea/tick and heartworm preventatives||• Routine anal-gland expression|
|• Microchipping||• Grooming or training|
|• Broken Bones|
|• Spay/neutering surgery|
The following table provides a summary comparison of the different types of pet insurance coverage options available and what they generally include:
|Pet insurance type||What it covers||What it doesn’t cover|
|Accident-only||• Physical accidents, including poisoning, foreign-body ingestion, cuts and lacerations, fractures, bloat, and surgery.||• Pre-existing conditions
• Intentional injuries
• Routine veterinary care
• May not cover older pets
• May not cover poisoning in certain circumstances
|Accident & illness||• Mild to severe illnesses, including allergies, cancer, asthma, and digestive issues
• Hospitalization, treatment, surgery costs, and prescription medication.
• Can cover alternative therapies
|• Pre-existing conditions
• Routine veterinary care, including vaccinations, dental cleaning, among others.
• May exclude pets over a certain age limit.
• Can exclude certain prescription medications
|Wellness||• Exam fees, vaccinations, routine lab work, spay/neuter operations, among others.||• Any pet-related illnesses or accidents|
How does pet insurance work?
Reimbursement under pet insurance differs from the norm for human health insurance. Unlike your own insurance coverage, it’s unlikely you’ll be able to pay just a copay at the time of treatment for your pet. Instead, you’ll be required to pay the bill in full and wait to be reimbursed for the agreed-upon percentage stipulated in your insurance plan.
As with human health insurance, pet insurance policies have deductibles you must meet before coverage kicks in. Policyholders can choose the deductible amount they are comfortable paying, typically ranging between $200 and $1,000. (The lower the deductible, though, the higher the premium, as a rule.)
As a rule, insurers don’t cover pre-existing conditions. That’s to say, if your animal has a medical problem that predates you enrolling them for insurance, you can’t claim the cost of treating it, as a rule.
However, some conditions may eventually be covered, provided your pet is symptom-free and deemed to be cured for a certain length of time – often 180 days. Every insurer has a different definition of what constitutes a pre-existing condition, so it pays to dig into these details before you buy a policy.
The reason for waiting periods is simple: they prevent pet owners from rushing to insure their animals after any diagnosis or symptom pops up. The traditional waiting period for pet insurance policies is 14 days, except for hip dysplasia and other conditions that have their own specific periods.
Most policies require that you choose certain coverage limits. These typically include an annual limit on reimbursed expenses, typically within a range of $5,000 to $30,000 — the higher the limit, the higher the premium. Lifetime limits are also sometimes imposed.
Also, many insurers set age limits on coverage. This means that after a certain age, coverage on existing policies will stop. Likewise, some pet insurance companies won’t issue new policies for pets over a certain age limit.
It’s rare for a policy to pay the entire expense for any type of care. The best cheap pet insurance will usually cover a set percentage — typically 70%, 80% or 90%.
As with many other types of insurance, you must also select an annual deductible to be paid upfront before reimbursement kicks in. These normally cost around $250, $500 or $1,000