Difference Between Pet Insurance Copay and Benefits Schedule

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There are currently over 30 pet insurance companies offering coverage in the United States. Each company has differences in coverage, claims processing, and reimbursement

A common question asked by pet parents is “What is the difference between providers that offer reimbursement on a benefits schedule and those that reimburse based on a copay?”

Let’s break down the differences and provide some examples.

How a Pet Insurance Benefit Schedule Works

Pet insurance companies that pay on a benefit schedule will cover up to a maximum dollar amount per condition. For example, Veterinary Pet Insurance offers a primary diagnosis allowance of $505 for constipation under the Nationwide® Pet Insurance major medical plan benefit schedule. If your dog is diagnosed with constipation and your bills add up to $505, you would theoretically be reimbursed that $505 (if you’d already paid your deductible). If your bills add up to $900, you would be reimbursed $505 and be responsible for the remaining $395.

How Pet Insurance with a Copay Works

In benefits with a copay, the maximum is dependent on your contract. For example, if you have a 10% copay, your insurance company would pay 90% of your vet bill after the deductible is paid. If your bill was $230 and you had already paid your deductible, your insurer would reimburse 90% of the bill (or $207.00). If your bills add up to $900, you should expect reimbursement of 90% of the $900 (or $810.00).

Many pet owners like the security of knowing what their insurance is going to pay if they have a pet health issue. When you have a copay of 70%, 80%, or 90%, you can easily figure out your reimbursement amount.

I hope this gives you more information about the difference between pet insurance on a benefits schedule and copay-based pet insurance.

Information is provided using publicly available information as of 10/25/24 and is only meant to summarize program features, not a specific plan. Review each provider’s plan terms for more details. The descriptions of other providers’ plans were not provided by that company. If you have questions about other plans, please contact an agent of that company. It is our intention to provide fair and accurate comparison information. Although we attempt to keep information up to date, it may change from time to time. If you are aware of any inaccuracies or changes in the information provided, let us know by emailing info@petplace.com or mailing Independence Pet Holdings, Inc., 11333 N. Scottsdale Road, Scottsdale, AZ 85254.