Pre-Existing Conditions and Pet Insurance Explained

Sponsored by Embrace Pet Insurance

Pet insurance is an essential part of being a responsible pet parent, helping cover the cost of veterinary care and ensuring your pet gets the best possible treatment. However, when it comes to pre-existing conditions, navigating pet insurance can be more challenging.

Pre-existing conditions can significantly impact both eligibility for coverage and the cost of premiums, so it's important to understand what they are and how they can affect your pet's insurance coverage.

In this guide, we'll cover everything you need to know about pre-existing conditions and pet insurance. By the end, you'll have a clear understanding of how to choose the right insurance plan for your furry friend and ensure they get the care they need.

Understanding Pre-Existing Conditions

First, let's look at what pre-existing conditions are and how insurance providers define them.

Simply put, a pre-existing condition is any injury, illness, or disorder that your pet develops (or begins to exhibit symptoms of) before your insurance policy goes into effect. In most instances, pet insurance will not cover any of the costs associated with these conditions.

Examples of Common Pre-Existing Conditions

Common pre-existing conditions in pets include chronic illnesses such as diabetes, allergies, and arthritis. These require ongoing treatment and management, making them costly for insurance providers to cover. Allergies and skin conditions are also common and can lead to frequent vet visits and treatments.

Additionally, past injuries or surgeries that continue to affect your pet's health are considered pre-existing conditions. These will generally not be covered by insurance, including any related treatments or medications.

Imagine, for example, that your dog breaks their leg two months before you’ve selected a pet insurance plan. Whichever provider and plan you ultimately select will not reimburse the cost of x-rays or cover any additional charges associated with the injury. You will also have to cover these charges if your pet becomes sick or injured during a policy’s waiting period.

Curable vs. Incurable Pre-Existing Conditions

It's important to distinguish between curable and incurable pre-existing conditions, as this can affect your pet's eligibility for coverage. Here's a quick overview of each:

Curable pre-existing conditions. Illnesses or injuries that can be treated and resolved, allowing your pet to make a full recovery. Examples may include an ear infection or a broken bone that has healed.
Incurable pre-existing conditions. Long-term health conditions that are not curable but can be controlled with treatment, such as diabetes, joint and bone conditions, or allergies.

Typically, pet insurance companies do not cover expenses for incurable pre-existing conditions. However, coverage for curable pre-existing conditions can differ based on each provider's policies. Here are a few common incurable conditions that are excluded from policies by most providers:

Allergies
Arthritis
Cancer
Cruciate ligament disorders
Diabetes
Heart disease
Hip or elbow dysplasia
Urinary blockages

It’s important to note that related injuries and conditions are also excluded. For example, if your dog tears a ligament on their right side before you buy a policy, and then tears a ligament on their left side two years later, both injuries would be considered pre-existing conditions. This is because pets with an injury on one side are at higher risk for the same issue on the other side.

Many temporary, curable ailments are also considered pre-existing conditions. These include:

Diarrhea
Urinary tract infections
Respiratory infections

If your pet has a curable pre-existing condition, it's worth looking into policies that offer coverage for these conditions after a certain amount of time has passed. Some providers might still cover treatment for these conditions, but only if they're considered resolved or in remission when you enroll.

Embrace Pet Insurance, for example, will cover curable pre-existing conditions after a 12-month period of symptom-free status. This means that if your pet has been diagnosed with an ear infection but has not shown symptoms for 12 months before enrolling in their plan, they may still cover treatment for future ear infections. Some exceptions may apply, so be sure to carefully read the policy's terms and conditions.

How Top Pet Insurance Providers Handle Pre-Existing Conditions

Now that we've looked at what pre-existing conditions are and why they matter, let's explore how some of the top pet insurance providers handle them:

ASPCA Pet Insurance. ASPCA’s policies exclude pre-existing conditions but will consider them cured if your pet goes 180 days without symptoms or treatment. Knee and ligament conditions are permanently excluded if they occur before coverage starts.
Embrace Pet Insurance. Embrace makes a distinction between curable and incurable pre-existing conditions. Curable conditions may be eligible for coverage if your pet remains asymptomatic for a 12-month period. Incurable conditions, such as diabetes and arthritis, are not covered.
Healthy Paws. Healthy Paws does not cover pre-existing conditions at all. Their policies focus on providing comprehensive coverage for new illnesses and injuries, ensuring that any new health issues your pet encounters are covered. They are known for their straightforward claims process and customer service, despite the exclusion of pre-existing conditions.
Nationwide Pet Insurance. Nationwide’s policies exclude pre-existing conditions, but they may offer coverage if you can provide veterinary records showing the condition has been cured for at least six months.
Petplan Pet Insurance. Petplan does not have a specific policy for pre-existing conditions due to the complexity of covering them adequately. Instead, they review each case individually. Curable conditions may be covered after a certain period, often 3 to 12 months, depending on the condition. For example, a condition like kennel cough may be covered after three months of being symptom-free, while more serious issues like a perforated eardrum may require 12 months. Incurable conditions, such as arthritis, are not covered.

How to Determine if a Pre-Existing Condition Is Covered

If you have a pet with a pre-existing condition, it's important to determine if they'll be covered by the insurance policy you're considering. Here are some simple steps to help you find out:

Investigate various pet insurance companies and compare their policies concerning pre-existing conditions.
Carefully examine the terms and conditions of each policy, making sure to focus specifically on the clauses related to pre-existing conditions.
Note any waiting periods for coverage or specific requirements for a condition to be considered resolved or in remission.
If you have any questions, reach out to the pet insurance provider for clarification before enrolling.
Keep thorough and organized records of your pet's medical history in case you need to reference them in the future.

By taking these steps, you can better understand how pre-existing conditions are handled by different pet insurance companies and make an informed decision about which policy is best for your furry friend.

Are Pets with Pre-Existing Conditions Insurable?

If you've read this far, you likely know the answer to this question is... it depends! As we've seen, different pet insurance providers have different approaches to handling pre-existing conditions.

Some may offer coverage for certain curable conditions after a period of time has passed, while others may not cover them at all. But if your pet has an incurable condition, such as diabetes or arthritis, it's unlikely that you will find pet insurance coverage for them.

It's important to carefully consider your pet's medical history and potential future health risks when choosing a pet insurance policy to determine if it's worth the investment. Additionally, it may be worth looking into alternative options such as setting aside a savings account specifically for your pet's healthcare needs or exploring other types of financial assistance programs.

Ultimately, the decision will depend on your individual situation and what you feel is best for your pet's health and well-being. And remember, it's a good idea to have some form of pet insurance coverage in case your pet encounters any new illnesses or injuries, regardless of their pre-existing conditions.

Wondering if pet insurance is right for your cat or dog? Click here to learn more.

Embrace Pet Insurance Agency, LLC (“Embrace”) is a licensed insurance agency. PetPlace is a trademarked brand name owned by Independence American Holdings Corp. (“PetPlace”) and is not a licensed insurance agency or an underwriter of insurance. Embrace and PetPlace are affiliated companies; and PetPlace may receive compensation for referrals. All inquiries regarding insurance should be directed to Embrace or the licensed insurance agency you contact through this website. The information contained in this website is for illustrative purposes only and coverage under any pet insurance policy is expressly subject to the conditions, restrictions, limitations, exclusions (including pre-existing conditions), and terms of the policy documentation issued by the insurer. Insurance products are underwritten by one of the licensed insurers of American Modern Insurance Group, Inc., including American Modern Home Insurance Company d/b/a in CA as American Modern Insurance Company (Lic. No 2222-8), and American Southern Home Insurance Company.