Pet Insurance: Understanding Pre-Existing Conditions
In theory, pet insurance and health insurance policies work more or less the same way. They provide financial assistance for both routine healthcare and unexpected medical events.
Since the passage of the Affordable Care Act, health and pet insurance providers differ in one new, fundamental way. The ACA made it illegal for health insurance providers to deny a person coverage, or charge them more for coverage, because of a pre-existing health condition. As for pet insurance plans, they rarely cover the costs associated with such conditions. Pets with pre-existing conditions won’t be denied coverage, but their owners face significantly more out-of-pocket expenses.
What Are Pre-Existing Conditions?
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.
Imagine, for example, that your dog breaks its 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.
Incurable vs. Curable Conditions
In general, incurable pre-existing conditions are excluded from coverage throughout the life of your insurance policy. Here are a few common incurable conditions that are excluded from policies by most providers:
- Cruciate ligament disorders
- Heart disease
- Hip or elbow dysplasia
- Urinary blockages
It’s important to note that related injuries and conditions are also excluded. Bilateral conditions like cruciate ligament tears provide a useful example. Embrace Pet Insurance notes that a pet with a condition on one side of its body “runs a higher risk of the same condition on the other side of the body.” So, if your dog tore a ligament on their right side before you purchased a policy and, two years later, tears a ligament on their left side, both tears would be treated as pre-existing conditions.
Many temporary, easily curable ailments are also considered pre-existing conditions. These include:
- Respiratory infections
- Urinary tract infections
Insurance providers differ in how they approach curable pre-existing conditions. Embrace policyholders must show that their pet has been symptom free for 12 months after enrolling to get coverage. Certain exceptions may apply. The company uses a cat with Giardia-induced diarrhea as an example. If the cat experienced unrelated diarrhea after several months under the plan, treatment would be covered.
The American Society for the Prevention of Cruelty to Animals (ASPCA) considers any pre-existing condition cured if a pet goes 180 days without showing symptoms or undergoing treatment. Their own insurance policies only exclude knee and ligament conditions.
Why Aren’t Pre-Existing Conditions Covered?
Insurance is intended as a precautionary and preventive measure, not a corrective one. You would not, for example, purchase homeowner’s insurance to address existing flood damage. Complete coverage for pre-existing conditions could enable an unsustainable situation where pet owners buy policies to obtain immediate treatment and cancel them soon after.
Keep in mind that providers will differ in how they define and address pre-existing conditions. What’s more, your pet’s pre-existing conditions are just one of the factors you should consider while comparing pet insurance plans. Learn more about assessing your options and making an informed selection here.