Pet Insurance Coverage Exclusions and Limits
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Written by
Leslie Kasperowicz
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Reviewed by
Melanie Musson
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UPDATED: Jun 10, 2021
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Pet insurance is a great and worthy investment if your dog, cat or even bird gets sick or has an injury.
As we all know, the costs of treating our pets can become expensive and that is why pet insurance is such a life-saver, sometimes literally and usually financially!
There are many decisions you need to make when signing up with a new policy: the company, what type of coverage you want as well as pricing.
Our quick primer on how pet insurance works can give you an overall idea of what to look for in coverage and how to make the most of a pet insurance plan.
There are also many things that are not included in a pet insurance policy and are usually found under “exclusions”.
Each pet insurance company is different in what they exclude so it’s important to read the fine print carefully.
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FACT: Pet insurance pays up to 90% of vet bills when your pet is sick or injured!
Table of Contents
The Typical Coverage Exclusions are the following:
Pre-Existing Conditions
All pet insurance companies will not cover any pre-existing condition or illness that your pet has developed prior to signing up with the new company.
Any condition or illness that is on your dog or cat’s medical record will be excluded from coverage.
The reason pet insurance companies exclude sickness or conditions is to help keep the insurance prices down. If all pets that signed up were pets were sick or injured the prices would be astronomical.
The waiting period when signing up for a policy is just for this purpose…to make sure that all conditions that are pre-existing are disclosed.
Because pre-existing conditions are always excluded, it’s best to insure your dog or cat when they are young.
Related: 10 Things You Must Know Before You Buy Pet Insurance
Routine Procedures
Any preventative care procedures are not included in a typical pet insurance plan.
They typically include the following:
- Annual Checkups
- Vaccinations
- Teeth Cleaning
- Flea & Tick Control
- Spaying and Neutering
- Heartworm
- Microchipping
- Ear cleaning
However, there are some pet insurance companies that offer a wellness plan that will cover a certain amount of these costs at an additional fee. Wellness plans are added on to a pet insurance policy.
These routine procedures are easily paid out of pocket and not worth the additional costs.
Real Cost Savings from PetFirst Clients
Luna
PetFirst saved his parents
$6,712
A happy energetic Luna one morning couldn’t hold her food down. After months of multiple costly vet visits to specialists and an endoscopy, the problem was discovered and fixed. Luna put 22 pounds back on in no time and her parents were grateful for having PetFirst by their side to pay the bills.
Office Visits and Exam Fees
Some pet insurance plans exclude the vet office fee visit when you take your dog or cat in for an exam.
Yet, most will pay for the diagnostic testing that accompanies the exam.
Most that have a payout limit will include the exam fee, while other plans that have unlimited benefit limits won’t pay the fee.
For example, Figo, if you choose the benefit limit level that has a maximum of $15,000, it includes the exam fee.
And, Healthy Paws, which has unlimited annual and lifetime benefits does not include the exam fee. Which makes sense because they are paying for all other unexpected and big expenses.
Age Limits
Some pet insurance companies have limits on the age when you can enroll your dog or cat (usually up to 10 years) while others have no upper age limits.
However, most companies will not deny your pet coverage at any age once enrolled.
Deliberate Injuries
Any deliberate injury to your dog, cat or even turtle is not covered. These will usually include injuries that are inflicted at home and injuries and illnesses after a fight as well as injuries resulting from cruelty and neglect.
Injuries that are a result of dogfighting or racing are also not included and for good reason!
Injuries due to an accident, however, are covered.
Treatments That Haven’t Been Approved by the Vet
Most pet insurance companies will not cover treatments that aren’t prescribed by the vet.
Prescriptive Food
Some pet insurance companies will not cover prescriptive food. There are some that will pay half of the prescriptive food if the food is for an illness and not merely being overweight.
Pet food, vitamins and supplements are not covered.
However, all pet insurance companies will cover prescription medicine from your vet.
Boarding Costs
Most pet insurance companies won’t cover boarding costs while you travel.
Breeding
Breeding, or anything related to pregnancy, is not covered.
Cosmetic or Elective Procedures
Elective procedures such as ear cropping, tail docking, nail trimming or claw removal aren’t covered.
DNA Testing/Organ Transplant
DNA testing, stem cell therapy or Organ transplants.
Real Cost Savings from PetFirst Clients
Gidget
PetFirst saved his parents
$2,194
Artemis was a beautiful and friendly cat to all who were willing to pet him. Unfortunately, he developed feline diabetes which required regular vet visits and medications that his Mother could not otherwise afford on her fixed income. Having PetFirst insurance, she called and discussed the problem with a friendly PetFirst agent. To her surprise, she found out that Artemis’ ongoing required vet visits and medication would be covered by his PetFirst insurance. Artemis was able to live out the rest of his life with proper medical care and medicines thanks to PetFirst insurance.
Grooming Costs
Anything related to the grooming of your pets which includes bathing, hair trimming, removal of anal glands, or anal sacculitis.
Parasites
Flea, tick or any parasite prevention or treatment even including any illness that is transmitted by parasites
Dental
Unless covered by a dental plan, orthodontics, endodontics and/or the removal of the deciduous teeth.
Behavioral Training
Most plans will not cover behavioral training, while there are some that cover behavioral therapy that is a result of an accident or illness. Or considered as a treatment of both.
Avian Flu
Most pet insurance plans, even those for birds will not cover Avian Flu.
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Final Thoughts on Pet Insurance Exclusions
While it seems like there are many exclusions, there are also many, much more expensive veterinary expenses and treatment that are covered when you insure your pet.
Before signing up with any pet insurance company, make sure you understand what is included AND excluded in the policy.
Our top 10 pet insurance companies are all very reputable, honest companies that can tell you what is covered in your policy.
Other articles you may find helpful:
Is Exotic Pet Insurance Necessary?
The Best Pet Insurance By State
Fun Facts, Dog FAQ’s, And Unsolicited Dog Advice
5 Training Commands to Save Your Dog’s Life
The Ultimate Guide to Safe Foods for Dogs
Pet insurance is similar to other insurances but does have some major differences as compared to your health insurance. Below you will find a definitive list of frequently asked pet insurance questions to help in your decision.
Types of Pet Insurance Coverage
Comprehensive Pet Insurance Explained
Insurance vs. Wellness Pet Insurance Plans
Is Pet Dental Insurance Worth the Extra Cost
Best Pet Insurance Plans with Shortest Waiting Periods
Pet Insurance Coverage Exclusions and Limits
Pet Insurance Benefit Limits Explained
How to Make a Claim on your Pet Insurance
Is my Pet too Old for Pet Insurance Coverage
Top Reasons to Purchase Pet Insurance
How much does Pet Insurance Cost
Pet Insurance for Multiple Pets
Pet Insurance that Covers Spaying and Neutering
Does Pet Insurance Cover Shots
Pet Insurance with Pre-Existing Conditions
