What Is Not Covered by Pet Insurance?

Pet insurance—depending on how much you are willing to spend—provides a wide array of coverage for wellness, accident, and illness, all of which can be expensive to treat. Unfortunately, pet insurance also comes with exclusions, restrictions, and conditions that are not covered. Pet insurance, for example, seldom covers preexisting conditions. Some restrictions apply to all pets, while others apply only to certain species and breeds.

Three Main Types of Coverage

Each of the three main types of pet insurance—wellness, accident, and comprehensive—provides a specific set of coverage that is uniform from one policy to another. It’s important to understand that the coverage provided by one type of policy generally does not include coverage offered by another type.

Wellness coverage, for example—which is for routine and preventative care, including annual checkups, vaccinations, and some dental work such as teeth cleaning—provides no accident or illness coverage. Likewise, an accident-only policy doesn’t cover wellness or illness. Comprehensive policies cover both accident and illness but rarely provide wellness coverage.

Exclusions

The exclusivity of each type of coverage is only part of the picture. Exclusions or restrictions often outnumber covered conditions, so when considering pet insurance, make sure you locate and review the list of exclusions before signing the contract. Exclusions are typically found in a section titled along the lines of “What’s Not Covered” on the insurance company website.

Such a section is often more of a synopsis than a complete list. For example, on the Nationwide Pet Insurance website, you have a “What’s Not Covered” page that includes the following text in the subsection “Plan restrictions”: “See the full list of exclusions here or refer to the ‘What We Do Not Cover: Exclusions’ section of your policy and your policy Declarations Page.” If you click on the link, it takes you to a far more detailed list of all policy restrictions. That’s the nitty-gritty info you need.

Here are some of the most common exclusions found in pet insurance policies.

Waiting Period

Almost all pet insurance policies have a waiting period (usually 10 to 30 days) during which there is no coverage. In addition to no coverage during the waiting period, most policies provide that, once the waiting period is over, any problem that began to present itself during the waiting period is also not covered.

Preexisting Medical Conditions

Far and away the most common exclusion is for preexisting medical conditions. Anything in your pet’s medical history before the policy starts is subject to exclusion. This also applies when you cancel one policy and take out another.

Pregnancy and/or Birth

If your dog or cat becomes pregnant, the cost will likely be borne by you. Some policies offer coverage in the event of complications, but most consider pregnancy totally excludable.

Death or Theft of a Pet

The theft or death of a pet is usually not covered by regular pet insurance. Special life and theft policies are available for purchase by zoos and owners of rare or expensive animals.

Bilateral Condition

This common exclusion refers to anything that can happen to both sides of your pet’s body, such as (hip) dysplasia, cruciate ligament issues, or cataracts. Normally, these conditions are covered unless your pet has already suffered the condition on one side of its body. In that case, it’s excluded.

Preventable Diseases

If you fail to have your pet vaccinated for a preventable disease—such as canine influenza, kennel cough, giardia, and parvovirus—and it gets that disease, treatment will likely be excluded from coverage.

Breed Exclusion

Some breeds of dogs and cats are excluded or only insurable at a high cost, because they are predisposed to certain medical conditions such as diabetes or ligament injuries.

Age Exclusion

It’s not uncommon for insurers to refuse to cover pets at either extreme of the age spectrum. For example, most insurers will not cover a pet younger than eight weeks of age or write a new policy for one 14 years old or older, depending on species and breed. Even if coverage is provided for older pets, it will likely be much more expensive the older the pet gets.

Elective Procedures

Most elective procedures are not covered. Examples include anal gland expression and removal, tail docking, ear cropping, nail trimming, feline declawing, and dewclaw removal.

Nonstandard/Non-Veterinary Services

Not surprisingly, procedures or activities not normally associated with veterinary services or those services not part of standard care are excluded. This includes waste disposal, food, nutritional supplements, boarding, transportation, grooming, and bathing. Other services that are not covered include behavioral training, experimental care, and the cost of compliance with any government rule or regulation.

Cost vs. Value

How much pet insurance costs and whether you think it is worth it depends on a variety of factors, including how important what is not covered is to you.

Insurance costs vary with coverage and policy, but in general:

• Wellness coverage costs $20 to $25 per month.
• Accident only coverage runs $11 to $16 per month.
• Comprehensive coverage averages $49 per month for dogs and $29 per month for cats.