How Does Pet Insurance Work?

All pet insurance plans reimburse you for emergency vet bills and allow you to go to any licensed vet. Aside from those common features, pet insurance policies work slightly differently. We’ll explain waiting periods, how to file a claim, direct-to-vet payment options, and more.

Most pet insurance companies don’t require a wellness exam before fully covering your pet, but some—including Healthy Paws—do. You may lose coverage if you don’t submit these records on time, so make sure you understand what’s required. 

Other pet insurance companies suggest submitting vet records to prove that no pre-existing conditions exist at the start of coverage. Without this baseline officially documented, you may not gain full insurance coverage against certain hereditary and congenital issues. In other cases, waiting periods for issues like ligament injuries may not start until you submit those first exam records.

Long story short, it helps to get a wellness exam done and file the paperwork with your pet insurance provider, even if they don’t strictly require it.

In most cases, you can’t file a pet insurance claim the day after signing up for coverage. Many policies won’t cover injuries or illnesses that occur within the first 14 or 15 days of signing. Any congenital or hereditary ailments that occur within the first six to 12 months are usually considered pre-existing and won’t qualify for policy coverage.

If a short accident or illness waiting period is important to you, check out AKC Pet Insurance. You only have to wait one day to file an injury claim and five days for an illness claim.

Differences in coverage set pet insurance companies (and their prices) apart. Your policy should clearly define what’s covered and what’s not, as well as any exceptions. For example, a policy that doesn’t offer coverage for routine dental care may list an exception for a broken tooth.

Pre-existing conditions don’t qualify for coverage with pet insurance, which is a great reason to sign your pet up sooner rather than later. After buying the policy, you’ll have to complete a waiting period of six to 12 months. If certain injuries or illnesses occur during that waiting period, they’re considered pre-existing conditions and the policy won’t cover them for the rest of your pet’s life. 

Some companies, like Healthy Paws and Figo, offer exceptions for cured congenital conditions. If your pet receives treatment for certain congenital conditions and doesn’t suffer a relapse for a specified period, the condition is no longer considered pre-existing and future occurrences would qualify for coverage.

Just as car insurance doesn’t cover maintenance costs, pet insurance typically doesn’t cover preventative care. Instead, you’ll need to budget for the basics like wellness exams, vaccinations, flea and tick medicine, and even routine dental cleaning. 

That said, some pet insurance companies offer fixed-rate riders for preventative care. These optional policies assign a maximum annual reimbursement limit to each preventative procedure. For example, your preventative care plan might reimburse you up to $50 for wellness exams and up to $20 for deworming. 

Preventative care usually includes the following procedures: 

• Wellness exams
• Spay/neuter surgeries
• Microchipping
• Dental cleaning
• Grooming
• Deworming
• Vaccinations

Cremation, behavior treatment, prescription diets, and breeding-related care may not qualify for coverage with pet insurance, but assistance may be available through fixed-rate riders.

Every pet insurance policy we read also indicated that injuries sustained through racing (including sled racing) or other commercial use are not eligible for coverage.

Some also limit the number of times they’ll cover emergency obstruction surgery or cruciate ligament surgery per year.

Be sure to read your policy carefully for other exceptions.

All pet insurance companies will reimburse you once a claim is approved. The amount of the reimbursement depends on your policy, but it’s usually between 70% and 90% of eligible expenses. Claim processing speed varies from company to company and can take anywhere from two to 30 business days—or longer.

It’s relatively rare, but some companies also pay vets directly. Healthy Paws, Pets Best, and Trupanion do this. The vet has to agree to receive payment this way, so it may limit you to specific vet offices. However, direct pay is an excellent choice for people who don’t have the funds to pay the vet out of pocket and then wait for reimbursement.

To file a pet insurance claim, start by asking the vet’s office for a copy of your pet’s “SOAP” records. They can give you a hard copy or email it to you.

Then, log into your insurance company’s online portal and start the claims filing process. There should be an area for uploading medical records. Attach a digital file or take a picture of the hard copy and upload it when prompted.

If you prefer, you can also call the insurance company for instructions on how to file a claim through snail mail. 

The last step is to wait for the claim to be processed and the reimbursement to be issued. If a claims representative asks for additional documentation, provide it as soon as possible to ensure speedy reimbursement.

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