Pet insurance for pre-existing conditions can be a tricky subject. While exclusions for pre-existing conditions are common in the pet insurance industry, definitions and rules can vary among providers. When enrolling in pet insurance, reviewing your policy’s terms on pre-existing conditions is important to avoid surprise claim denials later. Let’s explore what it means for your pet to have a pre-existing condition and how it can affect your pet insurance coverage.
What are pre-existing conditions?
A pre-existing condition refers to any illness, injury, or other medical condition your pet had before the policy’s effective date. For example, if your pet had a heart condition before becoming insured, any medical treatment related to that condition would be excluded from coverage.
While some pre-existing conditions are quite clear, like your pet having a diagnosed case of diabetes or a recently fractured leg, others can fall into a bit of a “gray area.” These may include things that were undiagnosed at the time of enrollment, but your pet had a history of symptoms. For instance, a dog with a history of hind-end lameness may later be denied coverage for hip dysplasia — even if it was not diagnosed prior to the effective date. The pet insurance company may deem certain symptoms sufficient evidence of a pre-existing condition.
Does any pet insurance cover pre-existing conditions?
In general, pet insurance does not cover pre-existing conditions. However, different classifications for pre-existing conditions may have different rules. It’s important to familiarize yourself with these classifications and rules to understand your pet’s coverage better and be prepared for out-of-pocket expenses.
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Classifications of pre-existing conditions in pet insurance
Depending on your pet insurance policy, there may be different classifications of pre-existing conditions listed. The most common include curable, incurable, and bilateral conditions. Here’s what it all means:
Curable pre-existing conditions
The term “curable pre-existing condition” refers to medical conditions that can be considered cured after treatment. These typically include minor ailments and/or infections that respond well to medical treatment, are not part of a chronic disease, and resolve without having a lasting impact on your pet’s health. These may be eligible for future coverage.
Examples of curable pre-existing conditions:
- Ear infections
- Eye infections
- Bladder/urinary tract infections
- Upper respiratory infections
- Gastrointestinal issues (nausea/vomiting/diarrhea)
Incurable pre-existing conditions
The term “incurable pre-existing condition” refers to medical conditions that are considered chronic or have lasting effects on your pet. These typically need lifelong medical management and are excluded from coverage.
Examples of incurable pre-existing conditions:
- Heart conditions
- Brachycephalic Obstructive Airway Syndrome (BOAS)
- Hip or elbow dysplasia
- Cruciate ligament tears
- Renal disease
- Intervertebral Disk Disease (IVDD)
- Inflammatory Bowel Disease (IBS)
Curable vs. incurable pre-existing condition considerations
While incurable pre-existing conditions are typically never covered, most pet insurance providers offer leeway for curable pre-existing conditions — meaning that they may not affect future coverage.
To have a curable pre-existing condition covered, most pet insurance providers impose a waiting period of 180 days (although some require more). During this period, your pet must remain symptom-free to be eligible for coverage for the same condition again.
For example, a pet with a recent urinary tract infection (UTI) prior to insurance enrollment may have to remain symptom-free for 180 days before another UTI will be covered. If they are diagnosed with another UTI before the time period is over, the waiting period may restart or it may be deemed a chronic condition — therefore no longer classified as curable and re-eligible for coverage.
The term “bilateral condition” refers to medical conditions or injuries that affect both sides of the body, such as the eyes, ears, and limbs. Some pet insurance providers group bilateral conditions with pre-existing conditions because pets with a history of certain conditions affecting one side of the body are more likely to develop it in the other.
Examples of bilateral conditions:
- Hip and elbow dysplasia
- Torn cruciate ligaments
- Luxating patellas
In the eyes of an insurance provider — a dog with a history of a torn cruciate ligament in their right leg may be seen as too high of a risk for tearing the one in their left leg in the future. Therefore, although not yet injured, the cruciate ligament in the left leg may be deemed a pre-existing condition under a bilateral conditions clause. This example can apply to all bilateral conditions.
Understanding pre-existing condition coverage in pet insurance
Regarding pet insurance for pre-existing conditions, every provider can have different definitions and rules, so reviewing your chosen policy carefully is essential. Not all policies classify pre-existing conditions into “curable” vs. “incurable” or have stipulations on bilateral conditions.
It’s also important to consider your pet’s unique needs when dealing with pre-existing conditions and pet insurance. Have a brachycephalic breed like a Pug or Bulldog? You’ll want to carefully examine your policy’s terms on respiratory symptoms classified as pre-existing conditions — such as BOAS. Have a breed that’s prone to hip dysplasia, like a Labrador or German Shepherd? You may want to find a plan without bilateral condition exclusions.
It can take some time to decode all of your pet insurance plan’s terms and exclusions and sift through all the scenarios where coverage may be vulnerable, but it’s well worth it. You’ll want to ensure you get the most coverage possible for your pet and your wallet.
Why are pre-existing conditions excluded from pet insurance?
Much like home or auto insurance, pet insurance was created to cover future incidents, not past ones. Just as you wouldn't be able to purchase flood insurance after your home was flooded and have it covered, you cannot purchase pet insurance to cover a medical problem your pet already has. By utilizing this model, insurance providers can keep costs affordable. Prices would skyrocket if you could buy pet insurance only when your pet was sick or injured.
How will my pet insurance provider know my pet has pre-existing conditions?
During the enrollment process, your pet insurance provider will require a questionnaire about your pet’s history, a medical records review, and/or a recent veterinary exam of your pet to determine eligibility. Any previous medical problems or current underlying conditions will be revealed during this process and noted in your pet’s insurance profile. It’s important to be forthcoming during this process to avoid issues down the line.
Is there any way to avoid pre-existing condition exclusions?
Yes by insuring your pet early. Enrolling your pet in a pet insurance plan while they are young, preferably still a puppy or kitten, will give you the best chances of having no pre-existing condition exclusions. Of course, young pets can still have health problems, and older pets can still benefit from insurance, but generally, the earlier you insure your pet, the fewer exclusions there will be!
All pet insurance has exclusions on pre-existing conditions.
Pre-existing conditions typically refer to any injuries or illnesses your pet had before being enrolled in an insurance policy.
What defines a pre-existing condition can vary among providers with some offering leeway on certain conditions that are considered curable.
Insuring your pet early on is the best way to avoid having pre-existing condition exclusions in your policy.
- American Animal Hospital Association. How Does Pet Insurance Work.
- Pet Insurance Info, Inc. Pet Insurance Definitions.
- Pawlicy Advisor. Is There Pet Insurance That Covers Pre-Existing Conditions?