Updated - Nov 6th, 2023
- There are three types of coverage in pet insurance: accident-only, accident and illness, and wellness coverage.
- Some of the most common issues that aren’t covered by pet insurance include preventable illnesses, pre-existing illnesses, and elective procedures (such as spaying or neutering).
- Pet insurance typically doesn’t cover diagnostics or treatments that fall under routine care.
- Typically, pet insurance takes between 14 and 15 days to take effect. However, pet insurance plans that cover more serious conditions can take up to a year to go into effect.
Enrolling in a pet insurance plan is one of the most important things you can do for your furry friend – and your pocket. When your pet is ill or significantly injured, it can be a lifesaver and very much worth the cost.
However, there are some exclusions and disclaimers you need to be aware of if you want to avoid running into any surprises later.
In this article, we’ll cover what pet insurance exclusions are and give you the 10 most common types of exclusions to be aware of. We’ll also cover some of the most frequently asked questions about pet insurance so you’ll know exactly what to expect.
What is pet insurance?
Pet insurance is a policy pet owners purchase to help cover unexpected illnesses and accidents their pets may encounter. Its primary purpose is to offset the overall cost of an owner’s vet bills when something happens to their pet out of the blue.
In 2022, pet insurance premiums written in the U.S. amounted to over $3 billion. This is largely because pet owners realize how pet insurance can help them keep their pets healthy and save costs in the long term.
Pet insurance is typically intended for dogs and cats, though you can enroll in policies for other pets, such as rabbits, exotic birds, hamsters, and ferrets.
Pet insurance works differently depending on the provider, but there are generally three types of coverage:
- Accident-only coverage: This coverage provides the least amount of scope for pet owners of the three types. It’s typically limited to accidents and injuries that result in emergency care, surgeries, hospitalizations, or prescription medications.
- Accident & illness coverage: Also known as accident and illness coverage, these plans cover a wide range of illnesses and accidents, including things like broken bones, canine distemper, and cruciate ligament surgery. Comprehensive coverage can also include diagnostics and treatments for illnesses and accidents, such as alternative therapy, lab costs, diagnostic tests, X-rays, and MRIs.
- Wellness coverage: Some pet insurance providers also offer preventative plans to help pet owners pay for routine care. These plans often include flea and tick preventatives, vaccinations, and annual check-ups.
What are pet insurance exclusions?
Exclusions in pet insurance are areas your pet insurance doesn’t cover, and they can vary depending on your specific provider and policy. These are some of the most critical sections to review in a pet insurance policy, as diligently reading through them is essential to knowing exactly what you’re getting – and not getting.
The 10 most common exclusions in pet insurance
Here are some of the most common exclusions in pet insurance you need to be aware of:
1. Pre-existing conditions
When a condition is deemed “pre-existing,” the owner is responsible for paying out-of-pocket for any associated treatments for their pet.
However, some pet insurance companies may define pre-existing conditions differently than others. While one company may exclude any condition diagnosed before coverage began, others may look at 18 months before enrollment and the state of the situation to determine whether it qualifies for coverage.
For example, if the condition is curable and the pet has been symptom-free for 180 days, the disease might be considered cured and no longer excluded.
So, why don’t pet insurance companies include pre-existing conditions?
They do this to reduce the risk of insuring pets with existing health problems. This is because some pet owners wait to try to insure their pets until after a chronic condition is diagnosed – and this is financially unsustainable for insurance companies.
2. Routine and preventative health care
Your pet health insurance policy won’t cover routine or preventative health care unless you purchase add-on wellness coverage.
Routine and preventative health care include:
- Yearly wellness exams
- Dental and oral care
- Parasite prevention
- Spaying and neutering
Routine vet visits can help you prevent illnesses and detect health issues early so that treatment is simpler, less expensive, and less invasive.
It’s best to find a company that offers preventative and wellness coverage as an add-on option.
Though this type of coverage will cost you more every month, it can save hundreds of dollars per year on vaccinations and dental cleanings – plus thousands on preventable illnesses. So, in most cases, adding wellness coverage is absolutely worth it.
3. Age restrictions
Many pet insurance policies have age restrictions and don’t cover pets that are below or above certain ages.
Though age limits vary by provider and policy, kittens and puppies younger than eight weeks are generally not covered, and dogs or cats over a certain age (generally 14 years) will have limited coverage since their age makes them more susceptible to age-related medical conditions.
Discover 10 of the most common puppy accidents and how to avoid them.
4. Preventable diseases
Diseases that are preventable by vaccinations are typically not covered by pet insurance.
That’s because vaccines are considered a routine part of pet care. As a result, any costs associated with vaccines and illnesses caused due to a lack of these vaccinations aren’t covered.
Most insurers have a list of required vaccinations. Others require you to follow the vaccination schedule suggested in the American Animal Hospital Association (AAHA) Guidelines and the American Association of Feline Practitioners (AAFP) Guidelines.
Pet diseases that vaccines can prevent include the following:
- Canine parvovirus (parvo)
- Leptospirosis (lepto)
- Canine influenza
- Canine enteric coronavirus
5. Bilateral conditions
Bilateral conditions are health conditions that affect both sides of the body. An example is cataracts since both the right and left eye develop them. Depending on the provider, the bilateral conditions exclusion may apply to eye problems, hip dysplasia, luxating patellas, and cruciate injuries.
6. Breed restrictions
Unfortunately, certain breeds – especially dog breeds – are highly susceptible to illnesses or accidents (due to their lifestyle and physical characteristics). As a result, some insurers refuse to insure them or charge far higher rates.
Some of the most expensive dog breeds to insure include the American Mastiff, Bull Mastiff, Neapolitan Mastiff, Saint Bernard, English Bulldog, French Bulldog, Great Dane, and Rottweiler.
7. Behavioral problems
Some insurance plans cover behavioral issues. Others include it as an “add-on” for an additional fee. And then some don’t offer it at all.
8. Elective procedures
Elective procedures aren’t considered medically necessary and aren’t typically covered by pet insurance. They are often cosmetic and don’t fall into either the illness or accident category.
Examples of elective procedures include the following:
- Cosmetic surgery (e.g., ear cropping)
- Soft tissue surgery
- Dew claw removal
- Tail docking
- Spay and neuter
- Oral surgery
9. Pregnancy complications
Many pet insurance companies don’t cover costs related to pregnancy and birthing, such as cesareans. This is especially true if the complications are related to the breeding itself.
That being said, some pet insurance companies specialize in pet insurance for breeders.
10. Administration costs
Administration costs include the costs the insurance company charges to complete an insurance form, check it to confirm the customer’s details and patient’s medical records, and get a vet to sign it. They are rarely covered by pet insurance.
Other things that pet insurance might exclude
The list above includes the standard exclusions. But other treatments, including ear cleaning and nail trimming, aren’t included in any pet insurance policy.
And, while we’d like to make sure our pet is insured for when the worst happens, many pet insurance companies make it explicitly clear that they don’t cover specific situations. These include the following:
- Autopsy and cremation expenses
- Avian flu
- Attacks by armed forces
- Injuries that were intentional — for instance, those that resulted from neglect or abuse
- Illegal acts
FAQs about pet insurance
1. What’s considered an accident or illness in pet insurance?
Pet insurance companies can define what they consider “illnesses” and “accidents” in their policies. Generally, accidents are considered sudden, unintended, or unexpected events that result in injury to your pet — like a broken bone, a bite wound, or a swallowed sock.
On the other hand, illnesses are conditions that aren’t caused by accidents or injuries. They’re generally considered unhealthy bodily conditions, such as a bladder infection or liver disease.
2. How long does it take for pet insurance to be in effect?
All pet insurance companies have waiting periods – the period between when your pet insurance policy starts and when your pet is covered. While it varies from provider to provider, it generally takes 14 to 15 days for the insurance to kick in.
However, some plans – especially accident and illness plans – require longer waiting periods. Accident-only policies, on the other hand, may have shorter ones.
Pet insurance plans that cover particularly severe conditions, such as hip dysplasia and other orthopedic issues, often have a much more extended waiting period (up to a year).
3. Does pet insurance cover vaccines?
Routine vaccines are given to dogs and cats to help prevent certain infections and diseases. They can either be one-off or annual.
Most comprehensive pet insurance plans don’t cover routine vaccines since they’re a form of preventative care.
Vaccines are typically a part of “wellness coverage” – which is add-on coverage you can get for an additional fee. Under the wellness coverage umbrella, you’ll also find parasite screening, microchipping, spaying, and heartworm preventatives.
4. Does pet insurance cover cancer treatment?
As mentioned earlier, pet insurance doesn’t cover any pre-existing conditions (that aren’t curable). This means that if your pet already had cancer before you got pet insurance or during the waiting period, it likely won’t be covered.
However, if the condition isn’t pre-existing, some providers will cover it. For example, Pumpkin plans cover a wide range of accidents, illnesses, and care options to diagnose and treat cancer and growths.
Get reliable pet insurance with a Pumpkin plan
While pet insurance can help you pay for unexpected vet bills, it’s crucial to find a provider that tailors your plan to your pet. Be sure to read through the exclusions and disclaimer sections to learn everything you need to know about your new policy.
With a Pumpkin plan, you can create a pet insurance plan based on your fur kid’s breed, age, and other characteristics. Unlike other providers, we don’t have breed or upper age limits, and we can also cover preventable diseases.
If you find yourself in a situation where pet insurance won’t cover your pet’s current condition, learn what to do if you can’t afford veterinary care.