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What Are Pre-Existing Conditions in Pet Insurance?

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5 min read

Updated - May 31st, 2022

Pre-existing conditions can be a confusing and frustrating aspect of the pet insurance world.

As a loving pet parent, your pet’s health and happiness are always top of mind. So, if your pet’s claim is denied due to a pre-existing condition, it can leave you feeling confused and deflated.

We’re here to help you understand why pre-existing conditions exist in the first place.

To understand why some pre-existing conditions aren’t covered by most pet insurance plans, it’s important to first understand the purpose of pet insurance.

What is the purpose of pet insurance?

The purpose of pet insurance is to reimburse you for eligible vet expenses and help protect your pet’s health when the unexpected happens. You pay a pet insurance premium every month (or annually), in exchange for coverage for accidents and illnesses that might happen to your pet in the future. 

What are pre-existing conditions?

Pre-existing conditions are illnesses or injuries that occur before your pet insurance plan coverage starts or during a waiting period.  This can also include symptoms of illnesses or injuries. Depending on your pet insurance policy terms, waiting periods can be as short as a few days or as long as a few months.

Let’s look at a hypothetical scenario where a pet insurance claim might be denied due to a pre-existing condition:

One day, you notice your dog limping and take them to the vet. Your veterinarian notes that your dog may be displaying early signs of arthritis and may need medication in the future. You anticipate higher vet bills in the future so you enroll in a pet insurance plan after the vet visit. Once your plan goes into effect, it likely won’t cover the arthritis medication, since your dog has either a) already been diagnosed with arthritis and/or b) their arthritis symptoms have already shown prior to your coverage starting. 

Why do waiting periods exist in pet insurance?

Some pet owners may enroll in a pet insurance plan after they realize their pet has developed health issues. Though it makes perfect sense why they’re seeking coverage, pet insurance is designed to only cover accidents and illnesses that may occur in the future. Thus, many pet insurance providers instill a waiting period to help ensure that insurance benefits only cover accidents and illnesses that have not occurred, shown symptoms, or developed yet.

Does pet insurance cover pre-existing conditions?

As you can probably guess, the answer to this question is usually no.

However, it’s not all doom and gloom! Some pet insurance plans may have exceptions depending on your pet’s condition.

Curable conditions

Although incurable or chronic conditions that are pre-existing such as heart disease or hyperthyroidism typically won’t be covered, if your pet’s medical condition is curable, has been cured, and a certain amount of time has passed, some pet insurance plans may reinstate coverage for the condition.

Let’s look at a hypothetical scenario where coverage for a curable pre-existing condition may be reinstated:

Let’s say your cat was diagnosed with a respiratory infection before your pet insurance coverage went into effect. If the infection is curable, was treated and cured, and six months have now passed without any recurrence of the infection or the infection’s symptoms, the infection may no longer be considered pre-existing. 

Tip: With Pumpkin Pet Insurance plans, an injury or illness that is curable, was cured, and has been free of treatment and symptoms for 180 days will no longer be regarded as pre-existing, with the exception of knee and ligament conditions. If a knee or ligament condition occurs before the coverage effective date or during a waiting period, any future ones won’t be covered.

Hereditary conditions and congenital conditions

Some pet insurance plans cover eligible hereditary or congenital accidents and illnesses. Bear in mind that this is contingent on their coverage options. All pet insurance providers are different when it comes to their coverage options, so be sure to do your research before deciding on a provider

What is preventive care and why do some pet insurance plans not cover it?

These are not pre-existing conditions, but many pet parents are surprised to find out that their pet insurance plan does not cover them. Many pet insurance plans exclude preventive care and elective procedures such as:

  • Spay/neuter surgeries
  • Vaccinations
  • Annual wellness visits
  • Flea/tick control
  • Routine teeth cleaning
  • Routine ear cleaning
  • Parasite preventatives like heartworm medication

These treatments fall under the routine care category, which often excludes them from pet insurance coverage as they are not accidents or illnesses. However, some pet insurance plans may help pay for a teeth cleaning or ear cleaning if it’s prescribed to treat a covered condition like gum disease or an ear infection. The good news? Some pet insurance providers offer preventive wellness packages to help pay for a variety of preventive care services.

Tip: Pumpkin offers preventive essentials for both dogs and cats! It’s not insurance, but an optional wellness package you can add to your insurance plan.

What is the best pet insurance for pre-existing conditions?

This commonly-asked question is a bit of an oxymoron, and unfortunately, there is no easy answer.

The best pet insurance for you and your pet depends on a variety of factors. From your deductible amount, to your annual coverage limit, to what best suits your pet’s breed and behavior, there is so much to consider.

Regardless of what pet insurance plan you choose, our best advice is to enroll in one as early as you possibly can! The earlier in your pet’s life you enroll, the healthier they will likely be – which means the more help you can get them throughout the course of their life. So long as you do your homework and find a plan with amazing coverage, you will be one step closer to prioritizing your fur baby’s health and happiness.

At Pumpkin, we know a thing or two about prioritizing pets’ health and happiness. Pumpkin Pet Insurance plans help pay back 90% of eligible vet bills for cats and dogs every day. With no upper age or breed restrictions, plus coverage for eligible behavioral issues and even alternative therapies prescribed to treat covered conditions, the plans we offer help get pets the best veterinary care pawsible.

Don’t wait – fetch a free quote today!

Passionate Pet Experts & Parents
We are a team of writers, designers & product developers who all double as passionate (ok, obsessive) nerds of the pet world.

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