We put together a list of essential and sometimes confusing pet insurance terms to help you better understand policies and coverage.

Accident and Illness Coverage

A major medical plan is the base-level pet insurance plan. This provides coverage for accidents and unexpected illnesses. It's by far one of the most common types of pet insurance plans purchased, accounting for over 98% of all policies sold. This sort of policy covers veterinary treatment for unexpected health issues like broken bones, torn ligaments, and long-term diseases like cancer.

Accident Only Coverage

As the term suggests, this sort of plan only covers injuries or conditions considered accidental. This often includes injuries like broken bones, lacerations, or emergencies like the ingestion of foreign substances or accidental poisoning. The precise list of injuries and conditions covered by this emergency pet insurance may vary from one insurance to another. For this reason, careful comparison is vital before you enroll in an accident-only plan with a selected provider.

Adverse Selection

Adverse selection is when people with the highest risk of loss are usually the ones to purchase pet insurance. Pet insurance companies have waiting periods to protect themselves from adverse selection. For instance, if a pet owner has an older dog that has been limping for several weeks, they'll purchase a pet policy to assist with treatment costs once they visit the vet. Companies also use exclusions to protect their company against adverse selection. Pet owners are unable to enroll because these exclusions exclude pre-existing conditions that have occurred before enrollment.

Age Restrictions

All pet insurance companies have age restrictions once you enroll in a pet insurance plan. Each company features a minimum age requirement and cannot ensure pets under six to eight weeks old. Some pet insurers even have maximum age limits, which means you would have to enroll before a specific age. The most maximum age for enrollment is 10-12 years old. The key to enrollment is to do so while your pet is young and healthy to avoid being denied coverage. The great news is that when you enroll during a plan, your dog or cat will be covered throughout his life, as long as you continue to pay the premiums and deductibles.

Alternative Therapies

Pets can develop degenerative and chronic health issues just like their pet parents. Fortunately, today holistic treatments are more popular than ever before. The majority of pet insurance policies include coverage for alternative therapies. Certain employers require alternative therapies as part of their standard plan. Here's the takeaway:

AAHA

AAHA stands for the 'American Animal Hospital Association.' The AAHA is a veterinary association that offers veterinarians across the U.S. benefits in continuing education, professional development, and accreditation. The American Animal Hospital Associations, or AAHA, is the main governing body that issues accreditation status for pet hospitals within the U.S. and Canada. Suppose you're trying to find the best pet hospital for your furry best friend. In that case, you'll find an inventory on AAHA's website under "referral practice," which may be a fancy term for a veterinary clinic. These are clinics with MRI machines that may treat cancer or operations. The American Animal Hospital Associations (AAHA) was founded in 1933 and is based in Lakewood, Colorado. The AAHA currently has 5,500 accredited veterinary clinics and over 50,000 veterinary professionals.

Annual Deductible

A yearly deductible is an amount that has to be paid out of pocket by the pet owner annually before an insurer can pay claims. For instance, if you've got a deductible of $200 per year, you won't be compensated for claims unless they total more than $200 over a year. Alternatively, some pet insurance providers have a per-event deductible, which means you pay your deductible each time you have an incident whenever you create a claim. With this sort of deductible, if you had multiples claims in one 12-month period, you'd need to pay the deductible every time.

Annual Limit

The annual limit is the maximum amount a pet insurance company can pay for claims annually. Some companies start the 12 months once you enroll, while others use the general calendar year. Some pet insurance providers have an annual limit, while others have a per-incident deductible that you need to pay each time. Whether the pet insurance company you select has a yearly limit or per-incident limit, the higher your limit, the better it is for you and your pet.

Benefits Schedule

A benefit schedule sets a certain payout amount for a given health condition. This will include a long list of health conditions and veterinary procedures and what the pet insurance company will pay out each time for every benefit. The benefit schedule is not as used often in the pet insurance industry. Nationwide's Major Medical Plan uses this plan and pays claims using a benefit schedule. All other pet insurance base their payments on a portion of your actual vet invoices.

Bilateral Condition

A bilateral condition is any health issue that will occur on each side of your pet's body. For instance, your dog could have hip dysplasia on his left leg rather than his right leg. Bilateral conditions are most typical of orthopedic issues like hip dysplasia, elbow dysplasia, and cruciate ligament damage. It's essential to understand bilateral conditions because they're more often than not excluded from pet coverage. So if your pup suffers from a cruciate ligament tear in his left leg, then a tear in his right leg could also be considered a pre-existing condition and can be excluded from coverage.

Chronic Condition

A chronic condition may be a health condition or disease that's long-lasting or persistent. In most circumstances, once a chronic illness has developed, it is difficult to reverse. It's deemed incurable or likely to continue for the rest of the pet's life. Thanks to the longevity of chronic conditions, these diseases are often costly to treat. Suppose you enroll your pet in a pet insurance plan after they've already been diagnosed with a chronic condition; that condition is going to be considered a pre-existing condition and cannot be covered. That's why it's so important to enroll why your dog or cat is still young and healthy; Chronic conditions include the following:

  • • Addison's disease, Arthritis, Cancer, Cushing's Disease, Diabetes Epilepsy, Glaucoma, Hypothyroidism, & Inflammatory Bowel Disease. Sample Chronic Conditions in Cats: Cerebellar Hypoplasia, ear canal Ablation, & Throat cancer.

Age Restrictions

All pet insurance companies have age restrictions once you enroll in a pet insurance plan. Each company features a minimum age requirement and cannot ensure pets under six to eight weeks old. Some pet insurers even have maximum age limits, which means you would have to enroll before a specific age. The most maximum age for enrollment is 10-12 years old. The key to enrollment is to do so while your pet is young and healthy to avoid being denied coverage. The great news is that when you enroll during a plan, your dog or cat will be covered throughout his life, as long as you continue to pay the premiums and deductibles.

Claims

Pet insurance claims are a bit like auto insurance; pet insurance claims are a request to the insurance company asking for reimbursement after your dog or cat receives veterinary treatment. When making a claim, you'll send the form and copies of your itemized vet bills to your insurer. Once the company gets your submission, they will have an adjuster determine whether or not the treatment is covered under your policy. After this is done, the adjustor will calculate how much the payment is covered, your deductible, and your reimbursement rate. Most companies reimburse a percentage of your actual bill and a few payouts based on a benefit schedule.

Claims Adjuster

A claim adjuster examines pet insurance claims to decide if they should be paid and how much the insured is owed. Pet insurance is a need similar to auto insurance or homeowner's insurance; there's a policy. When your dog or cat becomes ill or injured, you file a claim with the insurance company. They then send you a check for what is owed.

Clinical Signs

Observable changes during a pet's normal healthy state, bodily process, or behavior. If your pets show signs of a disease or illness, when you enroll in a policy, those specific health issues will be considered pre-existing conditions. This is why it's so important to get insurance for your pet while they're healthy and symptom-free.

Co-payment

A copayment is a predetermined, flat fee that the pet parent pays for pet healthcare services. A $10 copayment for a visit to the doctor is one example of every office visit to the vet, no matter the sort or level of services provided during the visit. Copayments aren't usually specified by percentages but are stated in dollar amounts. Most companies don't use copayment, and therefore those that do generally only use them in pet wellness and routine care programs. Don't get the terms copayment and reimbursement rate mixed up that the percentage a corporation pays on your claims.

Congenital Condition

A congenital condition, or congenital disability, may be a health condition that's present at birth or that develops during the preceding month of a puppy or kitten's life. This should not be confused with a hereditary disorder. The great news is that some pet insurance plans cover both congenital conditions and genetic disorders (confirm before you enroll). Learn More: Congenital Condition.

Continuous Coverage

This means coverage is maintained from one policy period to the next without causing any inconvenience. Most pet insurance companies additionally offer a guaranteed renewal provision, which assures that the customer is covered at all times- the lifetime of your pet, no matter what percentage of health issues or claims you file. Your pet insurance firm must offer continuous coverage because the older your pet gets, the more likely it will need treatment. Always check before purchasing your policy/ Take a moment to read up on pet insurance reviews before making a final judgment.

Coverage

Pet coverage refers to the scope of protection within the policy. There is a diversification of options available, ranging from accident-only coverage to all-inclusive plans. The more exhaustive your coverage is, the better; therefore, the higher your limits, the costlier your plan will be. When it comes to pet insurance, there are three primary levels of coverage.

Accident Only Policy

These plans are less expensive than comprehensive medical insurance; however, they only cover accident claims. These policies are not recommended because illnesses like cancer are more expensive to treat.

Accident and Illness Plans

These plans account for over 98% of all purchased pet insurance policies. Except for wellness care, comprehensive pet insurance policies cover most things apart from wellness care.

Wellness Plans

A few pet insurance companies will let you add wellness coverage to a standard major medical plan. These programs pay for annual examinations, heartworm medication, and dental cleanings, among other things.

Cruciate Ligament

The cruciate ligaments in the knee. These ligaments help to stabilize the joint. The anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) are part of the cruciate ligaments of the knee (PCL). These ligaments are two solid and circular bands that connect from the head of the tibia to the femur. The major common ligament injury to dogs and cats may be a strain or tear of the ACL. If your dog tears his ACL, he'll need corrective surgery, of which costs may run from $3,000 to $6,000, depending on your pet and where you live.

Deductible

The amount of money that must be paid out-of-pocket before the insurer will reimburse you for claims. Some companies that offer per-incident deductible offer annual surplus plans.

  • • Annual Deductible
  • • Per Incident Deductible

The most common pet insurance deductibles range from $100 to $1000, and most pet insurance companies allow you to choose your deductible. It's also crucial to note that the higher the deductible you choose; your premium payments will lower because you're paying more before your insurance kicks in.

Effective Date

The effective date is that the 1st day when the coverage begins. After you enroll, there's a period until the effective date begins. Accidents, illnesses, genetic and orthopedic disorders all have their waiting periods. It's important not to confuse the effective date and the date of enrollment. Many pet parents think that coverage begins on the day they join, but this is not true. After the waiting time has passed, coverage commences on the effective date.

Emergency Vet

Describes treatments at either a veterinary hospital or veterinary clinic that gives emergency care. Suppose your dog or cat has a severe accident or suffers from a significant health condition. In that case, you'll go to a veterinary hospital because your regular veterinary clinic won't have the equipment for trauma situations. Pets are treated in emergency veterinary facilities. These have the following for emergency veterinary treatment: X-ray equipment, MRI scanner, an ICU, and surgical facilities are available at specific locations. Veterinary emergency clinics can help almost anything, but treatment comes with a price. Treatment for severe accidents and illnesses can reach from $1,000 to over $10,000 or more.

Enrollment Date

The date you buy your pet insurance policy. The enrollment date is important because it starts the waiting period, the time between enrollment, and the effective date. The effective date is the first day of coverage. Accidents, illnesses, genetic and orthopedic disorders all have their waiting periods.

Guaranteed Renewable

A guaranteed renewable policy is an insurance policy feature that ensures that an insurer is obligated to continue coverage as long as premiums are paid on the policy. While re-insurability is guaranteed, premiums can increase based on filing a claim, injury, or other factors that could increase the risk of future claims.

With a guaranteed renewable policy, the pet insurance company cannot cancel coverage apart from non-payment of premium by the policyholder; however, the pet health insurance company can raise rates if they choose, provided they have specified this in their policy. The increased rates have to be in accordance with the procedure. Guaranteed renewable clauses in insurance policies ensure that uninterrupted coverage provides you and your furry best friend with the peace of mind.

Hereditary Disorder

A hereditary disorder, or genetic disease, may be a condition that's passed right down to a puppy or kitten from their parents. This should not be confused with a congenital condition, which may be a health issue that develops within the womb or shortly after birth. It's essential that the pet insurance firm you select covers hereditary disorders because they will be costly to treat.

Illness Coverage

Illness coverage helps purchase veterinary care coverage when your pet suffers from a significant illness or health condition. Numerous veterinary treatments are costly. In contrast to accidents, which are relatively simple to treat, diseases and long-term health disorders may necessitate therapy over an extended period. In most cases, conditions are costlier because diseases may be lifelong and occur more often than accidents.

Incident

Every accident or illness that your pet suffers from during the lifetime of the policy. For example, if your dog broke his leg in April then swallowed a sock in September, that might be considered two separate incidents. The definition of an event is essential because pet insurance companies tailor their policies to support incidents. Some companies have per-incident deductibles, which means they charge a deductible for every incident. The choice to a per-incident deductible may be a standard annual deductible. Other companies even have incident limits, which means how much they pay out for individual limits.

Loss Ratio

A ratio is a relationship between incurred losses (claims paid) and premiums collected. It's always presented as a percentage. For instance, let's say a pet insurance firm paid out $55 million in claims last year and picked up $100 million in premium. Their ratio would be 55%.

Maximum Limit

The max limit is the most a pet insurance firm will reimburse you for claims. Some pet insurance companies have a per-incident limitation where the max limit applies to every individual incident. For instance, if your dog fractured his leg, the treatment for the broken leg would be subject to the maximum limit. Other pet insurance companies have an annual limitation that applies to all employees or any claims made during 12-month period. Before choosing a pet insurance company, it's essential to gather an understanding of what the company's maximum limit is so you're not surprised once you make a claim.

Orthopedic Condition

"orthopedic condition" refers to health conditions that affect the musculoskeletal system. The system is formed from bones (skeleton), muscles, cartilage, tendons, ligaments, and joints that make up the human body. Most pet insurance providers include 6-12 month waiting periods for orthopedic disorders to avoid adverse selection. This is often one of the various reasons it's important to enroll your pet while they're young and healthy. However, numerous pet insurance companies allow you to submit an orthopedic exam waiver after enrollment to shorten the 6-12 month waiting time. If your pet is confirmed to be healthy throughout the exam, this waiver will waive the 6-12 month waiting period.

Orthopedic Exam

An orthopedic exam is a medical evaluation that any certified veterinarian can perform to shorten the time for orthopedic treatment. The veterinarian will evaluate your pet's knees, elbows, hips, and back during an orthopedic exam to see any pre-existing orthopedic disorders. If your pet passes the orthopedic exam with flying colors, then waiting periods for orthopedic conditions such as hip dysplasia and ligament tears will begin are often reduced from 6-12 months to 14 days.

Per Incident Deductible

A per-event deductible is an amount that the pet owner must pay out of pocket for each incidence. For example, if your per-incident deductible is $200, you'll pay $200 each time you file a claim. So if your dog suffers from a broken leg in an accident, you would have to make a $200 deductible each time for treatment.

With this type of policy, if your pet has numerous accidents in one calendar year, you'll be responsible for the $200 deductible each time. Some pet insurance companies have an annual deductible where you simply pay the deductible once a year no matter how many claims you've submitted. Whether you select a pet insurance company with a per-incident deductible or annual deductible, it's important to note that the higher the deductible you opt for, the lower your pet insurance plan will cost you each year.

Per Incident Limit

A per-incident limit is the maximum a pet insurance policy can pay per incident. For example, if you've got a $5,000 per incident limit and your dog needs surgery because he ate a ball, the most your policy can pay for the surgery is $5,000. While some insurers have a per-incident other pet insurance firms impose annual limits on their policies. These companies do not set individual claim limits. However, they do cap what they payout during a given 12-month period. Knowing the maximum limit before purchasing a pet policy is essential, so you're not surprised once you file a claim.

Orthopedic Condition

"orthopedic condition" refers to health conditions that affect the musculoskeletal system. The system is formed from bones (skeleton), muscles, cartilage, tendons, ligaments, and joints that make up the human body. Most pet insurance providers include 6-12 month waiting periods for orthopedic disorders to avoid adverse selection. This is often one of the various reasons it's important to enroll your pet while they're young and healthy. However, numerous pet insurance companies allow you to submit an orthopedic exam waiver after enrollment to shorten the 6-12 month waiting time. If your pet is confirmed to be healthy throughout the exam, this waiver will waive the 6-12 month waiting period.

Pet Hospital

A pet hospital is a veterinary hospital! There are, however, some significant variations between pet and human hospitals. For instance, pet hospitals aren't required to be accredited like human hospitals. However, given the vast selection of pet hospitals in the U.S. and Canada, you'd be wrong not to take your dog or cat to an accredited pet hospital.

Pet insurance broker

There are two pet insurance agents: captive agents and independent agents. Agents that work for a single pet insurance company are known as captive agents. Independent insurance brokers sell insurance from a variety of pet insurance firms. The advantage of employing a pet insurance broker is that they can assist you in comparing options and explain coverage. There are licensed pet insurance agents who can answer your questions and assist you in finding the right plan.

Pet policy

A pet policy is simply like an auto or homeowner's policy. It pays claims when something unexpected happens. Pet insurance is insurance for your pet, so if your dog or cat gets sick or injured, it'll help pay veterinarian expenses. Most plans cover 80-90 percent of your veterinary bill, so if your pet becomes ill, you won't have to worry about high illness costs; the policy will reimburse you for the vet bills. Pet insurance policies contain six key sections. It is essential to know what's covered and what's not.

Pet Medications

Pet medications are often expensive, mainly prescribed pharmaceuticals for chronic conditions. Pet insurance companies have different coverage options associated with pet medication coverage, so it's important to know what's covered and what's not. See how each pet insurance firm pays out pet medications and enroll in a plan before your fur baby gets ill and needs expensive pet meds.

Policy Conditions

This provision places restrictions on the insurance company's promise to pay, not to be confused with pet health issues, which are provisions that impose a limit on the insurer's obligation to pay. If the insured (you) don't meet the policy's conditions, the insurance firm can deny a claim or limit payment. Some common pet policy conditions include:

  • • Documents proof of loss promptly
  • • Protect property after a loss
  • • Cooperate by providing timely pieces of information and detail during the claims investigation

It's essential that you follow the policy conditions to make sure your claims are paid and paid promptly. A pet policy is a contract with the insurance company that outlines your coverage.

Policy Declarations

The declarations sections or declarations page is usually the primary page or two in your pet policy. The declarations page is a summary of what your policy covers. It's a fast snapshot that provides consumers a transparent idea of what's covered and includes the following information.

  • • Company Name and get in touch with Info
  • • Customer Name and get in touch with Info
  • • Pet(s) Name, Breed, Age
  • • Effective Date
  • • Policy Period
  • • Coverage Overview
  • • Policy Limits
  • • Exclusions
  • • Reimbursement Rate
  • • Deductible
  • • Annual Premium
  • • Applied Discounts
Policy Definitions

Every pet policy features a definitions section. The definitions list important pet insurance terms utilized in the policy to assist you in understanding coverage. The definitions could also be included within the body of the policy or as an attachment. The definitions are essential because they supply clarity for what's covered and what's not covered. Policy Endorsements – A pet insurance firm may alter the policy's terms or amend coverage through endorsements and riders. Endorsements and riders are usually written at the renewal feature, delete, or modify provisions within the original policy. The pet insurance company is required to send you a copy of any policy changes. In most circumstances, endorsements and riders improve coverage, but they must be purchased at the time of purchase.

Policy Exclusions

Exclusions are health conditions that aren't covered by the policy. Every pet insurance firm has different exclusion lists. Some companies have only a few exclusions, while others attempt to exclude the maximum amount possible. Here's the takeaway on the most common exclusions:

  • • Pre-Existing Condition
  • • Bilateral Conditions
  • • Elective Procedures

Make sure you check which conditions are excluded before buying a pet insurance policy. It's important to know what's covered and what's not, so when your dog or cat does get sick or has an accident, you will see if you're covered or not.

Policy Insuring Agreement

The insuring agreements summarize the main promises of the policy. In summary, the insuring agreement is the base policy and describes what's covered and what's not covered. The insurance firm agrees to do certain things within the Insuring Agreement, like paying for covered losses and providing specific services.

Policy Period

The policy period is the period from the time the policy is effective. The policy duration for pet insurance starts on the effective date and lasts for 12 months. It's vital to note that pet insurance coverage does not begin until the waiting time has passed. However, there are no waiting periods if you renew your policy in consecutive years. Here's an illustration of how it all works.

  • • Effective Date: October 1st, 2014
  • • Policy Period: October 1st, 2014 to September 30th, 2015 (12 months)
  • • Waiting Period Accidents: 1st day from the effective date
  • • Waiting Period Illnesses: 14th days from the effective date
  • • Waiting Period Orthopedic: 6th months from the effective date
Pre-Existing Conditions

A pre-existing condition is any illness or injury that first occurred or showed signs before your policy starting. If your pet has suffered from a selected illness, injury, or other health condition before enrollment, then it'll be considered a pre-existing condition and cannot be covered by pet insurance. Unfortunately, no pet insurance firm covers pre-existing conditions, which is why it's so important to enroll during a plan while your pet is healthy.

Premium

The rates you pay for your pet policy. Most premiums payments are made every month, but you can also opt for annual payments. Your premium is based on underwriting factors which include the breed, age, and location.

Reimbursement

The amount a pet insurance firm pays you for veterinary expenses. It's expressed as a percentage starting from 60% to 100%. The most popular U.S. pet insurance plans reimburse 80% to 90% of your total vet bills. Alongside your deductible, reimbursement is how pet insurance claims are calculated.

Renewal

The automated re-establishment of a pet insurance health policy at the end of the policy term. Most insurance policies renew every year with no interruption in coverage. If your pet health insurance policy is being canceled, your carrier must notify you a minimum of 90 days beforehand, so you have time to look for other pet health insurance. As long as you keep up with your payments, the majority of renewals will be automated, still pay your premium, and don't voluntarily cancel your policy. Some companies provide guaranteed renewable policies, so regardless of how old your pet gets or what sort of health issues they need, the pet health insurance carrier guarantees to renew your policy annually for the lifetime of your pet. The value of your policy may increase at renewal. This is based on several factors, including inflation, changes in vet fees, increases in the cost of living, and additions in the price of pet meds. Some pet insurance companies will increase your rates annually as your pet ages and according to your pet's health.

Underwriter

An underwriter is a private or organization trained in evaluating risk and determining rates and coverage. Pet insurance underwriters decide whether to supply insurance and under what terms. They assess insurance applications and determine coverage amounts and premiums.

Veterinarian

A veterinarian may be a licensed professional who practices medicine. The majorities of veterinarians work in general practice and treat all types of pets. Other veterinarians concentrate on a selected group of animals like dogs and cats, livestock, zoo animals, or equines. A veterinarian can also focus on specific veterinary disciplines like oncology, surgery, dermatology, or general medicine.

Veterinary Review

A comprehensive assessment of your pet's health history. The purpose of a veterinary review is to work out if your pet has any pre-existing conditions. Pet insurance companies exclude pre-existing conditions from the coverage, so a veterinary review may be an excellent way to seek out what will be covered before it is time to file a claim. Some companies like PetPlan will perform veterinary examinations before you enroll. Other companies like Embrace will review immediately after you register and allow you to cancel your policy if you're not happy. You'll need to request a veterinary review in either case because it's not a standard service. The great news is that they're free and are fast. If your fur baby has a history of health issues or you're unsure of a few specific health conditions, then a veterinary review may be a good idea. Veterinary examinations are at no cost, and you don't have to do much apart from handing over your pet's veterinary records.

Waiting Period

A waiting period is between the day you enroll and, therefore, the day coverage starts. The day your coverage starts are mentioned because of the effective date. The reason for a waiting period is to avoid pet owners enrolling in a plan to cover a pre-existing condition. There are three different waiting periods:

  • • Waiting Period for Accident: 0 – 15 days
  • • Waiting Period for Illnesses: 14 – 30 days
  • • Waiting Period for Orthopedic Issues: 14 days – 12 months
Wellness Plans

Pet wellness plans are designed to ensure that pets have access to preventative care and exams by covering expenses related to pet health services. These are the usual expenses that are planned and predictable annually. Because the accident and illness plans, which are necessary to obtain a wellness plan, are designed to assist you in managing unexpected veterinary bills, you're receiving optimal coverage for your pet's care, whether expected or otherwise.