Pre Existing Conditions in Pets

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Contributor, Benzinga
December 15, 2021

Under the Affordable Care Act, health insurance providers can no longer deny coverage due to a pre existing condition you have when you sign onto coverage. Unfortunately, this rule does not apply to our furry friends — pet insurance providers regularly deny coverage for animals that have pre existing conditions when they sign onto coverage. 

While finding pet insurance for pre-existing insurance is more difficult, you still have a few options that you can use to get your pet covered. Learn more about pet insurance for preexisting conditions with Benzinga’s guide.

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Key Points

  • Pet insurance providers typically don’t cover pre existing conditions.
  • However, some insurance providers differentiate between curable and incurable preexisting conditions, and you may be able to find coverage.
  • Your pet insurance provider will use examinations, reviews of your pet’s medical records and waiting periods to determine pre existing conditions.
  • Even if your pet has a condition when you sign onto a policy, you may be able to find insurance that only excludes the pre existing condition.

What is a Pre Existing Condition for Pet Insurance?

A pre-existing condition for pet insurance depends on the insurance provider and the insurance policy. However, pre existing conditions are any kind of health issue or illness that your pet developed prior to the conclusion of the waiting period for your insurance policy to kick in. Any sign or symptom that occurs prior to the start of coverage could possibly be denied coverage.   

Do Any Pet Insurance Providers Cover Pre Existing Conditions?

In general, no. Most pet insurance providers do not cover any type of pre-existing conditions. It’s a common limitation among pet insurance policies. 

Similar to car insurance, the insurance provider wants to take on as little risk as possible, and preexisting conditions in a pet can be risky and expensive. 

Fortunately, there are different ways to get around this caveat in order to get insurance for your pet. Some insurance providers will distinguish between curable and incurable conditions to determine whether your pet’s preexisting condition can be covered or not. 

All insurance providers will have their own list of curable and incurable conditions that qualify for coverage, so be sure that your pet’s condition is included with the insurance provider you choose before signing up for coverage.      

Examples of Curable Pre Existing Conditions

Some pet insurance providers may offer coverage for preexisting conditions that they deem curable. A condition is typically considered curable if the condition doesn’t have any symptoms or recurrence for a certain period of time after treatment. 

Some conditions that are generally considered curable include: 

  • Ear infections
  • Urinary tract infections
  • Respiratory infections
  • Vomiting
  • Diarrhea
  • Bladder infections

Examples of Incurable Pre Existing Conditions

Incurable preexisting conditions are not usually covered under any circumstance. Incurable pre existing conditions are those that require frequent veterinarian visits, medications and sometimes surgery to correct. 

Some examples of incurable pre existing conditions include:

  • Cancer
  • Epilepsy 
  • Hip dysplasia 
  • Arthritis
  • Kidney disease
  • Heart disease
  • Urinary blockages
  • Diabetes
  • Allergies

What About Hereditary and Breed-Specific Conditions?

Hereditary and breed-specific conditions are considered diseases that are inherited and caused by a defect in certain genes passed from a parent pet to its offspring. These conditions can affect any type of animal, including purebreds. These conditions can appear at birth or they may develop as the animal ages.

Both hereditary and breed-specific conditions are typically covered by pet insurance policies. However, there are some limitations. As long as any symptoms or signs of the condition are not showing prior to the start of coverage, the condition will be covered under most insurance providers. 

It’s important to note that hereditary conditions can be both curable and incurable, so the same preexisting condition limitations apply even if the insurance provider claims to cover hereditary or breed-specific conditions. 

Some common hereditary or breed-specific conditions include:

  • Hip dysplasia
  • Elbow dysplasia
  • Patellar luxation
  • Intervertebral disc disease (IVDD)
  • Cherry eye (Entropion)

Why Don’t Pet Insurers Usually Cover Pre Existing Conditions?

Pet insurance providers earn money by taking on as little risk as possible when issuing a policy. When you apply for coverage, your pet insurance provider undergoes a special process called underwriting to determine how likely they are to need to pay out a claim for the pet you’re insuring if they accept you for coverage.

If your pet already has a preexisting condition when they’re approved for coverage, the insurance provider will likely need to immediately take on an expense to have your pet treated. This can quickly outweigh the amount that you pay in premiums, which results in an instant financial loss for the insurance provider.

Pet insurance providers ensure that your pet doesn’t have a pre existing condition when you sign up for coverage by requiring you to submit to a waiting period before you can use your plan benefits. 

During your waiting period, you cannot use your benefits to claim treatment reimbursements for any condition, as these symptoms are considered to be pre existing in nature. This prevents pet owners from signing onto an insurance policy only to immediately use their benefits for a preexisting condition. 

How Does a Pet Insurance Provider Determine What is a Pre Existing Condition?

Pet insurance providers often require a full examination of your pet prior to insuring them. If the examination shows symptoms or comes back with a diagnosis for a condition that is considered pre existing and incurable, the insurance provider will likely not provide coverage for it. If a pet insurance provider doesn't require an examination, they will do a full review of your pet’s medical history before deciding whether or not they will extend you coverage.

Even if there is no required examination or review of medical history, don’t lie to the insurance provider about any pre existing conditions or symptoms. Even if the condition is incurable, your pet insurance provider might allow you to sign onto a policy that covers all other standard inclusions with the exception of the pre existing condition. However, if your pet insurance provider determines that you lied about your pet’s medical history, they will likely cancel your coverage altogether. 

Is Pet Insurance Worth It if a Pet Has a Pre Existing Condition? 

Even if your pet has a preexisting condition, pet insurance can still provide a number of benefits, including:

  • Reduction of costs for veterinary care for other problems and conditions, not including the preexisting condition
  • Peace of mind knowing your pet can receive without worry about covering the costs of treatments for their preexisting condition
  • Encouragement to prevent future health conditions from developing by providing coverage for routine visits (if you purchase a wellness plan)

The earlier you get pet insurance, the more likely your pet is to get covered. If you wait too long to choose a policy, your pet could develop symptoms for a pre existing condition and the cost of the insurance will rise considerably. You may even be denied coverage if your pet is older when they develop this condition. 

Compare Pet Insurance

Getting multiple quotes for pet insurance is the first step to finding affordable coverage options. Consider starting by getting a few quotes from the recommended providers below. 

Finding Protection for Your Pet

Though finding coverage for a pet with a preexisting condition might be more difficult, it is by no means impossible. The key to finding affordable coverage is to begin your search for insurance as early as possible. 

Start by collecting multiple quotes from competing insurance providers to get an idea of what you might expect to pay for pet insurance. 

Frequently Asked Questions

Q

What is a bilateral exclusion in pet insurance?

A

Bilateral illnesses or injuries are conditions that affect both sides of your pet’s body. Hip dysplasia is an example of a bilateral condition. A bilateral exclusion is a part of the pet insurance policy that states that if there was an illness or injury on 1 side of the body prior to coverage, then if it develops on the other side, it won’t be covered.

Q

What happens if I lie about my pet’s preexisting condition?

A

Lying to an insurance provider about your pet’s preexisting condition is considered fraud and you could be subject to policy cancellation. As insurance fraud is against the law, you could also face fines and even imprisonment.

Q

How do pet insurance companies know about preexisting conditions?

A

Pet insurance companies will conduct an examination or review your pet’s medical history to determine whether there are any preexisting conditions.

About Sarah Horvath

Sarah is an expert in the insurance, investing for retirement and cryptocurrency space.