Pet Insurance for Pre-Existing Conditions: What Actually Gets Covered

Most pet owners discover the hard way that pre-existing conditions often lead to denied insurance claims. This widespread issue stems from misunderstandings about what "pre-existing"means. In this post, we'll dive into how pre-existing conditions are treated by pet insurance, which types might still get coverage, and how various policies manage these cases.

Types of Pre-Existing Conditions

Permanent/Chronic Conditions

Certain conditions are considered permanent or chronic. These include long-lasting issues such as diabetes, epilepsy, heart disease, and hip dysplasia. These are almost always excluded from coverage as pre-existing conditions; insurers generally will not make exceptions.

Curable/Temporary Conditions

However, it's not all bad news. Some temporary conditions, like an ear infection from 18 months ago or a fully healed broken bone, might qualify for coverage. Certain insurers will consider these if they're symptom-free before the policy starts and continue to be symptom-free within a set waiting period.

The Symptom-Free Waiting Period

For cured conditions to become eligible under your policy, expect to wait a period of symptom-free time. Depending on the insurer, this typically ranges from 6-18 months. For instance, Spot offers coverage after 180 symptom-free days for curable conditions (knee and ligament issues are excluded), while PetsOnMe requires an 18-month period.

The Bilateral Conditions Trap

An important caveat to understand is the bilateral conditions trap. If your dog tears its left ACL and it eventually heals, many insurers will still exclude BOTH knees/hips under a bilateral condition clause. They argue that the same structural risk exists on both sides, a major unnoticed exclusion in many policies.

What to Do at Enrollment

Getting a pre- or immediate post-enrollment medical records review is crucial. Insurers like Embrace offer a medical history review that outlines which conditions will be excluded as pre-existing. This preventive measure can save you from surprises when making claims.

PetsOnMe vs Spot: Comparison on Pre-Existing Handling

PetsOnMe

• Requires an 18-month symptom-free period for curable conditions
• Explicitly excludes bilateral conditions

Spot

• Allows coverage after a 180-day symptom-free period for curable conditions (excluding knee and ligament conditions)
• Bilateral exclusion applies; knee/ligament issues are not treated as curable under this clause

PetsOnMe: Comprehensive coverage with clear terms. Spot: Flexible terms for curable conditions.

Bottom Line

If your pet has ever had an orthopedic issue, a skin condition, or any recurring illness, scrutinize the policy's exclusion language thoroughly before purchasing. A policy summary page won't fully disclose all exclusions, and understanding these nuances can prevent future claim denials.

Where to buy

We don't sell insurance. If you're comparing plans because of breed-related health risks, a DNA test can flag inherited conditions worth asking an insurer about before you enroll:

• Wisdom Panel Essential Dog DNA Test: breed ID plus genetic health screening
• Basepaws Cat DNA Test Kit: cat breed, health, and dental insights
• Tractive Smart Dog GPS Tracker: live GPS, virtual fence, and health monitoring (subscription required)

*As an Amazon Associate, CompareMyPets earns from qualifying purchases. Prices and availability change often, so check Amazon for the current price.*