What does pet insurance not cover?

Pet insurance exclusions

Preexisting conditions, routine care, wellness services, elective procedures and cosmetic surgeries are among the most common exclusions in pet insurance coverage. Here are details about each:

• Preexisting conditions: Health issues diagnosed or treated before your policy’s start date
• Routine care: Checkups, vaccinations and other preventive services
• Elective or cosmetic surgeries: Procedures like tail docking, ear cropping or surgeries that alter your pet’s appearance
• Behavioral treatments: Obedience training, aggression management or anxiety therapy that does not treat a medical condition

Additionally, most pet insurance policies won’t cover:

• Preventable injuries or illnesses, such as those caused by fighting or abuse
• Breeding-related expenses like C-sections or birthing assistance
• Accidents or illnesses that occur while working (for service or police animals)

» LEARN: What does pet insurance cover?

Preexisting conditions

Pet insurance typically doesn’t cover preexisting conditions — any health issue diagnosed or showing symptoms before your policy’s effective date. For example, if your dog had arthritis before you signed up, arthritis treatments won’t be covered.

Some insurers, like Embrace Pet Insurance, offer coverage for curable preexisting conditions if your pet has been fully treated and symptom-free for a certain time. Others, like AKC Pet Insurance, extend coverage to some chronic preexisting conditions after 365 days of continuous enrollment. These exceptions vary by provider, so it’s important to review your policy carefully.

Routine care and wellness visits

While pet insurance can cover unexpected illnesses, injuries and emergencies, most policies exclude routine care. Common exclusions include:

• Annual checkups
• Dental cleanings
• Flea and tick prevention
• Nutritional counseling
• Pet food prescriptions
• Preventive exams
• Routine blood work and health screenings
• Spaying or neutering
• Vaccinations

These services are considered preventive and are usually excluded from traditional insurance plans. If you need coverage for any of these procedures, consider setting up a dedicated savings account for routine expenses or using low-cost clinics, such as those found through Petco Love’s free vaccination programs, for general care. Note that all pet insurance plans are different, and coverage can vary between providers.

Many insurers offer a wellness plan add-on to cover the costs of some routine procedures. For instance:

• Lemonade and Embrace let you bundle wellness coverage with standard insurance for a higher premium.
• Pumpkin Pet Insurance offers a stand-alone wellness plan to cover routine care like vaccines and health screenings, with no standard plan purchase required.

Wellness add-ons sometimes cover routine surgeries, so check with your insurer for details. Certain procedures like spaying or neutering may be covered if they’re medically necessary — for example, when treating pyometra or prostate conditions. Similarly, cosmetic surgery for a cleft lip might be included if the animal has trouble with essential functions like eating or breathing.

» MORE: How much does pet insurance cost?

Behavioral treatments and training exclusions

Most pet insurance policies exclude behavioral treatments or training, including obedience classes, aggression management or anxiety therapy. Exceptions may apply if the behavior stems from a covered medical condition, such as anxiety caused by a thyroid imbalance.

For help with behavioral concerns, consult your veterinarian, who might recommend medications or therapies. While these costs are usually out-of-pocket, you can find affordable resources like low-cost trainers or behavioral specialists in your area.

Coverage limits and caps

One drawback of pet insurance is that most providers impose reimbursement limits. These could be:

• Annual limits: A cap on how much you can claim per year (e.g., $10,000)
• Per-incident limits: Restricting how much you can claim for a specific condition or event
• Lifetime limits: Total reimbursement caps over your pet’s lifetime

Some plans offer unlimited annual coverage, but those policies usually charge high premiums.

Waiting periods and claims process

When signing up for pet insurance, understanding the timeline for coverage and how to file claims is invaluable. Both waiting periods and the claims process play a significant role in how and when your policy provides support for your pet’s care.

All pet insurance providers have waiting periods to prevent fraud. For instance:

• Accident-only plans tend to have shorter waiting periods.
• Illness coverage might require a longer wait time, with some conditions excluded for months after enrollment.

To file a claim, you’ll typically need itemized receipts and medical records. Most insurers offer online or app-based claim submissions. Reimbursements are processed based on your policy’s terms, usually as a percentage of the cost after your deductible is met.

Why does pet insurance have waiting periods?

Waiting periods act as a safeguard for insurance companies, ensuring that pet owners don’t sign up for coverage only after their pet gets sick or injured.

The length of a waiting period depends on the type of policy and the insurer. Accident-only policies tend to have the shortest waiting periods at a couple of days, while illness coverage typically requires a delay of around 14 days. Some orthopedic illnesses and curable preexisting conditions can come with waiting periods of up to a year.

How does the pet insurance claims process work?

Once your pet is covered, filing a claim is usually straightforward. After paying your veterinarian for services, you’ll submit a claim to your insurance provider. Most companies allow you to do this through mobile apps, online portals or even email.

When submitting a claim, you’ll typically need to include documentation such as an itemized receipt and medical records. Reimbursement is based on your policy’s coverage terms—usually a percentage of the total cost after you’ve met your deductible.

Processing times vary. Some providers offer faster claims resolutions within a few days, while others may take a couple of weeks. To make things easier, many insurers provide direct deposit options for reimbursements.