What exactly is pet insurance, and how does it work? Pet health insurance policiesare designed to help protect you from unexpected, large, or ongoing veterinary expenses resulting from your pet’s accidents and illnesses. Many different plan types and policy structures that meet variable needs and budgets are available, and most offer customizable policy terms so you can get the best value for your situation.
Spot Pet Insurance policies are based on two main plan types: accident-only and accident and illness. Base plans don’t cover routine care or expected care, like wellness exams or vaccines, but our preventive care add-ons can help offset those costs. Here, we explain pet health policy terminology and concepts to help you understand how a policy works.
Pet Insurance Terms Explained
Knowing insurance terms can empower you to make informed choices about your pet’s policy and healthcare needs. Here are some basic definitions:
Premium: A premium is the price you pay to enroll in or renew a plan. You can pay premiums annually or monthly.
Deductible: A deductible is the amount you must pay toward covered services before your plan begins reimbursing you. Deductibles reset each year when your plan renews.
Reimbursement rate: Your reimbursement rate is the percentage of a veterinary bill, minus any deductible and exclusions, your plan will pay.
Annual limit: The annual limit is your plan’s maximum reimbursement for covered services in a given year. Some plans offer unlimited annual coverage.
Waiting period: Waiting periods dictate how long you must wait after you enroll in your plan before benefits begin. Conditions that occurr during specified waiting periods are considered pre-existing and may be excluded from future coverage.
Adjusting plan customizations
When enrolling in a new plan, you can choose from a range of deductibles, annual limits, and reimbursement rates. High deductibles and low annual limits can lower your monthly premiums, but you’ll pay more out of pocket when your pet needs care. Conversely, low deductibles and high annual limits can raise monthly premiums but help control upfront veterinary costs.
Waiting periods are determined by the insurance company and the state where you live. Although you can’t choose your waiting period, some plans may allow waivers if a veterinarian certifies your pet is in good health.
Claims and reimbursements
Most pet insurance providers operate on a reimbursement basis. This means policyholders will first pay for their pet’s veterinary care and then file a reimbursement claim.
To file a claim, first visit your vet and pay for services. Then, send a copy of your paid invoice and any relevant medical notes or claims forms to your insurance company via phone, email, mobile app, or online portal. Once your insurance company processes the claim, they’ll send you a check or direct deposit reimbursement.
What are Some Exclusions in Pet Insurance?
Every pet health policy has a list of coverage exclusions and limitations. The most common exclusion across the board is pre-existing conditions, or health issues or symptoms that were present before enrollment or during the waiting period. Your insurance company will request and review your pet’s medical history after enrollment or when you file a claim to determine if pre-existing conditions apply to your pet’s plan.
Other exclusions—and inclusions—vary, depending on the company and specific plan, so you should always read a sample policy to ensure you’re understanding before enrolling. Common services not covered by pet health plans include:
Breeding or pregnancy costs
Routine care in the absence of a preventive care plan
Supplements and prescription foods
Holistic or herbal medicine
Cosmetic or elective procedures
How to Submit a Pet Insurance Claim with Spot
The Spot claims experience is simple and convenient. Follow these steps to submit a claim:
Obtain a copy of your paid, itemized invoice.
Log into the Member Center Portal on your computer or mobile device.
On the home page or claims page, click “Start new claim.”
Follow the prompts to enter information about your pet’s visit.
Upload a photo or copy of your invoice to submit with the claim.
Request that medical notes from your visit be sent to you or directly to Spot.
You will receive a check in the mail or a direct deposit for eligible expenses when processing is complete, which takes two days on average*.
Pet health insurance can empower you to take charge of your pet’s care without worrying about whether you can afford it. Knowing how pet health insurance works and how plan choices can impact costs and reimbursements will help you make informed decisions about your policy and pet’s veterinary care. If you have questions about Spot Pet Insurance plans, contact our helpful customer service team or check out our FAQs page.
*February 2024 to May 2024 claims administrator data
