Pet insurance companies consider a pre-existing condition any disease or symptom noted in your pet’s medical records before their insurance plan enrollment. Although some providers, including Spot Pet Insurance, distinguish between curable and incurable conditions, others automatically exclude these conditions from coverage.
While most plans won’t deny such coverage, your pet’s health history can significantly impact their eligibility for specific coverages. Understanding how pre-existing conditions in pet insurance can affect your policy ensures you know what to expect from your provider and allows you to plan for your pet’s health needs accordingly.
Definition of Pre-Existing Conditions in Pet Insurance
Pre-existing conditions in pet insurance are health issues, illnesses, or injuries with visible signs and symptoms in a pet before insurance coverage takes effect, including during applicable waiting periods. Once your insurance company determines that a health issue is pre-existing, they will temporarily or permanently exclude the condition from future coverage.
How are Pre-Existing Conditions in Pet Insurance Determined?
Pet insurance companies use your pet’s medical history to identify existing conditions, which go beyond official diagnoses and include any condition for which you sought veterinary care, including those that responded to treatment or did not warrant a full investigation of the underlying causes.
For example, an insurer may consider a bout of vomiting a few months before plan enrollment as a symptom of many possible gastrointestinal (GI) and systemic diseases. If vomiting recurs and requires control with diagnostics or treatments, the plan will likely exclude coverage for these expenses, because your pet showed the same disease signs in previous months.
Unless your veterinarian can prove the incidents weren’t related by using diagnostic test results or clinical judgment, the insurance company may assume the second bout of vomiting is because of an undiagnosed pre-existing condition.
Types of Pre-Existing Conditions Common in Pets
Pre-existing conditions may be considered chronic or curable, with each affecting coverage eligibility differently.
Chronic conditions
Pets may start showing signs of a chronic condition when they are young. Culprits commonly deemed pre-existing include:
Allergies
Inflammatory bowel disease
Heart conditions
Congenital disorders
Diabetes
Epilepsy
Curable versus incurable conditions
Some companies differentiate between incurable (i.e., chronic) and curable pre-existing conditions. Spot plans, for example, will extend future coverage for pre-existing conditions our experts deem curable and cured, such as a respiratory infection or minor injury, if your pet shows no symptoms or doesn’t require treatment related to the original problem for at least six months or 180 days. This does not apply to ligament and knee conditions. In contrast, incurable conditions will be excluded on a pet’s plan for their lifetime.
How Do Insurers Evaluate Pre-Existing Conditions?
Pet insurance companies use several strategies to make decisions about previous health conditions.
Medical records and waiting periods
When your pet is enrolled in a new plan or you submit your first claim, your provider will request past medical records for at least six months to a year, or longer for older pets. If you refuse to submit documents or comply with vet exam requirements, your provider may deny claims. Waiting periods can delay coverage start dates by several weeks or months, which allows more time for existing conditions to reveal themselves.
Exclusions and age considerations
Pre-existing condition exclusions sometimes vary based on a pet’s age. For example, an insurer may cover joint diseases in dogs younger than 5 years, but exclude them in older dogs, assuming that any joint disease that appears after that age likely developed when the pet was younger, and before the pet was enrolled. Older pets enrolling in a new pet insurance plan may have fewer options for comprehensive coverage than their younger counterparts.
The Importance of Getting Pet Insurance Early
Pre-existing conditions in pet insurance are less likely when you enroll pets at a young age. The longer you wait to insure your pet, the more likely they’ll have at least one condition affecting coverage.
For chronic conditions like allergies or epilepsy, which often appear during young adulthood, a pre-existing condition determination could cost you thousands over your pet’s lifetime. However, with regular preventive care and routine veterinary visits, you can manage your pet’s overall health and keep other issues from developing.
Conclusion
Pet owners should carefully review plan documents to understand how pre-existing conditions in pet insurance can affect other policy terms. Most importantly, enrolling pets at a young age minimizes the possibility of pre-existing conditions undermining future coverage and helps you get the most value from your plan. Learn about Spot’s curable pre-existing conditions policy in our FAQs, or visit our website for a quote.
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Elizabeth Kowalski holds a bachelor’s degree in biology from the University of Illinois and an associate’s degree in veterinary technology from Purdue University. After more than 10 years working as a certified veterinary technician, she chose to pursue veterinary writing, combining years of practical knowledge with a talent and passion for the written word. Elizabeth enjoys creating content for pet owners and veterinary professionals alike, and spends her free time playing sand volleyball and lounging at home with her pitbull, Piglet, and husband, Brenton.
Angela Beal is a veterinarian who loves using her writing to help pet owners provide the best possible care for their furry companions. Since 2020, she has worked full-time with Rumpus Writing and Editing, a veterinary-specific writing and editing company .Learn more at rumpuswriting.com.
