Our coverage for selected conditions
November 24 2015
Pre-existing conditions are not covered.
Congenital anomalies or disorders and Hereditary disorders are covered only under our Inherited Plus endorsement which is available for enrollment for dogs two years old and younger.
Chronic Conditions are covered unless they are pre-existing.
Other exclusions may apply. Please refer to the exclusions section of your policy for more information.
We do not reduce coverage or increase premiums based on your pet's individual claim history.
Summary description of claim payment determination
Determine allowable amount of claim (i.e. costs for covered conditions with onset dates in policy period after any applicable waiting period) which is then subject to the following adjustments stated in your declarations page:
- Annual deductible
- Co-pay amount
- Incident and annual limits
In order to do our part in administering fairness and affordability for all, we occasionally need to adjust a claim if it is significantly above what is reasonable and customary (R&C). These R&C amounts are derived and confirmed from both internal and external data whereby a given procedure or treatment on a veterinarian bill is cross checked with the cost of that same procedure or treatment charged by other Veterinarians in that geographical area.
Terminology and Meaning
- Chronic condition
- A condition that can be treated or managed, but not cured.
- Congenital anomaly or disorder
- A condition that is present from birth, whether inherited or caused by the environment, which may cause or otherwise contribute to illness or disease.
- Hereditary disorder
- means an abnormality that is genetically transmitted from parent to offspring and may cause illness or disease.
- Pet insurance
- An individual or group insurance policy that provides coverage for veterinary expenses.
- Preexisting condition
- Any condition for which a veterinarian provided medical advice, the pet received treatment for, or the pet displayed signs or symptoms consistent with the stated condition prior to the effective date of a pet insurance policy or during any waiting period.
- An individual who holds a valid license to practice veterinary medicine from the Veterinary Medical Board pursuant to Chapter 11 (commencing with Section 4800) of Division 2 of the Business and Professions Code or other appropriate licensing entity in the jurisdiction in which he or she practices.
- Veterinary expenses
- The costs associated with medical advice, diagnosis, care, or treatment provided by a veterinarian, including, but not limited to, the cost of drugs prescribed by a veterinarian.
- Waiting or affiliation period
- The period of time specified in a pet insurance policy that is required to transpire before some or all of the coverage in the policy can begin.
Benefit Schedule of Our Preventative Endorsements
|Maximum Allowable Limits|
|Spay/Neuter - Teeth Cleaning||$0||$150|
|Heartworm test or FELV screen||$25||$30|
|Blood, fecal, parasite exam||$50||$70|
|Urinalysis or ERD||$15||$25|