Insurance Basics

Policy Definitions

Throughout the pet health insurance policy, the following words with special meanings will be bolded when used:

Accident
An event causing injury to the pet, when such injury is neither expected nor intended by you.

Clinical Examination
a thorough examination performed by a licensed and registered veterinarian encompassing all body systems, also referred to as "full physical, physical consultation, full examination or veterinary examination."

Clinical Symptoms
Any manifested anomaly in, or deviation from the regular healthy state or function of a pet, including behavioral traits. Symptoms include any anomaly that is readily detectible by a thorough and complete physical examination even if not manifested in alteration of function, or if missed during the clinical examination.

Coinsurance
Your portion of the cost of insured veterinarian treatment. Your coinsurance amount is shown on the Declarations Page.

Condition
Any manifestations of clinical symptoms consistent with a diagnosis or diagnoses, regardless of the number of incidents or areas of the body affected.

Coverage
The pet healthcare coverage described in this policy form and on the Declarations Page.

Deductible
The amount you must first pay with respect to any one loss, deducted from the total sum paid or payable for the loss under the terms of the policy. The deductible is to be paid first, before the policy pays any part of the loss; however, we may affect settlement of a claim by paying the total amount and then seek reimbursement from you for the deductible amount.

Dental Health Care
The regular care required to maintain dental hygiene for the pet, including brushing, scaling, polishing, extractions and reconstructions.

Diagnostic Tests
Tests used to determine the overall health of your pet. Diagnostic tests can be used as a way to detect certain abnormalities, validate the current health of your pet, or help to evaluate an older pet more thoroughly before problems surface.

Hospital Boarding Fees
Charges for the boarding of your pet at a veterinary clinic, also referred to as hospitalization.

Illness
Sickness, disease and any changes to your pet's normal healthy state; any condition other than your pet's normal healthy state.

Medication
Any veterinary recommended medications prescribed by your veterinarian and approved by the Food and Drug Administration (FDA) for veterinary use.

Neutering
Orchidectomy, or surgical removal of the testicles.

Pet or Pets
A domestic cat or dog that is owned for companionship or as a help dog, not owned for commercial reasons. Commercial reasons include, but are not limited to, a racing dog.

Policy Inception Date
12:01 a.m. on the date the application is processed by Trupanion, subject to the waiting periods as defined in What We Do Not Cover 7.a.(1) and 7.a.(2).

Pre-existing conditions
Illness or the recurrence of any illness or condition which first occurred or displayed any signs and/or symptoms consistent with the stated illness or condition prior to your pet's policy inception date.

An injury or recurrence of an injury that occurred prior to the policy inception date.

Any condition or complication resulting from pre-existing conditions(1) or (2).

Property Damage Liability
Your liability for damages which cause physical damage to, or destruction of, tangible property, or loss of use of real property and for which you are legally responsible as a result of the actions of your pet named in the policy. This does not include tangible property, which belongs to you or any person who lives with you.

Racing Dog
A dog, which is owned and maintained for the purpose of competing in organized races or speed tests.

Spaying
Ovariohysterectomy, or resection of the ovaries and uterus.

Surgeries
Medical procedures that treat diseases or injuries by operative manual and instrumental treatment.

Vaccination
The administration of an industry-recognized commercial vaccine by a registered licensed veterinarian, in accordance with the manufacturer's recommendations, following a complete clinical examination, for prevention of disease.

Veterinarian
A properly licensed and registered veterinarian in active practice in the area where your pet is treated or examined.

Veterinary Treatment
X-rays, laboratory tests, medication, surgery, nursing and care provided by a licensed veterinarian and their staff under direct supervision.

Veterinary Examinations Fees
Fees charged for the professional opinion of a veterinarian, also referred to as consultation, examination, referral, and recheck fees.

We, Us, and Our
American Pet Insurance Company is the insurance carrier. Trupanion handles many of the administrative processes for this insurance on behalf of American Pet Insurance Company, and the context of We, Us, and Our should be construed accordingly.

Working Pets
Any pet involved in activities other than companionship or helping, including, but not limited to, racing, breeding, hunting, and law enforcement or guarding.

You and Your
The Insured/spouse/partner (Pet owner) named in the Declarations Page.

Your Pet
The dog or cat named in the Declarations Page or in the schedule.

Insuring Agreement

This section holds the details of pet health insurance including what is covered, the coinsurance (how much will be reimbursed), and how reimbursement will take place. It basically says "If you pay your premiums, we will provide the following pet insurance under these conditions".

The following is a snippet from the Trupanion pet insurance policy:


"WE COVER: Diagnostic tests, surgeries, and medications recommended by your veterinarian for conditions covered by this policy if your pet becomes ill or has an injury as a result of an accident after the policy is in effect."

This means that Trupanion will cover conditions that occur after the waiting periods.

The insuring section will also hold benefits and limits. 'Limits' are typically different from 'limitations' in that limits are a dollar maximum to be paid out, while limitations are coverage restrictions. Pet insurance providers may place dollar limits on a per incident, per year, per illness category, or per lifetime basis.

Per incident limits place a dollar limit per accident or illness. Multiple incidents of the same condition, for example skin cancer, may be considered a single incident. Similarly, some chronic conditions may also be considered a single incident, such as allergies or diabetes.

Lifetime limits are limits placed on total healthcare coverage for the pet regardless of policy renewals or claims filed. Per year limits are also common among pet insurance companies and place a dollar limit for the maximum amount allowed for the policy year. This amount will reset at policy renewal.

The insuring section will also explain coinsurance. Coinsurance is simply the portion of the bill that the policyholder is responsible for versus what the pet insurance provider will pay. Trupanion's coinsurance, for example, is 10%.

The insuring section will almost always explain how the policyholder receives coverage of claims. Almost all pet health insurance companies in the U.S. have a reimbursement plan, where the pet owner pays the veterinarian for services then submits the claim and receives money back directly from the pet medical insurance company. The insurance section will also explain to policyholders how to submit claims for reimbursement.

Exclusions and Limitations

Lastly the pet insurance policy will list all things that are excluded from coverage. Almost all pet health insurance providers in the US exclude pre-existing conditions (conditions that occurred or showed symptoms for before the policy went into effect). Exclusions include those non-insurance related costs such as costs for grooming, feeding, and elective procedures. Additional exclusions vary policy to policy. Hereditary and congenital disorders are excluded from many pet insurance policies. These are important to take note of because they are amongst the most common claims made and can also be the most costly. Similarly, some pet insurance companies will exclude conditions by specific breed.