Insuring Agreement
This section holds the details of pet insurance coverage 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 pet insurance 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.
The following is a snippet from the PetCare policy:
PetCare has placed limits on illness categories. This means that for a given category, the pet insurance policyholder would be limited over the pet's lifetime as to how much coverage they would have. For example, if the pet dog had skin condition in month 2 and used $2500 and then got another skin condition in year 7, they would have $500 left to use.
Per incident limits place a dollar limit per accident or illness. Most pet insurance companies would consider all skin cancer in year 1, for example, a single incident. Similarly, some chronic conditions would also be considered a single incident, such as allergies or diabetes.
Lifetime limits are limits placed on total pet insurance coverage for the pet regardless of policy renewals or claims filed. Per year limits are also common among pet insurance 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 pet insurance policyholder is responsible for. Most US Pet insurance providers will require the policyholder to cover 10%, 20%, or 30% of the bill, although there are some that will cover 100%.
Below is a snippet from PetPlan in USA:
"A thirty (30)% coinsurance as stated on your Declarations Page will automatically apply to covered claims in the event that:
a. your veterinarian refers you to a specialized referral veterinary facility; or
b. you take your pet to an emergency care veterinary facility (except for a life-saving emergency consultation); or
c. you take your pet to an after hours veterinary facility (except for a life-saving emergency consultation); or
d. you take your pet to an accredited school/college of veterinary medicine."
PetPlan changes their usual 10% coinsurance to 30% if the policyholder uses an emergency care facility instead of their usual veterinarian. This is done by the pet insurance provider to offset the higher costs of emergency clinics.
The insuring section will almost always explain how the policyholder receives coverage of pet insurance claims. Almost all pet insurance companies in the US 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 insurance company. The insurance section will also explain to pet insurance policyholders how to submit claims for reimbursement.
