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. Most U.S. pet insurance providers will require the policyholder to cover 10%, 20%, or 30% of the bill, although there are some that will cover 100%.
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.
