What Pet Owners Should Know About How Insurance Works: Deductibles, Payouts, Waiting Periods and Coverage

How reimbursements are calculated

Pet insurance generally works like health insurance: owners pay premiums for coverage, and the policy sets deductibles, reimbursement rates and payout limits. Many plans reimburse owners after they pay veterinary bills and file a claim.

For example, with an $800 covered bill, a $250 annual deductible and an 80% reimbursement rate, the article gives an expected owner cost of $360. Reimbursement rates commonly range from 50% to 90%; higher rates generally come with higher premiums.

Waiting periods and exclusions

A policy’s waiting period matters because injuries or illnesses that arise before it ends will not be covered. Owners would be responsible for those veterinary costs themselves. Policies also commonly exclude pre-existing conditions, and some may apply waiting periods to certain conditions depending on whether they are curable. Routine and preventive services, including vaccinations, annual check-ups and heartworm or flea and tick prevention, are usually excluded unless a wellness package is purchased.

Filing a claim

Usually, owners pay the veterinarian for services and keep the receipt. They then provide the insurer with details about the visit and treatment; the company may also request medical records or notes from the appointment.

Only a few providers offer direct payment to veterinarians. When available, the insurer pays the veterinarian directly, while the owner pays the deductible and any coinsurance at checkout.

Age limits and costs

Some insurers limit the age of pets they will cover. Those limits can range from 10 to 14 years, depending on the company. Premiums, deductibles, reimbursement rates, exclusions and limits all shape how much protection a policy provides and how much owners may pay out of pocket.