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Home > General > What Does Pet Insurance Not Cover? 13 Exclusions (With Examples)

What Does Pet Insurance Not Cover? 13 Exclusions (With Examples)

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Purchasing a pet insurance policy can help pet owners feel more confident in their ability to pay for unexpected medical care for their animals. However, even the most comprehensive pet insurance policy typically has at least a few exclusions. When shopping for an insurance policy, it’s essential to read the fine print regarding what is covered and what isn’t. In this article, we’ll cover 13 typical exclusions you might find in a pet insurance policy.

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Top 13 Things Pet Insurance Does Not Cover

1. Preventative Care

For Example: Annual exams, shots, heartworm test
Are They Ever Covered?: Add-on wellness policies sometimes available for an additional fee

Almost all pet insurance policies function as accident and illness plans. This means that they cover varying levels of care related to unexpected or emergency conditions, such as foreign body ingestion, car accidents, or illnesses. Pet insurance typically doesn’t cover the cost of routine or preventative care for healthy pets. Your yearly vet exam, shots, heartworm test, or routine, screening blood work probably won’t be covered. However, many pet insurance companies provide the option to purchase an additional wellness policy that covers some preventative care.


2. Pre-Existing Conditions

For Example: Any medical problem your pet had before getting insurance
Are They Ever Covered?: Sometimes, check with the insurance provider

Pet insurance typically doesn’t cover any medical conditions your pet suffered before purchasing the policy. Generally, insurance providers ask to view your pet’s medical history when you buy the policy to look for pre-existing conditions. However, every provider has different definitions of what qualifies as a pre-existing condition. If your pet is considered “cured” of a previous health problem, insurance may cover any recurrence after a certain length of time. To get your pet the most coverage possible, enroll them in an insurance policy as young as you can.

dog sitting on a weighing scale in vet clinic
Image By: Pressmaster, Shutterstock

3. Exam Fees

For Example: Actual cost of the physical exam
Are They Ever Covered?: Sometimes. Sometimes with an extra fee.

Most pet insurance policies don’t cover the cost of the physical exam if your pet suffers an emergency or accident. Vets usually charge more for sick visit exams because they take longer, while emergency or after-hour exam fees can be even more expensive. If your pet is very accident-prone, these costs can add up over time. Some insurance policies cover exam fees, while others offer the option to purchase an exam fee add-on to the standard policy.


4. Elective Procedures

For Example: Declawing, ear cropping, spay or neuter
Are They Ever Covered?: Spay and neuter sometimes as part of wellness coverage

Standard pet insurance generally doesn’t cover any elective procedures or those considered not necessary for the health of the pet. Common examples include cosmetic procedures such as ear cropping or tail docking. Declawing of cats or dewclaw removal in dogs are two other typical examples. Most insurance policies also consider spaying and neutering an elective procedure and won’t cover the associated costs. However, some companies offer puppy and kitten wellness packages that pay for spay and neuter surgeries up until a certain age.


5. Pregnancy and Birth Care

For Example: Ultrasounds, pregnancy complications
Are They Ever Covered?: Not typically

Generally, pet insurance doesn’t cover the costs of anything related to breeding, pregnancy, or birth care for pets. This could include anything from visits to the vet to find out if a female pet is ready to breed, extra pregnancy checkups or ultrasounds, and emergency care for birthing complications. Performing all necessary screening and medical care for breeding pets can be expensive, but because breeding is an elective process, insurance companies usually won’t help you out.

Pregnant Pug
Image Credit: Ezzolo, Shutterstock

6. Bilateral Conditions

For Example: Knee surgeries on both leg
Are They Ever Covered?: Sometimes

Knee ligament tears and injuries are common in energetic, large-breed dogs. If your pup suffers a knee injury that requires surgery, your pet insurance may cover the cost (depending on how long you’ve had the policy), but many of them won’t do it twice. If your dog suffers the same injury to the other knee, you’ll probably have to pay for that one yourself. Not every insurance provider handles bilateral conditions in the same way, so double-check the fine print of any policy you’re considering.


7. Boarding and Grooming

For Example: Nail trims, haircut, kennel stays
Are They Ever Covered?: Sometimes, with conditions

Pet insurance generally won’t cover boarding or grooming services for your pet. Some pet owners do not need these services anyway, but those whose favorite breed is a Poodle or a similar high-maintenance pet certainly might. Some insurance policies cover boarding costs under certain conditions. For example, if you are in the hospital and have no one to care for your pet, some policies will pay for them to be boarded. As always, compare individual policies to determine what’s covered.


8. Intentional Injury or Abuse

For Example: Cuts or broken limbs as the result of abuse
Are They Ever Covered?: Typically no

Any injury to your pet that is intentional or the result of deliberate abuse typically won’t be covered by pet insurance. Medical conditions caused by abuse can vary, including starvation or skin conditions resulting from neglected grooming. Other examples of intentional injury include free-roaming rural pets that may be shot at or poisoned to keep them away from neighboring chickens or other livestock. Check with your provider to confirm their policy on intentional injury, but most of these tragic cases won’t be covered.

dog injured Wound on paw
Image Credit: lovelyday12, Shutterstock

9. Preventable Disease

For Example: Diseases prevented by vaccines, like parvo or kennel cough
Are They Ever Covered?: Sometimes

This exclusion is less common and can vary widely in how it is interpreted and enforced. An insurance company may decline coverage for any condition or disease that they feel results from an owner ignoring a vet’s advice or neglecting routine preventative care. For example, insurance may not cover the cost if your pet contracts a disease with a reliable vaccine, such as parvo or kennel cough. If your dog gets heartworms because they aren’t on preventative medications, the cost of treatment may not be covered. Some insurance providers specify that they will still cover these costs.


10. Chronic Conditions

For Example: Diabetes, Cushing’s disease
Are They Ever Covered?: Sometimes

If your pet is diagnosed with a chronic condition, one that can’t be cured but will require lifelong management, insurance may not cover the long-term care. A typical example is a pet diagnosed with diabetes. These animals generally require special diets, insulin shots, regular blood sugar checks, and other medications.

An insurance policy may cover the initial costs of diagnosing diabetes but not all the expenses required to manage it. Some pet insurance policies specify that they will cover chronic conditions, although some may impose caps on the total amount covered.


11. Inherited Conditions

For Example: Breed-specific health conditions
Are They Ever Covered?: Sometimes

Some pet insurance companies won’t cover any medical condition with a known genetic cause passed from a parent. These are usually breed-specific because certain purebred dogs are known to suffer from conditions such as hip dysplasia or progressive retinal atrophy, which can be screened prior to breeding. Some thyroid conditions and even seizures could also fall into this category. Pet insurance sometimes will cover inherited conditions, but some may charge extra for certain breeds or cover them for all pets except specified species.

vet checking up dog with a catheter
Image Credit: RossHelen, Shutterstock

12. Behavioral Services

For Example: Anxiety medication, referral to a behavior specialist
Are They Ever Covered?: Sometimes

Many pet insurance policies won’t cover the cost of treating behavioral conditions your pet develops. Separation anxiety, litter box issues, and aggression are all examples of behavioral problems that pet owners might need professional help to address. More and more owners are attempting to solve behavior problems rather than surrender their pets, but the process often requires both time and money. Thankfully, some insurers provide coverage for behavioral care as part of a standard policy.


13. Alternative Therapies

For Example: Acupuncture, herbal supplements, CBD
Are They Ever Covered?: Sometimes

Pet insurance typically doesn’t cover any treatment considered experimental or alternative. However, this varies by policy, and some care previously viewed as alternative, such as acupuncture, has become more mainstream and may be covered. You may not be able to get everything covered, but some policies are more accepting of alternative therapies than others.

divider-pawConclusion

The 13 pet insurance exclusions might be the most common, but this list is by no means exhaustive. As you compare pet insurance policies, take the time to determine what each covers to find out what makes the most sense for you and your pet. No matter which policy you choose, some services will be excluded, so make sure you are prepared with alternate ways to cover the costs, such as a pet savings account.

There is still a lot that is covered with pet insurance and knowing what’s covered is important. We recommend checking a few different companies to compare policies and find the one that best fits your needs.

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