As a rule, pre-existing conditions are defined as any medical condition for which your dog or cat has been treated before your pet insurance plan comes into effect, and that includes any conditions and diagnosis during the waiting period. Most pet insurance providers don’t cover pre-existing medical conditions, period; other pet insurance companies provide limited coverage for pre-existing conditions with specific exclusions.
For example, some insurers will cover ‘curable’ conditions, provided they have successfully diagnosed and treated and haven’t recurred for up to 12 months. Curable conditions could include respiratory infections, diarrhea and bladder infections; however, if only the symptoms have been treated and no cause determined then condition is likely to be excluded.
Pre-existing conditions deemed ‘uncurable’ and which are excluded from most policies include orthopedic conditions such as luxating patellas (displaced kneecaps) and hip and elbow dysplasia, cancer, diabetes and hyperthyroidism.
Undiagnosed symptoms may also be considered pre-existing if they are present at the time you purchase your pet insurance policy. For example, if your dog has ongoing diarrhea when you purchase your plan and your vet is only able to determine the cause (a gastro-intestinal disorder) after the policy comes into effect, the disorder may be considered pre-existing and excluded from coverage.
Note: Some conditions may be considered pre-existing even though technically they haven’t occurred before. Bilateral conditions like cruciate ligament injuries, for example, tend to occur on both sides of the body, although not necessarily simultaneously. So, if your dog ruptures her right cruciate ligament and it is successfully treated, but three years after you purchase your pet insurance policy she ruptures the left side, it may be considered a pre-existing condition and won’t be covered.
Cancer is another example; your cat may be successfully treated for one form of cancer, but two years into your pet insurance policy he may get another type of cancer, which may be considered a pre-existing condition and excluded from cover.
Finally, some breed-specific conditions may also be excluded as ‘pre-existing’. For example, bulldogs, St. Bernards and basset hounds are prone to hip dysplasia, so some pet insurance providers exclude the condition from plans for these breeds.
Honesty is the best policy
It is crucial that you are completely honest and upfront with your insurance provider about all of your pet’s previous medical conditions, injuries and illnesses. If it is found that you intentionally lied or mislead the insurer you may be found guilty of fraud. At the very least this will result in your policy being cancelled, at worst it could land you in prison.
Insurance providers reserve the right to request your pet’s medical records for the past two years to verify the information provided. This is especially the case if you want to purchase insurance for a senior pet – bear in mind that the insurer may also require a complete physical from a vet before determining any exclusions (pre-existing conditions) and the extent of cover.
It works both ways, as insurance providers also have to be transparent about how they define pre-existing medical conditions and about which conditions are always excluded and which conditions are excluded conditionally, based on your dog’s or cat’s medical history.
A final piece of advice from veterinary Dr. Wilkerson is that if you ever want to upgrade your policy or change providers, you find out if any of the conditions you claimed for on your current policy will be covered or treated as pre-existing conditions and excluded.
Remember: If in doubt, it is in your best interests to ask.