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In pet insurance, a reimbursement is the money you could get back on covered costs, minus your deductible and up to your annual limit, after submitting an eligible claim to your insurance provider. MetLife Pet Insurance has reimbursement percentage options of 50%, 70%, 80%, and 90% you can choose from.1
We’ll discuss the types of reimbursement options available to you and how they work, then provide examples of MetLife Pet’s process so it’s all a little easier to understand.
There are generally two types of reimbursements: a percentage or a benefit limit dollar amount. Most of your standard pet insurance policies — like accident and illness plans or accident-only plans — calculate your reimbursement using a percentage (or rate). Optional plans, like a wellness add-on, might use a schedule of benefits with specific reimbursement limits to pay you back.
If your plan calculates your reimbursement based on a reimbursement rate, this is expressed as a percentage of the vet bill you’d get back — but only on costs that are covered by your policy. Many pet insurance plans are customizable, so you can choose a reimbursement rate that works for you. The higher your reimbursement percentage, the more money you may be able to get back on covered costs.
A schedule of benefits is a list of expenses that are covered under your plan, along with benefit (or reimbursement) limits for each — usually expressed as a dollar amount. With this reimbursement type, you can only be reimbursed up to the dollar amount listed in your schedule of benefits during that policy period for those specific expenses.
Because pet insurance often operates with reimbursements, that means you pay the vet bill and then submit a claim to get money back. If expenses are covered by your policy and occur after your waiting period is over, they can be eligible for reimbursement.
To start getting reimbursed, you typically have to meet your plan’s deductible first.1 Some pet insurance providers subtract your deductible amount from the vet bill before applying your reimbursement rate to calculate your reimbursement amount. Other insurers may apply your reimbursement rate to the vet bill first, and then subtract your deductible from that total to arrive at your reimbursement amount.
MetLife Pet subtracts your deductible first, and then applies your reimbursement rate.1 Mathematically, this method tends to result in a slightly higher reimbursement than if you subtract the deductible after applying the reimbursement rate.
An annual limit is a dollar amount that restricts the amount of money you can be reimbursed in a policy period. Once you’ve reached the maximum amount your insurance provider will pay out — aka the annual reimbursement limit — you won’t receive additional reimbursements until your policy renews. Some plans also have per-incident limits that may factor into reimbursements. MetLife Pet doesn’t have any per-incident limits.1
To help you see how reimbursements work, let’s look at a couple of hypothetical scenarios using MetLife Pet’s standard accident and illness plan, and our optional Preventive Care plan.
With a reimbursement rate of 90%, your pet insurance plan can pay you back 90% of eligible costs, and you’re responsible for the remaining 10%. Let’s say you have a plan with a 90% reimbursement rate, a deductible of $100, and an annual limit of $10,000. Your pet goes to the vet for limping, and after testing, they’re diagnosed with patellar luxation and later gets surgery to repair it. The entire vet bill totals $6,000, and all expenses are coverable under your policy.2
Since this is your first claim of the policy year, we subtract your $100 deductible from the $6,000 and get $5,900. From there, we apply your 90% reimbursement rate to that number and get a reimbursement amount of $5,310.2
One of the ways you can be reimbursed through our Preventive Care plan is according to a schedule of benefits. Say your plan lists vaccinations as a covered benefit, and the limit is $100 for the policy year. During that year, you could get up to $100 back on claims for vaccinations — your deductible doesn’t apply to this type of reimbursement. If you submit claims for vaccinations after you’ve reached your $100 limit, you won’t get reimbursed until your policy renews.2
The above examples should give you an idea of how reimbursements may be calculated with our plans. It’s also important to know how our reimbursement process works, so you can take full advantage of your benefits.
After a vet visit, you have 90 days to submit a claim, or it won’t be eligible for reimbursement. Before calculating your reimbursement amount, we must first figure out which expenses are covered by your policy. After we determine that dollar amount, we subtract any unmet deductible for your policy and then apply your reimbursement percentage. Once we have a reimbursement amount for your claim, we ensure you haven’t yet met your annual limit.
After submission, most MetLife Pet Insurance claims are processed within 5 days, but it could take up to 30 if additional information is needed.3 We’ll send any amount you’re owed using your preferred method — this could be through a direct payment or physical check.
Currently, MetLife Pet doesn’t offer the option to pay your vet directly. Like many pet insurance providers, we use reimbursements to help you manage pet care expenses, and strive to make the process as quick and easy for you as we can.
Transparency is what we aim for with reimbursements and coverage, so that using your pet insurance can be easy. After all, making sure your pet can get the care they need is where we want your focus to be — instead of on how your coverage is going to work.
Explore your plan customization options by getting a free quote and seeing your personalized rates.
