Understanding Pet Insurance and Pre-Existing Conditions

Common exclusions for pet insurance coverage are pre-existing conditions. Naturally, many pet owners frequently ask how and whether pet insurance can work with pre-existing conditions.

Let’s explore the different types of pre-existing conditions you may come across and how they’re defined by pet insurance coverage. We’ll provide details on whether MetLife Pet offers coverage for certain types of conditions and some tips to help you avoid pre-existing condition exclusions.

What Is a Pre-Existing Condition for a Pet?

MetLife Pet often defines a pre-existing condition as any injury or illness contracted, manifested, diagnosed, or treated prior to when pet insurance benefits went into effect — or during applicable waiting periods. This might look something like:

• Your cat was diagnosed with diabetes before being enrolled in a pet insurance policy, making it a pre-existing condition.
• You enrolled your puppy in a pet insurance policy with a 14-day waiting period on illnesses. They were diagnosed with leptospirosis 3 days after your policy’s effective date, classifying it a pre-existing condition.

For pet parents, it’s important to find a policy that can benefit your pet and your finances the most. Understanding how a provider defines pre-existing condition coverage is a key part in that.

Does Pet Insurance Cover Pre-Existing Conditions?

Because pet insurance is meant to help you cover the costs of vet bills related to new health issues, pre-existing conditions aren’t typically covered by policies. MetLife Pet vet claims adjuster Allison Faulkner states, “The number one reason we have to deny claims is pre-existing conditions.” However, MetLife Pet may be able to cover pre-existing conditions in certain circumstances.¹

How do pet insurance providers know pets have pre-existing conditions?

Depending on the provider, you may be asked if your pet has any pre-existing conditions when you apply for pet insurance. Or your pet might be required to have a vet exam to enroll. These can help insurers determine if your pet has pre-existing conditions.

Later, when you submit a claim for reimbursement, you also need to provide your pet’s relevant vet records along with your vet visit invoice.² This allows pet insurance companies to see a pet’s medical history and determine if the services provided were related to a pre-existing condition.

While it may seem like insurance companies make a reimbursement decision based on their own knowledge, Faulkner says, “... at the end of the day, it’s all about what’s written in the medical records. We’re not going to use our knowledge to contradict what the vet says.”

Why is your pet’s condition not covered when the website says it is?

Sometimes, you might submit a claim for a condition your pet insurance provider says they cover, only to be denied reimbursement.² It could be that when your provider gathered all the relevant vet records needed to process your claim, they found the condition your pet received services for is considered a pre-existing condition.

Faulkner offers some reassuring words, saying, “End of the day, we’re not in the exam room. All we can do is try to figure out what the story is.” Faulkner adds, “We have an appeal process in case we need more clarification.”

How Does Pet Insurance and Pre-Existing Conditions Work?

While pet insurance plans may not cover conditions or illnesses that occur before the policy begins, this doesn’t mean pets with pre-existing conditions are ineligible for pet insurance. Pre-existing conditions can make it complicated to understand how pet insurance works. So let’s break it down.

Curable pre-existing conditions

Curable pre-existing conditions are injuries or illnesses that can typically be “cured” or resolved with treatment. Pet insurance may cover these kinds of conditions if your pet has been symptom- and treatment-free for a period of time — or if the incident prior to coverage is unrelated to the same incident happening during coverage.

Some curable pre-existing conditions can include:

• Bladder infections
• Ear infections
• Diarrhea or vomiting
• Respiratory infections
• Urinary tract infections (UTIs)
• Fractures
• Wounds

If your pet had a curable pre-existing condition before being enrolled in a MetLife Pet policy, there’s a chance the condition could be covered in the future. As long as the future incident is unrelated — according to medical records — to the incident that happened prior to coverage.

For example, if your dog got an ear infection due to swimming before coverage, but got another ear infection after coverage began due to ear mites, even though it’s the same condition, since the second ear infection isn’t related to the first one it could be covered in part by your policy. Conversely, if the ear infection after coverage was found to be related to the ear infection before coverage, it would likely be considered pre-existing and excluded from coverage.

Incurable pre-existing conditions

Incurable pre-existing conditions are those a pet may have for the rest of their life (i.e., chronic) because they generally can’t be fully “cured” with treatment. This makes the condition an exclusion from pet insurance coverage in most instances.

Some incurable pre-existing conditions can include:

• Allergies
• Arthritis
• Cancer
• Diabetes
• Epilepsy
• Organ diseases (like heart, kidney, or liver)
• Hip dysplasia
• Orthopedic conditions

If your pet has an incurable pre-existing condition before you sign them up for a policy with MetLife Pet, the condition will likely not be covered by our policies at any point.

Hereditary and congenital conditions

Hereditary conditions are diseases, illnesses, and other health conditions a pet may be more likely to develop due to their genetics. But just because a pet may be more likely to develop an issue, doesn’t mean it’s automatically excluded from pet insurance coverage. It will, however, be excluded if it’s deemed a pre-existing condition as outlined by your policy — or if a provider specifically states a condition will never be covered.

Congenital conditions are health conditions pets have at birth. Coverage for these conditions depends on the provider. Some examples of congenital and hereditary conditions include brachycephalic airway syndrome (BAS), hypothyroidism, Addison’s disease, hip dysplasia, and more.

A standard policy with MetLife Pet can typically help provide coverage for hereditary and congenital conditions as long as they aren’t considered a pre-existing condition according to your policy.

Bilateral conditions

Bilateral conditions are health conditions that may start on one side of the body and could eventually affect both sides. For this reason, coverage of bilateral conditions usually depends on whether or not one side of the pet’s body is already affected — making it a pre-existing condition. Examples of bilateral conditions include hip and elbow dysplasia, cataracts, glaucoma, cruciate ligament injuries, and more.

MetLife Pet policies can typically help you cover bilateral conditions as long as your pet’s medical records don’t show that one side was previously affected. It would then be considered a pre-existing condition.

Should You Get Pet Insurance if Your Pet Has a Pre-Existing Condition?

If your pet already has a pre-existing condition that would be excluded from coverage, is it worth it to get them pet insurance post-diagnosis? While expenses related to that condition likely won’t be covered, your pet can still have coverage for new injuries and illnesses.

We never know when pets will get hurt or sick, and having pet insurance can help you cover vet expenses in the future. This could make new vet costs easier to financially manage — especially if you’re going to be paying for vet bills related to a pre-existing condition. It could also mean costly vet care becomes more financially accessible, so you can worry less about unexpected vet bills hitting your bank account.

With MetLife Pet, pre-existing conditions won’t ever disqualify your pet from being able to enroll in a policy. Plus, if your pet had a “curable” pre-existing condition, like an ear infection, they could be covered for new expenses from the same type of condition (e.g., another ear infection). Note that the future incident must be unrelated to the one before coverage.

How Does Pre-Existing Condition Coverage Work When Switching Pet Insurance?

If your pet is enrolled in a policy with another pet insurance provider but you’re looking to switch, health conditions that are currently covered would typically be considered pre-existing with the new provider. So what pet insurance covers pre-existing conditions if you want a new policy? MetLife Pet has a solution.

When switching to a MetLife Pet group policy, you may be able to get continued coverage for pre-existing conditions that were covered by your pet’s previous provider.¹ So if your dog’s arthritis is currently covered by another provider, and you switch to a group policy with MetLife Pet without a gap in coverage, expenses related to their arthritis could still be covered — at your reimbursement rate — under your new policy.²

Pre-Existing Condition Coverage Tips

Here are a handful of tips to help you make the most of pet insurance coverage, and help you avoid pre-existing condition exclusions.

• Get a policy early on. Enrolling your pet in a policy when they’re younger and healthier can mean there’s less of a chance that conditions they develop later on would be considered pre-existing and excluded from coverage.
• Look for specific conditions that, no matter what, may be excluded from coverage. Some policies name specific health conditions that are automatically excluded from coverage. If your pet is more likely to develop a hereditary condition that’s excluded, it may be wise to find another pet insurance option.
• Be proactive with routine pet care to help keep your pet healthy. Routine pet care can help keep pets healthier and might help decrease the chances of certain health conditions developing. These conditions could be excluded from coverage if your pet isn’t already enrolled in a policy.
• Be prompt with getting care for injuries and illnesses so things don’t get worse. You could help mitigate high vet bills, and potential exclusions, later on by treating injuries and illnesses when they happen.
• Look for policies with short waiting periods. If injuries or illnesses happen during a waiting period, they’re likely considered pre-existing and excluded from coverage. Getting pet insurance with short waiting periods could mean if your pet gets sick or hurt in the near future, your waiting period may be over already. MetLife Pet offers a 0-day waiting period on accidents and 14 days on illnesses.³

It’s not always possible to avoid pre-existing condition exclusions. But having coverage for new accidents and illnesses could make a difference in saving money on future pet care — especially if you have to pay for all of your pet’s pre-existing condition care.

Get Award-Winning⁴ Coverage for Dogs and Cats With MetLife Pet

Pre-existing conditions shouldn’t stop you from enrolling your dog or cat in a pet insurance policy.

With MetLife Pet, you could still have coverage for new vet bills that occur, and even routine vet bills if you add a Preventive Care plan to your policy. Take advantage of our 0-day waiting period on accidents — and Preventive Care — alongside our coverage of previously-covered pre-existing conditions when you switch providers through your employer.^1,3

Award-winning⁴ pet insurance is just a few clicks away. Explore your customization options by getting a free, personalized quote today.