Does Pet Insurance Cover 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.

At MetLife Pet, we understand that it can be confusing and want to be honest about the coverage your pet may receive. Here’s a breakdown on what pre-existing conditions are and how they impact pet insurance coverage.

What Is a Pre-Existing Condition for a Pet?

MetLife Pet often defines a pre-existing condition as any injury or illness contracted, manifested, or incurred prior to the date the policy goes into effect or before any relevant waiting periods end.

Pre-existing condition examples

Let’s take a look at a couple of examples to help you understand pre-existing conditions a bit better.

• If your cat is diagnosed with diabetes prior to you enrolling in a pet insurance policy, it’s typically considered a pre-existing condition, and related expenses likely won’t be covered.
• If you enrolled in a pet insurance policy with a waiting period of 14 days on illnesses, and your puppy was diagnosed with leptospirosis 3 days after your policy’s effective date, expenses related to the treatment of lepto likely won’t be covered.

Does Pet Insurance Cover Pre-Existing Conditions?

Typically, there isn’t pet insurance that covers pre-existing conditions — regardless of medical notation, diagnosis, or treatment. More often than not, these conditions are excluded from coverage. MetLife Pet vet claims adjuster Allison Faulkner states, “The number one reason we have to deny claims is pre-existing conditions.”

Like many insurance policies, pet insurance is generally intended to protect your pet from medical conditions that may happen in the future, not in the past. 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?

When you submit a claim, you’ll likely need to provide your pet’s relevant vet records along with your vet bill invoice. 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.”

You may also be asked if your pet has any pre-existing conditions when you apply for pet insurance.

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

If you submitted a claim for a condition that your pet insurance provider says they cover, yet you weren’t reimbursed for it, you may be wondering why. It could be that when your provider gathered all the relevant vet records needed to process your claim, they found that the condition your pet received services for is considered a pre-existing condition.

While another policyholder may be reimbursed for the same condition your pet has, it’s likely that it wasn’t considered a pre-existing condition for their pet when they submitted their claim.

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?

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

Typically, pet insurance can help cover veterinarian bills for accidents, illness, hospitalizations, and more. But since expenses related to pre-existing conditions likely aren’t covered, you’ll usually only be reimbursed for covered expenses unrelated to the condition.

When it comes to your policy’s coverage, you may also need to know the differences between curable and incurable pre-existing conditions. Pet insurance companies may account for these two kinds of pre-existing conditions differently.

Curable pre-existing conditions vs. incurable pre-existing conditions

A curable pre-existing condition is typically an illness or injury a pet experienced at one point, but they’ve been symptom-free for a period of time. Some pet insurance companies may cover curable pre-existing conditions, which can include:

• Bladder infections
• Ear infections
• Diarrhea
• Respiratory infections
• Urinary tract infections
• Vomiting

An incurable pre-existing condition is typically an illness or injury your pet can have for the remainder of their life. Usually, incurable pre-existing conditions are not covered by pet insurance companies. However, if your pet is diagnosed with an incurable condition after your policy has gone into effect, it could be covered depending on what type of pet insurance you’ve purchased. Some incurable pre-existing conditions can include:

• Allergies
• Arthritis
• Bladder crystals
• Cancer
• Diabetes
• Epilepsy
• Heart disease
• Hip dysplasia
• Kidney disease
• Orthopedic conditions
• Urinary blockages

Does Pet Insurance Cover Bilateral Conditions?

A bilateral condition is typically an illness or injury that affects both sides of the body. These can include cataracts, hip dysplasia, luxating patella, and more. A bilateral injury or illness could be classified as a pre-existing condition if it occurred prior to your policy’s effective date — even if it only occurred on one side of the body thus far. However, provided all terms of the policy are met, MetLife Pet Insurance may cover bilateral conditions that are diagnosed after policy coverage begins.

Are Pre-Existing Conditions Covered When Switching Pet Insurance Providers?

While MetLife Pet may not cover all pre-existing conditions, we can provide coverage for previously covered pre-existing conditions if a group benefits policyholder switches their coverage to MetLife Pet. If you’re looking to switch providers in this situation, rest assured you may be able to get reimbursed for MetLife Pet-covered expenses related to a pre-existing condition already covered under your current policy.

Don’t Let Pre-Existing Conditions Dictate Your Decision

If your pet had an accident or is diagnosed with an illness before you get pet insurance, you could be subject to a pre-existing condition exclusion in your policy. But remember, even if your policy doesn’t cover a pre-existing condition, your pet may still be eligible for coverage.

Purchasing a dog insurance or cat insurance policy can help you financially cover your furry family member’s health for years to come. While we strive to be as transparent as possible about our coverage and exclusions, your pet’s unique situation can dictate coverage. To see if your pet’s condition is covered, start with a free quote from award-winning² MetLife Pet Insurance. And if you still have questions, call our pet care experts at (855) 270-7387.