Glossary

Accident Only Plan

There are some pet insurance policies that cover accidents only. What this means is that it helps cover vet costs to treat accidental injuries, which usually include broken bones, poisonings and ingesting foreign objects (like tennis balls, a common cause of accidental injury). It does not cover vet costs to treat illnesses. These are usually the least expensive type of insurance plan.

Age-Related Deductibles

Older pets have a need for more medical attention, and as such, have a higher incidence of claiming. By increasing the deductible amount as your pet ages, it allows us to offer lower premiums to pets of all ages. The deductible is only applied during the years in which claims are made.

Annual Deductible

This is the amount you must pay each year before the insurance company starts paying.

Associated Condition

Any medical problem that is directly related to and caused by a primary medical Condition. This includes any medical Condition resulting from any Treatments for the Associated Conditions such as alternative therapies, diagnostic testing, medication and prescription diets.

Benefit Schedule

This is the maximum amount of money the insurance company will reimburse based on predetermined listed fee structure. Companies that use this structure tell you ahead of time the specific amounts they will pay for certain diseases.

Bilateral Condition

Any condition that can happen on both sides of the body.

Chemotherapy and Radiation Treatment Allowance

The schedule of benefits will also list the maximum reimbursement limit for chemotherapy and radiation treatment as they apply to specific conditions. These two amounts are generally split into two allowances with the allowance for radiation being much higher than that for chemotherapy.

Chronic Diseases

Chronic diseases are diseases of long duration and generally slow progression. They are usually not curable.

Claim Form

The form you submit to the pet insurance company to request reimbursement for veterinary costs.

Co-pay (Co-payment)

The percentage of covered expenses that you must pay after the deductible is met.  For example 80/20 means that the insurance company will cover 80% of the remaining balance after your deductible is paid and you must pay the remaining 20%.

Coverage

See Reimbursement Rate.

Coverage Limit (Cap)

Some pet insurance policies will limit the amount paid in claims for your pet.  There are four types of coverage limits:  Maximum payout per incident, Maximum payout per year, Maximum lifetime payout, and Maximum payout based on a schedule of benefits.  See each of the terms for a detailed explanation of each.

Covered Expenses

Treatment and procedures that are covered by the pet insurance policy. Not all treatments and procedures are covered.

Deductible

The amount of the veterinary bill you must pay before the insurance company starts paying.  For most companies this deductible must be paid per year rather than per incident. Be sure to understand your agreement, as the annual vs per incident deductible is a big deal. Per year is much better.

Exclusions

Medical conditions that are not covered by the plan.

Endorsements

Depending upon the insurance company you choose, you may be given the opportunity to purchase an “endorsement.” Usually this comes in the form of a cancer endorsement. This is like an add-on to your purchased insurance plan and extends the amount of coverage your pet receives for the specific illness listed – in this case, cancer.

General Anesthesia Allowance

On the schedule of benefits, companies will also outline the maximum limit for general anesthesia costs as they apply to specific conditions.

Hereditary Condition

An illness caused by genetic factors.

Incidents

The term incident is used to refer to the condition that is causing you to visit the veterinarian. Chronic conditions such as skin allergies are considered to be a single incident even if you pay your veterinarian multiple visits.

Maximum Lifetime Payout

This is the maximum amount of money the insurance company will reimburse you during the lifetime of your pet. Once you reach this limit, you will not receive any more money and your policy will be terminated.

Maximum Payout

The maximum amount of money the insurance company will give you.

Maximum Payout Per Incident

This is the maximum amount of money the insurance company will reimburse you for each new illness or injury. Once you reach this limit, that particular injury or illness will no longer be covered and you will not receive any more money for that particular injury or illness.

Maximum Payout Per Year

Also called Maximum Annual Payout, this is the maximum amount of money the insurance company will reimburse you each policy year. Once you reach this limit, you will not receive any more money for any injury or illness for that policy year.

Per-Incident Deductible

This is the amount you must pay for each new illness or injury before the insurance company starts paying. This deductible is paid once for each new illness or injury. If a pet is hit by a car, that is considered one incident and has one deductible regardless of how many times the owner must return to the veterinarian.

Policy Year

12 months starting on the date your policy begins.

Pre-Existing Condition

Illnesses or accidents/injuries that occur before you apply for a policy or that happen during the waiting period. Any illness or injury that occurs during this time will not be covered by your plan.

Premium

The amount you pay monthly or annually for your pet insurance policy.

Primary Diagnosis or Condition

This term will appear on your schedule of benefits and refers to the financial limit that the company places on a primary diagnosis or condition which includes injections, hospitalization, exams, surgery and treatment.

Reimbursement rate (Coverage)

The percentage of covered expenses that the insurance company pays out on a claim after the deductible is met.

Requirements

Things you must do to remain insured (e.g. annual exams, submission of medical records, adherence to the vaccination recommendations, etc).

Riders

Additional options that can be placed on an insurance policy. Typically, these have the potential of enhancing coverage in certain circumstances. However, in most circumstances, they may not be worth the extra cost.

Routine Care and Wellness

Refers to preventive procedures such as vaccinations, annual exams, heartworm testing/medications, spaying/neutering, etc. These procedures help keep your pet healthy and in turn reduce your veterinary bills.

Schedule of Benefits

The schedule of benefits is a document that is provided to you when you sign up for your policy. This document outlines conditions that are covered under your plan and the monetary allowance you are provided for each diagnosis.

Secondary Diagnosis or Condition

If your pet is treated for a second condition that occurs as a result of the primary diagnosis then it will be covered under the benefits listed as a secondary diagnosis or condition. This secondary condition will receive financial reimbursement in addition to the primary diagnosis or condition.

Underwriter

The underwriter of a pet insurance policy decides whether to accept the risk and insure the pet and how much coverage the pet should receive. It is the underwriter’s money that pays your insurance claims.

Veterinary Specialists

Veterinary specialists are board certified in a specific field of veterinary medicine such as internal medicine, surgery, dermatology, ophthalmology. Their certification gives them a higher level of expertise in their area of specialty than a general practitioner.

Waiting Period

The time you have to wait before coverage starts. If something happens to your pet during the waiting period, that condition will not be covered. There can be one waiting period for accidents/injuries and another for illnesses. There can also be waiting periods for certain injuries or illnesses like Anterior Cruciate Ligament Injuries and Intervertebral Disk Disease.