Petplan Terms & Conditions:
One of the most frequently asked questions by pet parents is about pre-existing conditions. Specifically: what are they and how are they determined?
At Petplan, we define a pre-existing condition as a medical condition which first occurred or showed clinical sign(s) or symptoms before the effective date of your policy or which occurred or showed clinical sign(s) or symptoms during the policy waiting period. Simply put, if your pet has or had any condition, whether diagnosed by your veterinarian or not, before enrolling in a Petplan pet insurance policy, it is considered pre-existing.
However, at Petplan we recognize there are two types of pre-existing conditions: those which can be cured, and those which cannot be cured. If your pet has experienced a curable condition previous to enrolling in a Petplan pet insurance policy, the condition, while pre-existing, may be eligible for coverage after an exclusionary period. Providing your pet's medical history shows no further episodes of the condition subsequent to the initial episode, coverage for the condition may be restored.
As is standard in the industry, there is a waiting period on Petplan policies before accidents and illnesses can be considered coverable. Your pet's accident or injury coverage will begin twenty-four (24) hours after the policy becomes effective. There is a fourteen (14) day waiting period after the effective date of the policy during which we will not cover any illness of your pet.
There is a (6) month exclusion on cruciates and patellas (please see below for more information). The waiting period will not apply to any renewal of this policy if continuous coverage is maintained.
Pet's last visit to vet
If your pet has not been examined by a primary care veterinarian within the twelve (12) months prior to the effective date of the policy, you must have your pet examined within the first 30 days. This examination will be used as the basis for determining any pre-existing conditions.
We cannot stress enough how important it is for us to establish your pet's baseline of health as soon as possible. Without a baseline of health for comparison, any condition which is noted in your pet's first visit to the vet must be considered pre-existing, even if it would have otherwise been coverable.
Annual wellness visits
We believe strongly that your pet's annual wellness check-ups are the best time to catch diseases early to achieve the best possible outcome. Because of this, Petplan insured pets must be seen annually for their wellness check-ups.
Cruciate and patellas (knees)
Petplan policies have a six (6) month exclusionary period on cruciate and patella disease (i. e. those affecting the knees) for all new pets enrolled. However, we do offer an easy option to have the exclusion for your pet's knees waived. Simply visit your vet within the first 30 days of your policy and ask them to make special note of the results of that exam pertaining to the knees. The results of your exam will be included as part of your pet's baseline of health.
If both your pet's knees are noted as healthy in the medical records, the exclusion can be waived.
Specialist and referral co-pay
Petplan policies define specialized treatment as "any veterinary treatment administered by a specialist veterinarian or at a specialist or referral veterinary facility, after hours veterinary facility, or accredited school/college of veterinary medicine."
Specialized treatments are reimbursed at 80%, except for life-saving emergency treatment, as defined by a veterinarian. If you have selected a 90% or 100% reimbursement level for your policy, your regular vet fees will be reimbursed at your selected level, and any non life-saving specialist treatments will be reimbursed at 80%.
If you have selected 80% reimbursement for your policy, both specialized and non-specialized treatments will be reimbursed at 80%.
Petplan does not offer routine care coverage. Our more than 35 years of experience shows us that insurance for regular, scheduled treatments can come at the cost of coverage of your pet's unexpected, and sometimes critical, health care costs. Routing care "riders" or policy add-ons can artificially inflate premiums and represent poor value for the policyholder. Instead, Petplan pet insurance policies are designed to give you the most comprehensive protection against your unexpected vet bills for the best possible value.
Coverage For All Plans:
Reimbursement subject to policy limits and deductible selected. You may also choose a co-payment option. Costs for routine or elective procedures not covered.
Veterinary Exam Fees conducted by a licensed veterinarian to treat or diagnose an injured or ill dog or cat.
Diagnostic Treatments including specialized chemistry and hematology are covered provided the treating veterinarian deems it a necessary part of investigating a covered injury or illness.
Surgery deemed medically necessary by a licensed veterinarian, including all hip and CCL (knee) surgical techniques. Elective procedures such as cosmetic or preventive surgeries are not covered.
Prescription Medications are covered provided they are prescribed by the treating veterinarian for an accident or illness. All prescriptions must be FDA approved for pets. Heart worm and flea/tick preventatives are not covered. Vitamins and nutriceuticals are covered provided they are prescribed by a licensed vet as part of the treatment for a "coverable" condition.
Imaging deemed medically necessary by a licensed veterinarian to help diagnose or treat your dog or cat's accident or illness. MRI, CAT scan and ultrasound are covered.
Cancer Treatments for veterinary oncology care and cancer treatments such as chemotherapy and radiotherapy.
Dental Treatments (non-routine) provided your pet has had it's teeth checked by a veterinarian in the 12 months prior to the effective date of coverage, and any treatment recommended was performed.
Rehabilitation prescribed by a licensed vet as part of a treatment protocol and performed at a veterinary facility.
Alternative Therapies such as acupuncture, homeotherapy, chiropractic treatment and stem cell therapy are covered provided the treatment is recommended and administered by a licensed vet.
Referral & Specialist Treatment including surgery, oncology, cardiology, opthamology, dermatology, dentistry and neurology are covered. Reimbursed at 80%.
Behavioral Therapies that your veterinarian prescribes are in the best interest of your pet. We will cover consultations with a licensed vet to diagnose and treat behavioral problems where an underlying medical condition is the cause of your pet's behavioral issues. Coverage does not apply to obedience training.
Additional coverage available for these optional services:
Boarding kennel fees
Advertising/Reward expenses related to the recovery of a missing pet
Loss due to theft or straying
Death from injury or illness
Vacation cancellation due to pet injury or illness