Pet Insurance - An Evaluation By Dr. Terifaj (DVM)

[Wylie's Mom]

Should You Buy Pet Insurance?

Dr. Paula Terifaj (DVM) and her office team evaluated the nitty gritty of ten pet insurance policies, then narrowed it down to 3....the above links to the full article and it's very informative!

[Wylie's Mom]

This some additional info provided by BonBon (thanks Bonny!) regarding PetPlan:

That is a wonderful article! The one thing that concerns me about it is that it doesn't point out two things that were very important to me when making my selection of insurance companies. Both things related to Petplan - which I think is one of the two best coverages out there - but I still think people should be aware of this part of Petplan's coverages:

1) The deductible you select is for every incident - it is not an annual deductible like it is with many companies.
2) You will be charged a higher co-pay than what you selected for your plan if you take your pup to an after-hours emergency center, are referred to a specialist, and there are other cases where you're charged more....go to Petplan's website and click on the little "?" after the word co-pay (or deductible) and a more detailed explanation will appear.

This information does not appear on their website anywhere else that I could find - you have to click on the little "?" symbol to read about it.

[Wylie's Mom]

As promised, we have just finished our in-depth insurance review conducted over the past three months. We now feel like exhausted experts on this topic! Initially – after looking at ten companies – we narrowed our focus down to these three: Petplan, Embrace and Pets Best. We found many similarities at first and later, major differences were uncovered, as we interviewed these companies over the phone and purchased a policy from each one.

I jumped in first, enrolling my pit bull mix-up, Brad Pit, with Petplan; Janet – our indispensable hospital manager and long time licensed veterinary tech – signed up her dog Cookie with Embrace; Inez, our sweetheart groomer, purchased Pets Best for her newly adopted dog, Tigre. Yep, the same dog we were fostering – they had a 3 month love affair going on right under our noses!

My hat and stethoscope is off to Janet, who painstakingly studied each contract and directed my attention toward problematic areas. What follows is everything we learned and what you need to know before you enter the mind boggling world of pet insurance. We have done a lot of necessary homework and now it is your turn to compare, ask questions, and take action!
It is our greatest hope to see all our patients protected by a good pet insurance policy in the New Year. As I stressed in an earlier post, pet insurance is no longer an option – it’s a necessity if you want to make sure your pet receives state of the art medical care without maxing out your credit cards!

We want 2010 to be the year of affordable veterinary care. As a responsible pet parent, I challenge you to work an additional $25 to $35 into the monthly budget. So, if you become the unlucky pet owner faced with a $1,000 vet bill (happens every six seconds in the U.S.) don’t worry – just get your pen ready (or go on-line) and fill out your claim form!

Let’s begin…

First off is my humble apology. For the past twenty years that I have been in practice, I have largely ignored pet insurance. Why? Unfortunately, my first experience with pet insurance was a bad one and I formed a rather negative view. It was the late 80s and pet insurance was the new kid on the block. Clients complained that company X (a start-up in California) was paying less on claims than expected and taking months to reimburse them. On my clients’ behalf, I started wrestling with the insurance company for higher payouts because no one could understand their complicated benefit schedule. Fast forward to 2009… the pet insurance neighborhood has wisely matured and veterinary medicine has made remarkable advancements in its technology and treatments, which many pet parents can ill afford to take advantage of.

Now for the $2,900 question: Why would a veterinarian buy pet insurance for her own pet? Answer: In the last four years, my dog Rosie (yes, it’s true – purebreds have more problems than mutts ) has needed an MRI to diagnose an infection in her spine, eye surgery by an ophthalmologist, and most recently, an urgent visit to Advanced Critical Care and Internal Medicine (ACCIM) in Tustin on a weekend to find out why she had stopped eating.
First the good news: bad tummy ache or in medical jargon, acute gastroenteritis, and Rosie is feeling much better. Now the bad news: a routine abdominal ultrasound revealed that Rosie has a tumor on one of her adrenal glands, presumed to be malignant. Making matters worse, I did not have insurance to defray costs incurred over the last four years – nearly $3,000, and that was with generous professional discounts! Don’t worry – Rosie will get the care she needs, but that vacation I wanted to take went off to dreamland. Lesson learned the hard way, which is apparently how I learn most things.

OK now…this is going to be a long read, so be prepared to take your time, a needed potty break, or go grab a cup of Joe. Just be sure to read it ALL and leave us your thoughts or any questions in the comment section here on the blog. We always appreciate reading your comments – thanks.

We found that the major difference between the top three pet insurance companies we reviewed was how they paid on chronic ongoing conditions.

• Dollar limits per condition: Pays out a specified maximum amount covered for each diagnosed condition. Once the maximum amount has been paid out the condition will no longer be covered. This type of policy can provide a good compromise for those unable to purchase comprehensive protection offered by lifelong polices.

• Time limits per condition: Ongoing illnesses are classified as pre-existing whenever the policy renews. The condition may still be covered but the reimbursement amount is reduced. Presumed to be a better option than dollar limits.

• Lifelong: Provides the most comprehensive protection for you and your pet – full coverage for both short term and long term illnesses. Pays out the maximum dollar amount on the policy purchased and that amount will be reset each year on renewal. With Lifelong coverage, any ailment your pet is diagnosed with will receive treatment indefinitely as long as you continue to renew your policy each year.

[Wylie's Mom]

So what’s not automatically covered?

Some common exclusions to look out for:

Pre-existing conditions – It is standard for pet insurance companies to deny coverage for the treatment of pre-existing conditions. Having said that, it’s always best to disclose any problems your pet has upfront, as future claims may be invalidated if you’re found not to be completely honest. Founders warns: apply for pet insurance as soon as you adopt. Puppies and kittens are most likely not to have any pre-existing conditions – hence you never need to worry if a claim will be paid!

Note: There is a mandatory waiting period (usually 14 days) from the time you enroll until your coverage begins. Also, all previous medical records will be reviewed in an attempt to prevent fraudulent claims submitted for pre-existing conditions. No cheating allowed!

Hereditary or congenital conditions – There is a lot of wiggle room here. Some companies will cover these conditions as long as they were not discovered prior to the purchase of your policy and therefore treated as pre-existing. Founders warns: read the fine print!

Routine checkups – Some pet insurance policies will cover an allocated amount for routine pet care. Those companies that do offer coverage for routine health care costs (vaccinations, parasite control, spay/neuter, dental cleanings, annual check-ups) seemingly do not pay out well for unexpected medical costs. Founders warns: avoid the temptation to buy routine coverage. Instead, budget for the known costs of basic pet care and buy polices that will afford you comprehensive coverage for the unexpected illness or life threatening emergency.

The ‘devil is in the details’ – read carefully and familiarize yourself with these terms:

Age restrictions: Eligibility for enrollment is based on age of your pet. Breed can also affect age limits. For example: a new policy may specify full coverage for mixed breed dogs up to age 8 years; purebred dogs up to age 6 years; cats up to age 10 years.

Pets Best states no age restrictions.

A representative at Petplan told us the age limit may be lifted in 2010.

Pets that are too old for full coverage may be eligible for accident type coverage.

Select breeds: The following breeds (some we’ve never heard of!) could face policy restrictions, age limits, or higher insurance rates:

Aidi, Akbash Dog, Appenzeller Sennenhund , Argentine Dogo / Dogo Argentino, Beauceron, Bernese Mountain Dog, Black Russian Terrier, Bloodhound, Boerboel, Bulldog (all Bulldog breeds), Bull Terrier, Ca de Bou / Perro de Presa Mallorquin, Canary Dog /Presa Canario, Cane Corso , Cão de Fila de São Miguel, Chinese Chongqing Dog, Clumber Spaniel, Coonhound , Deerhound /Scottish Deerhound, Doberman Pinscher, Dogue de Bordeaux /French Mastiff, Dutch Sheepdog / Schapendoes, Entlebucher Sennenhund, Fila Brasileiro /Brazilian Fila , Gran Mastin de Borinquen, Great Dane, Great Pyrenees / Pyrenean Mountain Dog, Greater Swiss Mountain Dog, Griffon Brabancon, Irish Wolfhound, Kangal Dog, Landseer, Leonberger, Maremma Sheepdog, Mastiff (all Mastiff breeds), Mioritic Sheepdog, Newfoundland, Ovtcharka, Rottweiler, Scottish Terrier (Scottie), Saint Bernard, Shar-Pei, Staghound , Tibetan KyiApso, Thai Ridgeback, Tosa Inu.

These breeds display a higher degree of severity of disease and as such different terms and conditions may apply.

[Wylie's Mom]

Pre-existing condition: Refers to a condition, injury or illness that was present – or which manifested itself – prior to the effective date of the policy. Coverage for any pre-existing condition was excluded under all the policies we reviewed.

It’s best to contact the insurance company prior to purchasing a policy if you’re not sure your pet has a pre-existing condition. For example, with Embrace, if your dog tore her right cruciate ligament (a common knee problem which requires surgical repair) before you bought your policy and later ruptures her left cruciate ligament – the new left cruciate tear is considered a pre-existing condition and will not be covered. Insurance business can be tricky stuff!

Per Incident limit: Refers to the maximum amount that will be paid for a single incident. Some companies will have a per-incident limit for the lifetime of the policy (as long as your pet lives) referred to as a lifetime limit. Companies may offer a range of lifetime limits to choose from. Pets Best offers lifetime limits ranging from $42,500 to $100,000 with corresponding per-incident limits from $2,500 to $14,000. For example, if you choose Pets Best Basic Plan with a lifetime limit of $42,500, there is a corresponding per-incident limit of $2,500. If your pet becomes ill with diabetes, then the maximum available reimbursement for any diabetes treatment would be $2,500 for the remaining life of your pet. RED FLAG: When treating chronic conditions, this could result in a total lack of coverage whether or not you renew your policy with Pets Best. Remember, pre-existing problems will not be covered if you later change insurance carriers.

Other companies, such as Petplan and Embrace, have no per-incident limits and will reimburse for a single incident up to the maximum annual policy benefit. For example, if you had Petplan’s Gold plan with a $20,000 maximum annual policy benefit, then you could be reimbursed up to $20,000 for a single incident. However, if you max out coverage for your policy year – no further coverage can be provided until your policy renews.

Benefit schedule: Insurers can use an itemized list of reimbursement amounts for specific medical diagnoses and treatments. This makes it very difficult to know what amount of any claim will be reimbursed and what amount you will pay out of pocket (remember company X!). Petplan, Embrace and Pets Best do not use a benefit schedule; instead, they reimburse you up to the limit of your policy. This has been a major improvement, leaving inferior insurance companies in the dust!

Chronic Conditions: Any condition that is likely to reappear and/or is not likely to be cured, such as allergies, some gastrointestinal diseases, diabetes, heart disease, cancer and so on.

Embrace offers restricted continuing care for chronic conditions that last more than one policy term. Its maximum reimbursement you can receive in any given year for chronic conditions is 25% of your policy maximum. For example, your cat is just diagnosed with kidney disease. If you choose a policy with a $2,000 annual limit (too low in my opinion – I would recommend at least $10,000 of coverage) a full $2,000 could be applied to treat the kidney disease. RED FLAG: However, when your policy renews in the second year, your cat now has a chronic condition and coverage for her kidney disease will only amount to 25% of your annual limit. So, with a $2,000 policy, only $500 will be reimbursed for care and treatment in all subsequent years. The remaining $1,500 is available for all new conditions, which again will be considered chronic in the following year.

Pets Best will cover up to the per-incident limit for the lifetime of the policy – so there is a cut off point on coverage. If your per-incident limit is $2,500, you can expect a total payout for the care and treatment of kidney disease not to exceed this limit over your pet’s lifetime. Also, with their lifetime $42,500 policy – you now have $40,000 worth of coverage when you renew your policy. Contrast lifetime limits with lifelong coverage – which do you want?

Only Petplan offers full lifelong coverage – any chronic condition the pet develops will be covered for the life of the pet so long as the policy is renewed annually and it will be renewed back to the full amount the of policy limit.

Congenital condition: Any condition or disorder that is present at birth or is recognized anytime after birth. Congenital disorders can be a result of genetic abnormalities or occur during fetal development. When discussing congenital, hereditary, and genetic conditions it becomes confusing when comparing different companies. For example, Pets Best lists patellar luxation (knee cap displacement) as a congenital condition which is therefore excluded from coverage. However; Embrace lists patellar luxation as a breed-specific condition (hereditary or genetic defect) which is covered as long as it’s not pre-existing. If you are paying attention you have just blurted out loud; “How can a problem be considered genetic (born with it) and not also be considered pre-existing at the same time?” Well, if the problem was never noted in your pet’s medical record prior to the effective date on your policy – it did not exist! Fortunately for your pocketbook, your vet failed to discover the problem on physical exam or the problem had not yet started to show any symptoms. Petplan also covers congenital conditions as long as they are not discovered as pre-existing conditions.

Hereditary condition: Refers to a condition, defect or disease, which was transmitted to the pet genetically from its parent(s). The condition, defect or disease may not be manifested until later in life. Some common examples are orthopedic problems such as Hip Dysplasia, Elbow Dysplasia, Osteochondritis Dissecans, and Legg-Calve-Perthes Disease; an eye disease leading to blindness called Progressive Retinal Atrophy; a blood disease called Von Willebrand disease; and Cryptorchidism – failure of one or both testicles to descend into the scrotum. Pets Best does offer coverage for what it considers to be hereditary conditions, but coverage is limited and the pet must have been enrolled before their 2nd birthday. Both Petplan and Embrace cover hereditary conditions as long as they aren’t pre-existing. Note: it is unlikely that the hereditary condition, Crytorchidism, would qualify for coverage, as it can be detected by veterinary exam as early as eight weeks of age, making it a pre-existing condition.

Be aware that the incidence for hereditary problems occurs far more often in purebreds than the good old fashion mongrel. Purebreds demand higher premiums and earlier age enrollment, making mutts a more affordable option. :-) Save your money and save a life – Adopt!

Select your own veterinarian: Be aware that some companies require you to select a veterinarian from a network. Founders is not part of any such network and we feel strongly that everyone should be able to choose their own docs!

Annual check-up by veterinarian: Preventive health care measures such as annual exams and laboratory testing may be required to maintain your coverage. Petplan requires an annual health check, dental exam and any treatment normally recommended by the vet to prevent illness such as an annual heartworm test and preventative medication if indicated. For renewal of older pets*, an exam, blood test and urinalysis two months prior to the date of renewal is required. Embrace only requires an annual check-up performed by a veterinarian. Pets Best does not require annual check-ups. Personally, we don’t understand Pets Best position.

*Dogs 8 years or older OR 5 years and older if a select breed; cats 10 years or older.

Emergency and Specialist care: Emergency visits and care provided by specialists such as orthopedic surgeons, oncologists, ophthalmologists and internal medicine doctors should be included in any policy you purchase, or pass on it! Companies may vary their rates on co-pays for this type of coverage or have some restrictions. Please inquire before you purchase your policy.

Alternative care: considered as acupuncture, hydrotherapy and chiropractic. Will only cover alternative treatments when administered by a licensed veterinarian. Policies that cover alternative care may or may not cover equipment purchase or rental. We recommend you get a pre-certification before treatment so you know if it will be covered and how much will be reimbursed.

Dental care: (excludes routine dental cleaning) Basic policies with Pets Best and Embrace* will cover orthodontic care such as tooth extractions only if caused by accident or injury like a hit by car. Therefore, a company may or may not consider a broken tooth due to chewing on something hard as an accident or injury. Petplan will cover orthodontic care such as a tooth extraction for any reason deemed necessary by your veterinarian.

*Embrace does have the option to add a Drug & Dental plan at extra cost which would treat dental problems and extractions due to other reasons besides accident injuries.

Cancer treatment: includes surgery, radiation and chemotherapy.

Years in business: Petplan was founded over 30 years ago in the United Kingdom and was launched in the U.S.A. in 2006. Pets Best and Embrace are newer companies in operation since 2005.

Licensed in the State of California [apply this info to other states]: An insurer may or may not be licensed within the state it operates. If it is not, the insurer cannot participate in the insurance guarantee funds created by California law. Therefore, if the insurer becomes insolvent and is unable to make payment to you as promised, these guaranteed funds will not pay your claims.

[Wylie's Mom]

Additional Considerations

Ask if prescribed medications are covered under the policy you are considering. For example, Embrace will only cover take home medications if you purchase their Drug & Dental plan.

You should check and see if a pre-authorization is needed for treatment that may lead to substantial veterinary fees or if pre-certification is needed for certain types of procedures such as MRI or CT scan.

If your pet is diagnosed with a condition that could lead to other medical problems – such as hyperthyroidism – your policy may not cover kidney, heart and high blood pressure problems if hyperthyroidism is considered to be a pre-existing condition. This gets complicated, but it’s a good question to amuse policy writers and expose less scrupulous insurance carriers!

Understand the policy you are purchasing. For example, Petplan offers benefits for boarding and kennel fees (for an additional cost) under their Silver and Gold plans. However, these fees are reimbursed at reasonable costs up to the maximum annual benefit only if you are in the hospital as a result of sickness, disease, or bodily injury – not when you’re away singing: It’s 5 o’clock somewhere!

And lastly, here are some important points to consider. Classic pet health insurance is intended to protect you from expensive unexpected pet illness and injuries. Don’t purchase it hoping to get your money back – do you buy car insurance and hope to get into an accident so your insurance company can foot the bill? Of course not! If your pet did not become seriously ill or injured in any policy year – be happy and know that someone else was not so lucky. Also, realize that providing good health insurance coverage would not be possible without a sizeable number of loyal policy holders making a large pool of funds available.

So, the payment you make next month might just help pay for the $5,000 medical bill for the naughty pup that ate his owner’s underwear and requires emergency surgery with post-op care in ICU for a life threatening intestinal obstruction. Be glad it wasn’t your pup and rest assured that if the worse happens, you too won’t bear the financial burden – in addition to a sleepless night.

As a safety net, the pet insurance industry has evolved over time to meet the needs of worried pet owners afraid that they might not be able to afford costly medical care or surgery. More often than not, we witness the difficult financial struggle our devoted clients must undertake in order to follow our best care recommendations. We hate to watch you fret when you mention that you have kids in college, the car needs repair, or there has been a job loss in the family.

No pet lover should ever have to say no to treatment that could be life saving or prevent needless suffering. The cost of monthly pet insurance could be as little as two movie tickets and a heaping bag overflowing with popcorn! Skip the pricy movie theater to watch a home movie snuggled up with your favorite hunk of fur and pop your own corn for pennies. We know your pet is worth that small sacrifice and so much more!

[Wylie's Mom]

QUICK REFERENCE CHART FOR COMPARING INSURANCE COMPANIES (click on jpg/picture below)

***PLEASE CHECK WITH INSURANCE COMPANIES TO CONFIRM THE STATEMENTS/BENEFITS COVERED IN THIS THREAD ARE STILL CURRENT