Petplan pet insurance terms and conditions explained
Our fine print—in plain view
At Petplan, we strongly believe that nobody benefits by being surprised about what your pet insurance policy does—and does not—cover.
That’s why we recommend all of our new policyholders read through your policy terms and conditions* during the first 30 days of your policy. In encouraging transparency, we have included a sample policy terms and conditions for your review. Click on the sample policy applicable to your state below to read more. Please note: Policy terms and conditions can vary by state.
- For residents in AK, AL, AR, AZ, CO, CT, DC, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WI, WV, WY: View sample policy
- New Jersey residents: View sample policy (effective 7/21/18)
- Other states not listed: View sample policy
In the event of a per condition deductible purchase, policyholders will receive an endorsement to the policy outlining that the deductible is per condition, not annual. Policyholders should refer to their specific terms and conditions located in the Account Portal for more details.
To help explain some areas of the Petplan policy terms and conditions asked about most frequently, we break down our fine print below:
Pre-existing 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 a clinical sign(s) or symptom(s) before the effective date of your policy or which occurred or showed a clinical sign(s) or symptom(s) 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. Provided your pet’s medical history shows no further episodes of the condition subsequent to the initial episode, coverage for the condition may be restored. For further information, visit our FAQs.
Waiting periods
As is standard in the industry, there is a waiting period on Petplan policies before injuries and illnesses can be considered coverable. The waiting period will not apply to any renewal of this policy if continuous coverage is maintained.
There is a fifteen (15) day waiting period after the effective date of the policy during which we will not cover any injury or illness of your pet.
There is a six (6) month exclusion on hip dysplasia*, cruciates and patellas.
Waiting periods vary by state. Check your policy terms and conditions for full details.
Pet’s last visit to vet/first exam
If your pet has not been examined by a veterinarian within six (6) months prior to the effective date of the policy, you must arrange to have your pet examined at your own expense within thirty (30) days of the effective date of this policy. (First exam period may vary; see your state specific terms and conditions for complete details.)* Any medical condition(s) or clinical sign(s) observed or recorded during the first exam—and all costs associated therewith—are automatically excluded from coverage.
Failure to have a first exam of your pet may void the policy. If voided, the policy premium will be refunded. Additionally, any conditions that are related to, caused by or resulting from a medical condition(s) or clinical sign(s) observed or recorded at the first exam performed after the effective date of the policy are also excluded from coverage. This section applies to both new policies and policy years where your pet has not received the care described in Section VII.6.a of the terms and conditions.
For the avoidance of doubt, if your pet does not receive its annual health check during a policy period of renewal coverage, the next examination will be used as the basis for determining any conditions which will be excluded from coverage.
Annual wellness visits
We believe strongly that your pet’s annual wellness checkups are the best time to catch diseases early to achieve the best possible outcome. As a condition of this insurance, you must take care of your pet and arrange and pay for your pet to have an annual health check, an annual dental exam, and any treatment normally suggested by a veterinarian to prevent illness or injury.
Cruciate and patellas (knees)
Petplan does not cover any costs arising out of or related to any treatment associated with damage or rupture of cruciate ligaments, luxation of the patellas or other soft tissue disorders of the knee where a clinical sign(s) occurs during the first six (6) months that the policy is in effect.
However, coverage will be afforded if your pet is examined by a veterinarian within the first thirty (30) days after the original inception date of the policy, and the medical record specifically notes your pet does not have any pre-existing conditions relating to the knees, subject to the waiting period.
If your pet has received treatment or has shown clinical signs of a cruciate or soft tissue injury to one knee prior to the effective date of this policy or during the first six (6) months of this policy, where no certificate of knee health has been provided, then the other knee is automatically excluded from coverage.
Routine care
Petplan pet insurance policies do not cover routine or preventive care. Instead, our policies are designed to give you the most comprehensive protection against your unexpected vet bills at the best possible value.
Behavioral Disorder
Any change in your pet’s temperament, activity or inactivity that is abnormal, dysfunctional or unusual for which there is no underlying medical condition(s). Behavioral disorders include, but are not limited to, aggression, separation anxiety and phobias.
Clinical signs
Changes in your pet’s normal healthy state, its bodily functions or behavior (as observed by any individual, recorded in your pet’s medical record or identified in previously performed examinations or treatments for your pet).
Copay
The percentage of your claim for which you are liable before any applicable deductible is applied.
Curable medical condition
Any medical condition or injury that can be completely resolved without recurrence or any manifestations of clinical signs.
Curable Exclusionary Period
There is a three hundred sixty-five (365) day exclusionary period for any curable medical condition that is observed, recorded or identified up to three hundred sixty-five (365) days prior to the original inception date of the policy or during the waiting period.
A second three hundred sixty-five (365) day exclusionary period will apply if the curable medical condition reoccurs within the first three hundred sixty-five (365) days after the original inception date of the policy.
If the same curable medical condition reoccurs during the second exclusionary period, then it will be excluded from coverage for the rest of your pet's life.
Deductible
The fixed amount per policy period for which you are liable prior to receiving any claims settlement that will be deducted from any reimbursement made to you, after any copay amount has been deducted.
Exclusion
Any situation, event or medical condition not covered by this policy.
Holistic Therapy
Any treatments including but not limited to acupuncture, aromatherapy, chiropractic and homeopathic therapy administered by a veterinarian to treat an injury or illness.
Illness
Any change to the normal healthy state of your pet such as a sickness, disease or medical condition—except behavioral disorders—not caused by an accident.
Injury
Physical harm to your pet caused by normal activity or an accident.
Medically Necessary
Any treatment or procedure which is directly and materially related to a covered illness or injury, as recommended and documented in your pet’s medical records by the treating veterinarian.
Physical Therapy
Any treatment including but not limited to hydrotherapy, laser, underwater treadmill, kinesiotherapy, land-based exercise, massage, stretching and electrical stimulation administered by a veterinarian to treat an injury or illness.
Preventive Care
Any treatment, service or procedure, including but not limited to physical examinations, medications, surgeries, inoculations or laboratory procedures, for the purpose of prevention of illness or injury or for the promotion of general health where there has been no injury or illness.
Sick Visit Fee
The veterinarian examination cost for treating your pet’s injury or illness.
Supplements
Any medicinal substance including but not limited to nutraceuticals, vitamins and herbal medicines not requiring a prescription that a veterinarian recommends for the treatment of an injury or illness.
Telehealth Treatment
Any treatment administered by a veterinarian to treat any injury or illness by means of remote telecommunications technology, including but not limited to phone, email, Internet, text and video.
Treatment
Any veterinary care and prescribed medications administered by a veterinarian—or under a veterinarian’s direct supervision—in treating your pet’s injury or illness, within the United States or Canada.
