How do insurance companies determine pre existing conditions

A pre-existing condition is any condition your pet showed signs of, was diagnosed with, or was treated for before the waiting period of your pet health insurance policy ended.

What’s a pre-existing condition?

A pre-existing condition refers to any kind of illness or health issue your pet developed before your waiting period was up on your insurer. It doesn’t mean pet insurance companies won’t insure your pet, it just means your plan won’t cover costs that directly relate to any ailment they had in their medical history before they signed up for a pet insurance policy.

Does pet insurance cover pre-existing conditions?

Probably not.

Your policy explains that any diagnoses, treatments, or symptoms of a condition listed in your pet’s medical record before they were actively insured can indicate a pre-existing condition. Since pre-existing conditions are excluded from a pet health insurance policy, you won’t be able to receive reimbursement for care relating to anything traced back to that initial finding.

So while treatment for diabetes is covered under a basic policy, you’ll only be reimbursed for eligible costs if your pet is diagnosed with diabetes (or has test results that show elevated glucose levels) after your policy was already active.

How do insurance companies determine pre-existing conditions?

A pre-existing condition is determined by your pet’s medical record. So any signs or diagnoses of an illness that show up before your policy waiting periods are up would be considered a pre-existing condition.

Certain breeds are prone to certain illnesses. If you know your cat is more likely to develop a hereditary condition like asthma because she’s a Siamese, should you assume it will be considered a pre-existing condition? Not exactly.

Your pet may not show signs of these medical conditions at birth, or in the first few years of their life. But if you wait until they develop symptoms to get insured, the condition probably won’t be covered in your policy, which is a pretty big game-changer for pet owners struggling with vet bills related to a chronic condition.

What if a pre-existing condition is cured? 

The condition or injury that was pre-existing must have no recurring symptoms or treatment for at least 12 months to be considered cured. A cured condition is a temporary condition or injury that is resolved for at least 12 months and may be considered for coverage in eligible states (check with customer service to find out if curable conditions are covered in your state). Knee or ligament conditions and chronic conditions such as allergies, asthma or cancer cannot be cured. 

Example of how a pre-existing condition can affect your pet’s pet insurance coverage

Let’s say it’s your birthday, and your wife chooses to celebrate the best way possible: She brings home a 2-month-old pug! You name him Romeo. It’s in your best interest to get Romeo a pet insurance plan as soon as possible, so if and when he develops a condition common to his breed—like pug encephalitis or a luxating patella—you’ll be covered for the related costs of that care (minus your deductible, of course).

If you wait to see Romeo limping before getting insured, you’ll be out of luck. That limp would be noted in his medical record, and a luxating patella confirmed later would be considered a pre-existing condition. That means you won’t be covered for any medicine or orthopedic surgery related to it.

Is pet health insurance still worth it if my pet has a pre-existing condition?

As a rule of thumb, you never want to wait until you need insurance to get it… that’s not how it works. You have to already have a policy in place in order for it to be worth it. But pet health insurance coverage could still be worth the cost for pet parents, even if your biggest costs today are related to treating your pet’s pre-existing conditions. The only way to truly know if it’s worth it for you and your four-legged friend is to get a pet insurance quote.

Let’s go back to the example of Romeo. While hip dysplasia would be considered a pre-existing condition, he could still develop respiratory infections, urinary tract infections, heart disease, or another hereditary condition like pug dog encephalitis.

If you got Romeo insured before he showed signs of that last condition, you’d be covered for the related costs, which are daunting: anti-fungal medications, steroids, antibiotics, and the $5,000 in veterinary care, including the diagnostics and hospitalization it would take to diagnose Romeo in the first place. And if you have a Preventative and Wellness package, like we offer at Lemonade, you’d be covered for the costs of Romeo’s preventative and routine care, including his annual exam, vaccinations, and more.

Insurance is all about being able to handle unexpected costs. When it comes to your pet’s healthcare, that could include some pretty devastating surprises—like a cruciate ligament tear, or even cancer. So even if you have some conditions excluded because they’re considered pre-existing, a pet health insurance policy means being ready for tomorrow’s unknowns. Considering the risks of your dog or cat being diagnosed with a second or third big health crisis, a pet health insurance policy is an investment in your fur fam’s health that’s worth it.

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