Pet Insurance Exclusions

Not sure what your pet will be covered for? Learn what exclusions to look for in the fine print of your pet insurance policy.

Much like health insurance, pet insurance doesn't cover everything. While it's not fun to pore over your policy's Product Disclosure Statement, it's important to know exactly what isn't covered, as doing so could greatly impact the policy you choose, and determine whether you decide pet insurance is worth it for your situation.

This article will explore some of the main exclusions to be aware of in your policy, and what each of them means, so you can avoid some common pitfalls.

10 common pet insurance exclusions

1. Pre-existing conditions

This is the big one and encompasses anything your pet has suffered from before commencing cover or during the applicable waiting period. This category also normally covers bilateral conditions, which are conditions that can affect either the left or right side of your pet or both. For example, if your pet suffers from cruciate ligament damage in its right leg, then surgery on its left leg for the same condition will not be reimbursed. Conditions such as arthritis or skin lumps are often grouped together no matter where they occur, so if your pet suffers from arthritis in its shoulder, then arthritis in its hip will be considered a pre-existing condition. Learn more about pre-existing conditions.

2. Ordinary day-to-day and preventative care

Pet insurance does not cover you for grooming services (including the use of medicated shampoos), pet food, vaccinations and standard preventative visits. This exclusion also encompasses behavioural and alternative therapies as well as specific diets or vitamin supplements that are prescribed by your vet.

3. Dental treatment

Most insurers don’t cover treatment for fractured teeth, gingivitis or regular cleaning, although you can purchase dental coverage as an optional extra on some policies. One of the big draws for routine cover and wellness care programs is the inclusion of a benefit for dental services.

4. Infectious diseases and parasites

Even if all your pet’s vaccinations are up to date, most insurers won’t cover you for infectious diseases such as Feline Immunodeficiency Virus (FIV) or canine hepatitis. Illnesses caused by worms, fleas or ticks (other than paralysis ticks) are also excluded.

5. Occupational use, deliberate harm and negligence

Injuries to your pet that are deliberately caused by yourself or anyone living with you are not covered. This usually encompasses failing to keep your furry friend safe from health risks such as consuming poisonous substances. Animals that are used for guarding, pig hunting or racing are also excluded, but this restriction does not extend to guide dogs or assistance animals.

6. Travel and emergency boarding exclusions

Ambulance transport is normally excluded as is admission to a veterinary hospital except if it is essential to save your pet’s life. Most insurers will cover your four-legged friend if it’s travelling with you overseas, except if you are visiting a country from which your pet must be quarantined upon return. There are also exclusions for emergency boarding if you are the sole carer of your fur baby, and you have to be hospitalised due to pregnancy or cosmetic procedures.

7. Elective treatments

This covers anything that is not medically essential, including nail clipping and cosmetic procedures such as ear cropping. Even though the RSPCA recommends desexing as part of being a responsible pet owner, it still falls under the heading of an elective treatment.

8. Pregnancy and obstetrics

If your furry friend is a desirable breed and you would like it to have kittens or puppies, you will not be covered for any service or product related to the pregnancy. For some breeds, such as pugs, which commonly require caesarean delivery, this can be a major expense.

9. Transplants, prosthetics and other complex treatments

Genetic testing, cell replacement therapy (except when a blood transfusion is essential for your pet’s survival), and organ transplants are normally excluded. You will also not be covered for pacemakers, artificial limbs and other prosthetics.

10. Selected services and conditions

Anything not mentioned elsewhere is mopped up under clauses with general titles like this one. In the selected category, you can expect to find limits related to medications, diseases that cannot be conclusively diagnosed and any decision you make to follow a different course of action other than the one recommended by your vet.

Other general exclusions

These apply to all claims you might make under your policy. One of the main exclusions to be aware of is that you can’t make claims for unnecessary procedures or costs that should be your responsibility and should have been expected.

Specifically excluded conditions

Some health conditions might be specifically excluded by your policy, or you might only be covered for them in certain events. One important exclusion you might encounter is that breed-specific congenital conditions may not be covered, as well as conditions that certain breeds are at exceptionally high risk of.

Depending on the policy these could be excluded, or take the form of higher premiums for certain breeds.

These can include:

  • Patella luxations (dislocating kneecap)
  • Elbow dysplasia
  • Intervertebral disc disease
  • Illnesses or injuries caused by parasites, except as specifically covered by your policy.
  • Cruciate ligament conditions, except as specifically covered under your policy
  • Infectious canine hepatitis (canine adenovirus)
  • Parvovirus
  • Canine distemper
  • Parainfluenza
  • Kennel cough
  • Panleukopenia
  • Chlamydia
  • Leukemia
  • Feline immunodeficiency virus (FIV)
  • Viral rhinotracheitis
  • Calcivirus
  • Herpes
  • Cat flu

Treatments that are generally excluded

Some treatments are not claimable under policies, even when recommended by a vet or considered to be the most useful treatment by the veterinary community.

  • Cell replacement therapies
  • Prescription diets
  • Medicating shampoos or baths
  • Training, socialisation and alternative therapies, even when recommended by a vet
  • Treatments that are consistent for anything not covered by your policy, when the diagnosis is inclusive
  • Treatments that were not recommended by a vet, unless specifically authorised by the insurer
  • Routine examinations
  • Cosmetic procedures

What other limits apply?

Other policy conditions may apply.

  • No more than one incident of surgically removing a swallowed foreign object per policy period
  • No cover beyond the annual limits specified in your policy
  • No cover for individual treatments or procedures beyond the specified sub-limits

Exclusions that apply to pet insurance options and extras

Pet insurance extras aren’t treatments, and instead have different exclusions which may apply.

  • Emergency boarding: Cannot be claimed if there’s someone else who can reasonably take care of the animal.
  • Euthanasia cover: Will only be paid if deemed necessary and humane as the result of an illness or injury covered by your policy.
  • Overseas pet insurance: No cover for costs relating to your pet’s return to Australia, or while your pet is not under your direct care.

Pet insurance traps to avoid

While most exclusions are common to the majority of insurers, you might be surprised about some of the details in the fine print. For example, most companies will only cover essential euthanasia on the condition that the ailment which forces you to have your pet put to sleep is not on the list of exclusions.

Another common clause is that only one instance of surgically removing a foreign object swallowed by your pet is covered per policy period, which usually equates to 12 months. So if your furry friend is notorious for snacking on toy cars and other things it shouldn’t put in its mouth, this is an exclusion to look out for.

What to look for in the fine print

While the PDS is a reasonably comprehensive document describing what will and won’t be covered by your policy, it’s important to remember that it’s still more general than your certificate of insurance. The certificate of insurance is tailored to your specific animal, which is why you really need to pore over it line by line.

For example, the PDS might include a note about special rules that apply to selected dog breeds, but it might not list exactly which breeds these are. So there is a chance you won’t find out that your Pyrenean mountain dog is one of them until you receive your certificate of insurance. It's a good idea to ask your vet to review the certificate as well and confirm that your level of cover is consistent with their recommendations.

If you have major doubts, most insurers offer a cooling-off period of between 21 and 30 days, during which you have the option of cancelling your policy without charge, as long as you haven't submitted a claim within that time.

Why does pet insurance have so many exclusions?

Exclusions are a way to balance the risk for the insurer, while still providing policyholders with a reasonable level of coverage at an affordable price. Since most pet insurance plans are underwritten by a very small group of companies, the typical exclusions are usually similar, but the details do vary.

The list of exclusions is long enough to make some people wonder whether the coverage is worth the investment. This list of exclusions can be useful if you view it as a list of potential hazards to be mindful of. If the main reason you want insurance for your dog is because you take it pig hunting, then you’re probably wasting your money. On the other hand, if you know you’re not covered for emergency boarding when you are in hospital for cosmetic surgery, you know you have to find someone you trust to look after your furry friend.

It’s also worth remembering that routine care pet cover, often available as an extra with comprehensive insurance, can help with costs such as desexing and dental care, which are normally excluded from your main policy.

Receive quotes for pet insurance from Australian brands

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Major Medical Cover
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Andrew Munro

Andrew writes for finder.com, comparing products, writing guides and looking for new ways to help people make smart decisions. He's a fan of insurance, business news and cryptocurrency.

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2 Responses

  1. Default Gravatar
    AnniemacSeptember 29, 2017

    We have had our Golden Retriever insured since he was 8 weeks of age – he is now 6. We have just received our insurance renewal and it has increased over 19.5%. The monthly premium is now causing issues to our budget, however, our pup has had both his back knees replaced (TPLO surgery) due to cruciate ligament and he has arthritis. I have not been able to find a provide who is willing to cover us for these conditions if we move our policy stating that they are pre-existing conditions – BUT we have been paying insurance since he was 8 weeks of age – these condition are not pre-existing to insurance cover – they are only pre-existing to a new company. Why won’t policy writer’s “transfer” conditions that have been covered by other providers???? We have done the right thing but are now in a position of having to stay and pay the exorbitant fee increase our current insurer has levied, or we move and lose the cover we have had for the past 6 years.

    • Staff
      JoanneSeptember 29, 2017Staff

      Hi Anniemac,

      Thanks for reaching out.

      Some of conditions that could affect your pet’s premium over time would be age and premium loading and that is discussed further in detail on this page.
      For the pre-existing condition that the new insurer is considering, you will need to discuss this with the previous/existing insurer.
      In line with that, it may still be possible to obtain pet insurance with pre-existing conditions on record. This page will discuss what the options are and how an insurer will determine a pet’s pre existing conditions.
      As always, please read the fine print carefully and familiarise yourself with the product disclosure statement (PDS), as each insurer’s definition of a pre-existing condition may vary.

      Cheers,
      Joanne

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