Pet insurance exclusions

From dental care to pet pregnancies, find out what isn’t covered by insurers and where to find the fine print for your policy.

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Pet insurance won't cover you for everything that could happen to your furry friend, so it's important to understand some common pet insurance exclusions. Find out what you need to know below.

10 common pet insurance exclusions

1. Pre-existing conditions

If your pet has already been treated for a condition or illness (or is showing symptoms) before you buy a policy, this is considered to be a pre-existing condition which isn't usually covered by insurers. It could be something as simple as an ear infection or as complicated as heart disease.

💡Good to know: This category also covers bilateral conditions – in other words, something that can affect both the right and left sides of your pet. For example, if your pet has suffered 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 usually grouped together, too. So, if your pet suffers from arthritis in the shoulder then arthritis in the hip will be considered a pre-existing condition.

2. Ordinary day-to-day and preventative care

With pet insurance, you won't be covered for grooming services (including the use of medicated shampoos), pet food, vaccinations or routine visits to the vet. You also won't be reimbursed for visits to a behavioural or alternative therapist, or for vitamin supplements prescribed by your vet.

3. Dental treatment

Most insurers don't cover treatment for fractured teeth, gingivitis or regular cleaning, although you can get cover for pet dental care on some policies. One of the big draws of taking out routine cover or joining a wellness care program is the inclusion of a benefit for dental services such as teeth cleaning.

4. Infectious diseases and parasites

Even if all of 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

If you, or someone you live with, deliberately hurts or injures your pet, your insurance won't cover you. This includes making sure your beloved pet is safe from harmful substances.

💡Good to know: 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

Most providers won't cover you for at-home vet visits or ambulance transportation to the veterinarian practice, unless it's an emergency. There are also exclusions for emergency boarding unless you're the sole carer for your pet, or if you have to be hospitalised for non-emergency cases such as pregnancy or cosmetic procedures.

What if I'm travelling abroad with my pet? You'll usually be covered if you want to take your pet overseas with you. That's unless you're visiting a country that will mean your pet needs to quarantine on its return.

7. Elective treatments

An elective treatment is anything that's not a medical emergency but could help to improve your pet's quality of life. It includes surgeries such as amputations, tumour/mass removal and hernia removal.

💡Good to know: While the RSPCA recommends desexing as part of being a responsible pet owner, it still falls under the heading of an elective treatment unless you get a plan with routine care cover.

8. Pregnancy and obstetrics

If you're thinking of pet breeding, you won't be covered for any service or product related to your pet's pregnancy. This includes anything from treatment during the pregnancy itself to difficulty giving birth.

💡Good to know: Some breeds, such as pugs, require a caesarean to give birth, a procedure that you will need to foot the bill for.

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

More general exclusions are hidden under clauses in PDSs with general titles like this. Exact details vary from policy to policy, but you'll usually find limits related to certain medications and diseases that can't be conclusively diagnosed and if you act against the advice of your vet.

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Other exclusions that may be included in your pet insurance

Dog and cat side by side

General exclusions apply to any claim that you make under your policy and usually include:

  • Accessories or everyday items, such as bedding, crates or grooming
  • Procedures deemed unnecessary by a vet
  • Behavioural problems of any kind, such as anxiety disorders or chemical imbalances
  • Breeds that are not legally allowed to be kept as pets in your location
  • Commercial use such as hunting, guarding or racing
  • Damage caused by your pet
  • Deliberate acts by you or someone living with you, such as deliberately injuring a pet
  • Dental care and treatments, except as explicitly covered under your policy
  • Widespread pandemic or epidemic diseases
  • Prosthetic items and related surgery
  • Injuries or illnesses resulting from illegal activities
  • Medications not approved or recognised, or not prescribed by a vet
  • Injury or illness resulting from a failure to take care of your pet and follow vet recommendations
  • Illnesses or injuries that could have been prevented by vaccinating your pet
  • Unnecessary procedures or costs that should be your responsibility and should have been expected

Pet house

Certain health conditions might be excluded by your policy, or you could only be covered for them in certain events.

An important exclusion to be aware of is breed-specific congenital conditions that may not be covered, as well as conditions that certain breeds are at a particularly high risk of developing.

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

🐶 For dogs specifically, policies might exclude cover for:

  • Infectious canine hepatitis (canine adenovirus)
  • Parvovirus
  • Canine distemper
  • Parainfluenza
  • Kennel cough

🐱 For cats specifically, policies might not cover:

  • Panleukopenia
  • Chlamydia
  • Leukemia
  • Feline immunodeficiency virus (FIV)
  • Viral rhinotracheitis
  • Calicivirus
  • Herpes
  • Cat flu

Treatments that are generally excluded

You can't claim for some treatments, even when they're recommended by a vet. These usually include:

  • Cell replacement therapies
  • Prescription diets
  • Medicating shampoos or baths
  • Training, socialisation and alternative therapies
  • Routine examinations
  • Cosmetic procedures

Other limits that could apply to your policy

Other policy conditions may apply, such as:

  • 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 will not cover you for costs relating to your pet's return to Australia, or while your pet is not under your direct care.

🔎 What to look for in the fine print

While most insurers have similar exclusions, it's still important to check the fine print.

Your pet insurance PDS is a detailed document that highlights what will and won't be covered by your policy. However, it's still more general than your certificate of insurance. The certificate of insurance is tailored to your specific animal, so it's a good idea to go through it line by line.

An example: Your PDS might include a note about special rules that apply to certain 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.

💡Good to know: It's worth asking your vet to review the certificate as well and confirm that your level of cover is consistent with their recommendations.

Pet insurance traps to look out for

A couple of common pet insurance traps to look out for include:

  • Some companies will only cover essential euthanasia on the condition that the ailment that forces you to have your pet put to sleep is not on the list of exclusions.
  • Others limit surgically removing a foreign object swallowed by your per to once per policy period, usually 12 months.

If you have major doubts once you've purchased your policy, most insurers offer a cooling-off period of between 21 and 30 days. During this period, you have the option of cancelling your policy without being charged, 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 details do vary.

With such a long list of exclusions, you may be wondering whether pet insurance is worth your investment. It's important to look past the exclusions and use them as a list of potential hazards to be aware of. After all, your pet insurance will still cover you for a long list of illnesses, accidents and genetic health conditions.

💡Good to know: 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.

Protect your pet: Compare pet insurance plans in Australia

Name Product Accidental Injury Illness Paralysis Tick Benefit Maximum yearly benefit Reimbursement rate Reimbursement Rate
Budget Direct Pet Insurance
$1,500
$12,000
80%
80%
⭐Finder Exclusive: Receive a $55 eGift card after your 21-day cooling off period. Apply by 31 December 2021. T&C’s apply.
Kogan Pet Luxury Cover
$2,000
$15,000
80% up to age 8 & 65% over age 8
80% up to age 8 & 65% over age 8
Sign up and get $75 Kogan.com credit with a $10 ongoing monthly credit. T&Cs apply.
Medibank Ultimate Pet Care
$1,200
$15,000
80%
80%
Get a sweet 16% off your first year. Sign up and use promo code SAVE16 by 2 Feb 2022. T&Cs apply.
PD Deluxe Plan
$15,000
$15,000
100%
100%
Apply online and get your first 1 month free. T&Cs apply.
Knose Pet Insurance
$25,000
$25,000
70%, 80% or 90%
70%, 80% or 90%
⭐Finder Exclusive: Get 10% off your first year's premium. Lower prices for lower risk pets. T&C's apply.
Vets Choice Elite Cover
$2,500
$15,000
80% or 100%
80% or 100%
Get a 5% discount when you insure more than one pet.
PIA Major Medical Cover
$1,200
$15,145
80%
80%
Covers specified accidents and illnesses, with Routine Care Cover included. Get 2 months free when you sign up.
Petsy Dog Accidental Injury and Illness Cover (Vet Select)
$1,500
$25,000
100%
100%
Enjoy 2 months free and personalised pet tag with promo code: PETSYPET. Petsy members enjoy free personalised gifts, exclusive pet discounts and perks for humans.
Coles Premium Cover
$2,500
$15,000
80% or 100%
80% or 100%
Get 10% off your new Coles pet policy till 31 Jan 2022. Plus, earn 10x Flybuys points per $1 spent on pet food at Coles Supermarkets. T&Cs apply.
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2 Responses

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    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.

      Avatarfinder Customer Care
      JoanneSeptember 29, 2017Staff

      Hi Anniemac,

      Thanks for reaching out.

      Some of conditions that could affect your pet’s insurance premium over time would be age and premium loading. 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. Our 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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