Can my pet be covered if it already has a pre-existing condition?
There are several good reasons to choose a pet insurance policy as early as practicable. One of the biggies is that you’re less likely to have a claim refused because the condition you’re getting treatment for was classified as “pre-existing”. However, even if you only decide to purchase cover for your furry friend after they've suffered from health problems, it may still be possible to obtain pet insurance with pre-existing conditions on record.
Compare pet insurance policies from Australian brands
What is a pre-existing condition?
The general definition of this category is any health complaint your pet has suffered from prior to your insurance policy commencing, or during the waiting period. The “illness” component of a comprehensive pet insurance policy normally includes a waiting period, and if your pet develops any signs or symptoms of being unwell during this time, the condition is also classified as being pre-existing. This waiting period can vary from as little as 21 days to 6 months or more, depending on the specific health problem involved.
It doesn’t matter whether the condition has been treated or diagnosed by a vet or not. If there are any noticeable signs at all that your four-legged friend is unwell prior to being insured (as well as during the waiting period), - if it's limping, for instance, then its health problem is defined as pre-existing. In such cases, your claim might be refused even if the condition doesn’t worsen to the point your pet needs treatment until after you are eligible for reimbursement.
As always, 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. It's also a good idea to check with your vet if there are any details you are uncertain about.
How do insurers deal with pre-existing conditions in pets?
An insurer’s specific approach to pre-existing conditions varies from company to company, but generally, exclusions are treated as either temporary or permanent. The first major consideration is whether the ailment can be fully cured, or whether it is likely to have permanent consequences. If your pet recovers completely from an acute health problem and remains clear of any related symptoms for a designated time, many insurers will agree to reinstate cover for that condition.
By contrast, if your furry friend is treated for a health problem in a specific part of its body but your vet is unable to figure out the precise cause, then a later diagnosis in the same area will tend to be treated as pre-existing. Let’s say your pet is treated for diarrhoea, but the disease that caused it is not identified. If the animal develops gastro several months later then the condition is likely to be deemed pre-existing on account of the previous case of diarrhoea.
Similarly, all instances of certain conditions may be considered as a group, regardless of what part of your pet’s body they might affect. So if your pet develops arthritis of the knee after suffering from an arthritic shoulder, this will still be considered pre-existing.
Some insurers classify cancer as a pre-existing condition even if your pet does not show any symptoms at all before you are eligible to claim. This is because the illness can develop very slowly over time, and might have been undetectable while your pet was still uninsured.
In some cases, if your pet hasn't shown any signs or symptoms of a curable condition (such as a broken bone) for a specific period of time (usually 18 months) you may be able to apply for a pre-existing condition waiver that will no longer exclude that condition.
What should I know before getting pet insurance?
Some insurers offer a lifetime cover guarantee that covers your pet’s chronic and/or recurring conditions as long as you continue your policy without a gap in cover. So as long as you get insurance before your pet has developed any clinical conditions, and continue paying premiums, your pet should be covered.
However, make sure that you read the fine print to ensure that the insurance company doesn’t reset pre-existing conditions, which means they can exclude any conditions that have been diagnosed or treated in the last 12 months. When shopping around, it’s a good idea to ask the insurer if there is a limit on the period in which you can claim for a particular condition, or a maximum amount you can claim for recurring or chronic conditions.
What is a bilateral condition?
In the realm of comprehensive pet insurance, bilateral conditions typically fall under the umbrella of pre-existing health problems. The term “bilateral” refers to parts of your pet’s body that have a “left” and “right” version, such as its ears or limbs. Bilateral conditions can affect either the left side of your pet’s body, or the right side, or both.
As an example, this means that if your pet suffers from dysplasia in its left hip, then dysplasia in its right hip will not be covered because it is considered to be pre-existing. This is despite the fact that only the left hip was previously affected.
What are my options if my pet has a pre-existing condition?
Just because your pet might not be covered for a recurrence of one specific illness – such as arthritis – it will still most likely be insured for an unrelated problem – for example, an ear infection – that develops after your insurance is in full swing.
The simplest way of minimising your likelihood of being hit with horrendous vet bills, even if your animal companion faces exclusions due to several pre-existing conditions, is to purchase accident-only insurance. This will still cover your pet for a wide variety of health emergencies, ranging from snakebite to fractured bones.
In addition, some pre-existing conditions are classified as curable, meaning your furry friend’s cover may resume if your pet has fully healed and any applicable exclusion period has elapsed. For example, Fluffy the cat might develop a respiratory illness for which she requires expensive antibiotic treatment. Once Fluffy is back to perfect health and the disease does not recur within the specified time frame, her cover for respiratory infection will be reinstated. The duration of temporary exclusions like these is related to the type and severity of the illness involved, but the range is typically between three months and two years.
What about insurance for older pets?
Most insurers won’t let you commence cover after your furry friend reaches a certain age (usually nine years old), and by that time, there is a strong probability it will already have some pre-existing conditions in its veterinary history. Usually the only option on offer for older pets is a lower-value accident only policy. A good way to avoid potential pitfalls is to buy insurance that offers guaranteed lifetime cover while your pet is young. As long as you renew your policy every year, and there are no interruptions to your cover, some insurers will continue to honour claims for chronic illnesses such as arthritis, unless it was diagnosed before the policy commenced.
Even if you do have guaranteed lifetime cover, there will still be limits on how much you can claim for chronic conditions each year. It’s also crucial to fully understand exactly what the so-called “lifetime guarantee” encompasses. In some cases, all it means is that the animal will be insured for the duration of its lifetime, even after its ninth birthday, not that it is permanently covered for ongoing health complaints which would normally be defined as pre-existing.
Are congenital conditions covered?
Hereditary conditions and congenital conditions are those which have been present in your furry friend since birth, rather than developing as a result of infection or injury. By definition, such conditions already exist at the time you purchase an insurance policy and may not affect your pet’s health until later in life. Fortunately, most insurers agree to cover both congenital and hereditary disorders, as long as there is no clinical indication of these affecting your pet’s health until after the waiting period has elapsed.
Remember that you will not be covered for specific health problems mentioned in the list of exclusions on your insurance certificate, no matter how comprehensive the policy may seem on the surface. Some of these exclusions may have a genetic basis, so if in doubt, ask your vet to explain any details in the PDS that seem contradictory or confusing.
What conditions are normally excluded?
There is no single list of conditions that all insurers place in the “pre-existing” category, but the problems below generally make the grade.
- Bilateral conditions
- Bladder crystals and urinary blockages
- Cruciate ligament problems
- Heart disease
- Hip or elbow dysplasia
- Skin lumps
- Thyroid problems
Why don’t insurance companies cover pre-existing conditions?
Unless you opt for routine cover, the objective of pet insurance is normally to provide you with financial relief in unforeseen circumstances. It’s always a bit of a gamble between your pet’s statistical likelihood of illness or injury, the premiums you pay, and the reimbursement the insurer is going to be liable for.
The only way to create a win-win situation for both the insurer and the policyholder is to cover future events which may or may not eventuate, rather than health problems that are already known to exist. If insurers paid claims for pre-existing conditions, then people would only take out insurance after their pets became ill, which would mean either the premiums would be unreasonably high or the insurer would go bankrupt.
Both options defeat the whole purpose of insurance, which is to make a small investment now in case you need a big safety net later.
It's a good idea to be transparent about any medical issues that your pet has had before applying for insurance, because misleading the insurance company may lead to your policy being cancelled. Similarly, it's good practice to ask the insurer (in writing if possible) what conditions are excluded from cover.