Pet insurance exclusions
What are pet insurance exclusions?
Pet insurance offers peace of mind, but to truly benefit from your policy, you need to understand not only what is covered but also what isn’t. These ‘not covered’ items are called exclusions.
Every pet insurance policy is different, and some insurers may exclude certain veterinary treatments, specific conditions, circumstances and vet bills. Insurers list these in each insurance policy’s Product Disclosure Statement (PDS). Exclusions are not intended to catch you out; they define the boundaries of the cover and help keep premiums manageable for everyone.
What does pet insurance not cover?
Pet insurance can cover your fur baby for life, for as long as the product is offered, provided there are no breaks in the cover over the whole policy period, and subject to the policy terms and conditions.
Most Australian pet insurance policies allow you to get insurance coverage for your pet from the time your pet is six weeks old and up until they reach eight or nine years old. Some insurers may have age limits, with policies becoming more expensive or harder to obtain as your pet gets older.
Many policies also include a waiting period, which can range from 30 days to six months, depending on the insurance product and the benefits you wish to claim. Insurance premiums will differ based on your pet’s age, your pet’s needs, your pet’s health and the pet insurance plan. Several terms and conditions may also impact your ability to claim.
Always read your Product Disclosure Statement (PDS) to understand your benefit limit and any sub-limits that apply to specific conditions or therapies. The Target Market Determination (TMD) can help you understand if the insurance policy is the right fit for you and your pet.
While exclusions vary between insurers and policies, there are some common exclusions across most pet insurance providers in Australia:
Pre-existing conditions
If your pet has been diagnosed or shown symptoms of a condition before the policy started (or during the waiting period), it’s generally considered a pre-existing condition and won’t be covered.
Therefore, it is important to consider taking out cover while your pet is as young as possible, so they’re covered before developing any pre-existing conditions.
Some policies may cover certain pre-existing conditions if your pet has been cured and symptom-free for a set period (e.g. 18 months), but this varies across different insurance providers and policies. Chronic conditions are often excluded from cover, even if your pet is symptom-free.
Routine and preventive care
Depending on the insurance company and the level of cover on your pet’s policy, sometimes you may be able to claim reimbursement for routine care. However, standard policies typically don’t cover routine or preventative care unless you’ve purchased an optional wellness add-on. These include:
- Vaccinations
- Flea, tick, and worm treatments
- Desexing
- Dental check-ups
- Microchipping.
If your policy does cover routine care, make sure you understand your annual benefit limit.
Pregnancy and breeding
Pet insurance is designed for pet owners rather than breeders, which means most pet policies don’t cover pregnancy, obstetrics, or difficulties that occur during breeding or labour.
Elective procedures
Elective treatments that are not medically necessary, such as tail docking, ear cropping, or cosmetic surgeries, are generally excluded. This can include de-sexing and other therapies that aren’t medically necessary.
Dental procedures
Most pet insurance policies do not cover dental treatments such as cleaning and therapy for oral diseases. However, some insurers allow you to add dental care as an optional extra to your policy to cover a portion of dental treatments. Some policies exclude dental disease altogether, while others only cover it if regular dental checks are documented. Coverage might exclude:
- Periodontal disease
- Tooth extractions
- Routine dental cleaning.
Waiting periods
Pet insurance policies in Australia typically come with waiting periods (usually around 14 days for accidents and up to 30 days for illnesses). Waiting period prevents you from claiming soon after your policy commences and protects the insurer from paying for existing injuries or illnesses.
What does pet insurance cover?
Pet insurance in Australia is typically structured around three levels of cover:
- Accident-only policies
- Accident and illness policies
- Comprehensive policies (accidents, specific illness and optional routine care add-ons).
The key to finding the most suitable pet insurance for your furry friend is understanding the levels of cover for vet bills and selecting a cover option with an insurance benefit that balances cost with coverage based on your pet’s needs.
Before you buy a new policy, it’s important to read the underwriting of the policy and understand the exclusions, limitations, and waiting periods of your insurance plan. If your pet is prone to certain health issues, you may like to consider comprehensive plans with added benefits like routine care.
While exclusions are important to understand, it’s also crucial to know exactly what your policy covers as applicable waiting periods may still apply for many treatments and conditions.
Accident-only cover
Accident-only policies provide coverage for incidents where your pet sustains injuries due to unforeseen accidents. These policies do not cover vet visits for illnesses or medical conditions that develop over time.
Common conditions covered under accident-only policies include:
- Tick paralysis: Treatment for paralysis caused by ticks
- Accidental injuries: These can be due to car accidents, burns, allergic reactions, or any other unintentional trauma
- Snake bites: Including treatment for venomous snake envenomation
- Swallowing foreign objects: Covers treatment if your pet eats something it shouldn’t, such as a toy that requires removal
- Wounds, cuts, and lacerations: Injuries caused by trauma, such as being cut by sharp objects or injured in a fight with another animal
- Ligament and tendon injuries: Coverage for sprains, strains, and tears (exclusions may apply for injuries related to pre-existing conditions or accidents)
- Broken or fractured bones: Including treatment for fractures, dislocations, and associated medical costs like casts, surgery or pain relief.
Accident and illness cover
This more comprehensive coverage adds protection for a range of illnesses, which are typically excluded under accident-only policies.
Conditions commonly covered under accident and illness policies include:
- Cruciate ligament conditions: Treatment for injuries or diseases affecting the ligament (such as elbow dysplasia or hip dysplasia)
- Cancer: Coverage for diagnosis and treatment of various types of cancer, including surgery, chemotherapy and radiotherapy
- Ear, eye and skin conditions: Covers conditions like infections, rashes, allergies, or more severe problems like cataracts
- Emergency boarding: If you’re hospitalised or unable to care for your pet temporarily, some insurers may cover the cost of emergency boarding services
- Hospitalisation: Covers medical costs if your pet requires overnight stays in a veterinary facility due to illness or injury
- X-rays: Diagnostic tests, imaging for injuries, fractures, or internal health issues like tumours
- Surgery: Coverage for surgical procedures related to illnesses or injuries
- Chronic conditions: Some policies also cover chronic conditions, but these can vary widely between insurers.
Comprehensive cover (accident and illness plus routine care add-on)
Comprehensive plans provide the broadest coverage, including accident and illness treatment, as well as additional benefits for maintaining your pet’s overall health.
Routine care add-ons generally include coverage for:
- Microchipping: Ensures your pet can be identified if it gets injured or lost
- Vaccinations: Preventive treatments like flea, tick and heartworm vaccines can help with keeping your pet healthy
- Annual blood tests and health checks: These types of tests can detect early signs of disease
- Ear infections and cleaning: Treatment for chronic ear infections or regular cleaning to prevent issues
- Desexing: Covers the costs of spaying or neutering your pet, which can prevent certain health issues and unwanted litters
- Training for behavioural problems: Some insurers offer coverage for behavioural therapy if your pet develops issues like anxiety, aggression or excessive barking
- Alternative therapies: Treatments like acupuncture, chiropractic treatment, hydrotherapy, and other non-traditional therapies may help with chronic pain or rehabilitation
- Prescription diets: If your pet has dietary needs due to a health condition (e.g. kidney disease, food allergies), some policies may cover these costs
- Teeth cleaning and dental illnesses: Preventive dental care, such as teeth cleaning, as well as treatments for conditions like gingivitis, periodontitis, and tooth extractions.
Excess and premium costs
It’s important to fully understand how the excess, premiums, and gaps work in your pet insurance policy to avoid unexpected costs and to ensure your pet’s healthcare is financially manageable:
- Excess: The excess is the amount that the policyholder pays when they claim. This amount is agreed between the insurer and the policyholder when the policy is taken out or renewed. An excess can apply per condition or annually, depending on your policy.
- Premium costs: The ongoing payments for your pet insurance can vary based on factors like your pet’s breed, age and the level of coverage.
- Gap-only coverage: Gap Only pet insurance coverage allows pet owners to claim their insurance benefits on the spot at participating veterinary clinics, only paying the difference (or “gap”) between the vet expenses and the covered portion of the claim. This means you don’t have to wait for reimbursement and reduces the upfront out-of-pocket cost of veterinary care.
Meet our pet insurance expert, Adrian Taylor
As a General Insurance expert with over 13 years’ experience in financial services, Adrian Taylor knows that dogs and cats get themselves into all sorts of mischief. One part of Adrian’s work is to help empower consumers to understand how pet insurance can help save them from exorbitant vet bills when their pet gets injured or falls ill.