Pet insurance for pre-existing conditions
Does pet insurance cover pre-existing conditions in Australia?
No, pet insurance in Australia generally does not cover pre-existing conditions, and most insurers treat them as a permanent exclusion in most cases.
Pre-existing conditions are defined as any illness, injury or condition that your pet had before the policy started. This can also include issues that have arisen during the waiting period. Some insurers may offer partial cover for certain pre-existing conditions if they are deemed cured and meet insurer-specific criteria.
As an example, conditions such as ear infections or urinary tract infections could be covered if they were treated successfully and had not recurred in your pet (usually in past 12 to 18 months). Lifelong, chronic conditions such as diabetes, arthritis or allergies are incurable and will likely be excluded permanently.
What is considered a pre-existing condition in pet insurance?
A pre-existing condition is any illness, injury or medical issue your pet showed symptoms of, or was diagnosed with, before your policy started. This can include:
- Chronic illnesses such as kidney disease, diabetes or arthritis.
- Previous injuries such as broken bones or ligament tears.
- Symptoms noted by a veterinarian, even if no formal diagnosis was made (e.g. limping, vomiting or persistent coughing).
When you apply for cover for your pet, it’s essential to provide your insurer with your pet’s complete medical history. Always read the Product Disclosure Statement (PDS) to know what is and isn’t covered under your policy and the Target Market Determination (TMD) to understand if the policy suits your needs.
What are the types of pre-existing conditions in pets?
Pet insurers will categorise pre-existing conditions into curable, chronic and hereditary conditions. Curable conditions can usually fully resolve and, as long as they are not recurring, may be reassessed for cover. Chronic and hereditary conditions will often be excluded from cover permanently as they require ongoing management.
These three categories include:
- Curable conditions such as ear infections, skin rashes or urinary tract infections, which may be reassessed for cover if they have been successfully treated and are symptom-free for 12–18 months.
- Chronic conditions such as arthritis, diabetes or heart disease, which are usually excluded permanently from cover.
- Congenital and hereditary conditions such as hip dysplasia, elbow dysplasia, cruciate ligament, luxating patella, heart murmurs or brachycephalic syndrome, which are often considered pre-existing if diagnosed or symptomatic before cover begins.
How do pet insurance companies know about pre-existing conditions?
Pet insurance providers may require a copy of your pet’s health records when you claim or apply for cover. These records include:
- medical history from birth or the adoption date
- notes on past illnesses, injuries or symptoms observed during vet visits.
If a condition is documented before the policy begins, it will likely be classified as pre-existing. Some insurers, particularly if your pet is older, may request a vet consultation to ensure your pet is in good health before a policy can be issued.
What is the waiting period for pet insurance?
Pet insurance waiting periods are the set time after you buy the policy before a claim can be made – ranging from 0 days to several months. Most often you will see waiting times of about 0-2 days for accidents (sudden, external events such as car accidents or swallowing objects), 14 days to about a month for injuries (think things like fractures and cuts) and up to several months (from 6 to 12 months) for specific hereditary conditions.
Waiting periods protect insurers from fraudulent claims and ensure that policies cover unforeseen events rather than pre-existing conditions.
The applicable waiting periods vary depending on the insurer and the type of cover and are usually specified in the certificate of insurance as follows:
- Accidental injuries cover with a short waiting period (usually 24-48 hours), sometimes including a zero-day waiting period offered for specific injuries such as snake bites or bone fractures. Injuries are usually defined as the physical damage caused solely by an unexpected accident. Insurers may offer limited immediate cover for specified accidental injuries so pet owners can get assistance without delay.
- Illness cover with waiting periods usually around 14-30 days.
- Orthopaedic or hereditary conditions with a waiting period of 6 months or longer.
What should I know about managing pre-existing conditions in pets?
Most pet insurance policies will not cover pre-existing conditions, so managing your pet’s health, policy timing and alternative options is important. Key considerations include insuring your pet early, regular vet care, switching policies and alternative funding options.
Here’s what you need to know.
Why are regular vet check-ups important?
Regular veterinary visits help keep your pet healthy and can also support your pet insurance cover by reducing the risk of exclusions and improving claim outcomes. As pets can hide signs of illness, routine check-ups can also detect issues early before they become more costly to treat. This also can help reduce the likelihood of conditions becoming classified as pre-existing in the future. Insurers will not often cover a pre-existing condition that could have been identified or treated sooner.
Regular health check-ups also create a documented medical history trail that insurers can use when assessing a claim. In some cases, missing preventative care (such as a dental check-up appointment) may affect your ability to claim if a condition is considered avoidable or untreated.
Early detection allows for treatment before symptoms escalate, potentially preventing the condition from being excluded under future policies.
What happens if my pet develops a chronic condition while covered?
If your pet develops a condition after the policy starts, it will be covered for the policy period, provided you keep renewing it (and there is no lapse in cover). If there is a lapse in coverage, or the policy is cancelled, the condition may become reclassified as pre-existing and excluded going forward. If you switch to a new insurance policy or provider, that condition may not be covered under the new policy.
Pet insurance appeal processes for pre-existing conditions
Policyholders can request a reassessment from their pet’s insurer for cover of pre-existing conditions by providing additional documentation from a veterinarian. Steps in the process include:
- submitting a detailed condition history (including vet reports and treatment records)
- demonstrating that the condition has been resolved and symptom-free for the required period (typically 12-18 months)
- awaiting the insurer’s review decision, which is at their discretion.
Alternative options for pets with pre-existing conditions
If your pet has significant pre-existing conditions, you could still have options to provide care for your furry friend, even if the condition itself is not covered by your insurer.
- Savings accounts can help you set aside funds for potential veterinary expenses.
- Wellness plans are offered by veterinary clinics and may provide discounted routine care rather than insurance-style cover.
- Specialised policies may provide tailored cover or wellness plans for pets with pre-existing conditions, though these are rare.
Are there exceptions to exclusions for older pets?
Yes, while most insurers will restrict cover for older pets and consider pre-existing conditions excluded, they may offer specialised plans. These plans may have a higher premium and still will not cover pre-existing conditions, however.
Senior pets are more likely to develop health issues as they enter older age and are at increased risk of chronic conditions such as dental disease or heart issues. This is why it’s important to insure your pet when it’s young, if possible, to ensure it has cover for any condition it may develop as it ages.
Can I switch pet insurers if my pet has a pre-existing condition?
Yes, you can switch pet insurers if your pet has a pre-existing condition. As the condition will be on your pet’s health record, it will carry over and is likely to be excluded from cover. It’s also important to know that if you switch insurers, you may need to serve waiting periods again. Compare policies to see which provides better cover for other health concerns.
While most Australian pet insurance providers exclude pre-existing conditions, understanding the nuances of cover, waiting periods and how conditions are assessed can help pet owners make the best choice for their furry friends. Some insurers may offer partial cover or help with other unrelated health issues if your pet has a pre-existing condition.
Thorough research, comparison, early action and open communication with your insurer are essential for finding suitable protection for your pet.
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.