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Compare pet insurance by what it covers, what it excludes, how it calculates claim payments, and how much you could still owe—not by the reimbursement percentage alone. Check the policy form offered in your state: definitions, limits, and state requirements can differ.
Start with the type of coverage
Pet policies commonly fall into accident-only, accident-and-illness, and wellness categories, but the services and exclusions vary by policy. The National Association of Insurance Commissioners (NAIC) describes these coverage types and recommends checking what each policy actually pays for in its consumer guidance and its Pet Insurance overview, updated April 16, 2025.
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- Accident-only: Check which injuries and accident-related services qualify, and whether illness treatment is excluded.
- Accident-and-illness: Review covered illnesses as well as accidents; do not assume every diagnosis or treatment is included.
- Wellness: Find out whether routine-care benefits are an insurance policy or a separate program, and list the specific preventive services it pays for.
Premiums and eligibility depend on factors including the pet’s species, breed, gender, age, location, coverage, and deductible, according to the NAIC. A plan that suits one pet or household may not suit another.
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Look for exclusions relating to pre-existing, hereditary, congenital, and chronic conditions, along with any other conditions or services the policy names. Most pet insurers exclude pre-existing conditions and hereditary or congenital conditions, the NAIC says, but contract wording determines how a particular policy treats a condition.
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Read the definitions, not just the exclusion headings. In particular, check how the insurer defines a pre-existing condition and whether it has a rule for conditions it considers curable. Do not assume another insurer uses the same definition or waiting period before a previously treated condition could qualify.
Compare waiting periods and eligibility requirements
Check waiting periods separately for accidents, illnesses, or other types of claims; a single headline waiting-period figure may not describe every benefit. Also note when the policy takes effect, the pet’s enrollment-age eligibility, and any exam or medical-record requirements. Ask whether signs recorded during a waiting period could later be treated as evidence of a pre-existing condition. These rules vary by insurer and policy.
Find out how the reimbursement formula works
A displayed reimbursement percentage is not necessarily that percentage of the final veterinary bill. The contract may reimburse a percentage of eligible expenses, use a benefit schedule, or limit payment to a usual-and-customary or prevailing-charge amount. The NAIC consumer checklist and its Pet Insurance Model Law address these different claim-payment bases.
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Calculate the deductible, your share, and the caps
For each policy, identify when the deductible applies, what portion of eligible costs you pay after reimbursement, and the maximum the policy will pay. A lower deductible or higher reimbursement percentage does not by itself establish which plan leaves you with the lower bill: caps and the claim-payment formula also matter.
- Is the deductible applied annually, per condition, or another way?
- What copay or coinsurance remains your responsibility after the deductible?
- Is there an annual or lifetime maximum?
- Does the policy or benefit schedule impose a lower cap for a particular condition, procedure, or treatment?
Use the policy and benefit schedule to identify all applicable limits. The NAIC Model Law calls for disclosure of key terms such as exclusions, waiting periods, deductibles, coinsurance, annual or lifetime limits, and certain claim-payment bases. It is a model framework, not proof that the same requirements apply in every state.
Check claims handling and veterinarian access
Ask how to submit a claim, how payment is made, and how long claims usually take to process. Confirm whether you can use your chosen veterinarian or must use a network. These answers should come from the terms and claims process for the specific policy, not assumptions about pet insurance companies generally.
Use a side-by-side comparison before buying or renewing
Record the answers from each policy’s actual documents. If an item is unclear, ask the insurer to explain it and locate the relevant wording in the policy offered in your state.
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| Comparison item | What to record for each policy |
|---|---|
| Coverage | Accident-only, accident-and-illness, or wellness; covered services and treatments |
| Exclusions | Pre-existing, hereditary, congenital, chronic, and other excluded conditions; definitions and any curable-condition rule |
| Waiting and eligibility | Waiting periods by claim type, effective date, age limits, exam or record requirements, and treatment of signs noted during a waiting period |
| Claim calculation | Percentage of eligible expenses, benefit schedule, or fee-based limit; which charges qualify |
| Owner’s costs and limits | Deductible trigger, copay or coinsurance, annual or lifetime maximum, and any smaller condition or treatment caps |
| Access and administration | Claim-submission method, typical processing time, payment method, and veterinarian or network rules |
For a local question or complaint, contact your state insurance department; the NAIC provides a directory of state insurance departments. State rules and policy forms can differ, so verify the contract and requirements that apply where you live.
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