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Discussion Starter #1 (Edited)
Since I'm "going through this process", I thought I'd document my experience for others. I am including information that I have encountered, but am deliberately not identifying, nor recommending, any specific insurance. Frankly, I think that's homework you should be doing.

First, I found this thread, also on GRF, that has some pretty good information (somewhat similar to what I'm posting). For those looking for input on specific providers, the thread addresses various providers (albeit the information is somewhat dated).

First, while insurance doesn't need to be uber-expensive, it's not free. Then again, my dad, a mechanic, frequently said; "If you can't afford to 'fix it', then you can't afford to 'buy it'". Your four-legged-family-member is dependent on you for its care, so the responsibility for it's care is part of the package that includes a fun companion.

First Things First
Before I launch into "specifics", the most important thing I learned was "know why you're getting the insurance, and what you expect it to cover". Knowing your expectations will help you make decisions on service-vs-cost issues, and will also assist when comparing different plans/coverages.

"Medical and Illness" vs "Wellness"
I believe most think of "medical/illness" when they think "insurance". This is where I'm at (think "catastrophic situations/charges). Going down this route may also impact your attitude towards deductibles and reimbursement percentages. After all, if this is for (hopefully) emergencies and worst-case-scenarios, you might be willing to trade higher deductibles and lower reimbursement rates for lower monthly payments.

Most pet policies, unlike the human variants, do not cover "wellness". This includes things like spay/neuter, checkups, etc. If you want wellness coverage, it's often available (although some insurers don't provide it), but it'll cost you. Also, while most providers only offer it if you already have their medical/illness coverage, there's at-least-one provider that offers wellness a-la-carte.

Open network or "in network"
Do you want the ability to select any veterinarian, or are you okay picking from a list of "in network" providers.

%-of-Cost vs Allowed-Expense
How is the reimbursement amount determined. Some insurances have a defined cap that they will reimburse for different conditions. Others simply reimburse a percentage of "actual cost", irrespective of what that cost is.

What's "not covered"?
Many (most?) of the insurances do not cover everything associated with your pet's care, even if the care itself is covered. A common thing I found was "office visit". Even if the treatment and care is for a covered condition, "medical and illness" policies seem to exclude this. So, if the vet visit was $1,000, but the office visit was $100, expect to be reimbursed based on a cost of $900.

Insurance Caps/Limits
Some insurance have annual caps/limits on reimbursement. Others don't. It seems that if you're okay with having a cap/limit, you can use that to reduce your monthly costs. For me, the lower caps didn't make sense, and the higher caps were not much of a saving over "no cap". And, in the event of a worst-case-scenario, the last thing I want to be worried about is "caps and limits". But, they're there and something to consider in your selection process.

Deductible ("Per Year" vs "Per Condition")
Other than using the size of the deductible to manage the amount of the monthly payment, there was at-least-one insurer that had a "per condition" deductible vice "annual". If your pet was seen for Condition-A and Condition-B, the deductible needs to be met, separately, for each condition. But, once that deductible is met for a condition, you don't have to deal with it again.
The "per year" is more straightforward, and is based on the "covered year". Once it's met for the year, everything else works on the contracted reimbursement schedule. If treatment rolls over to a "new year", then the deductible kicks back in.

One "weird thing" I discovered is that, pretty much for all insurers, the "deductible" represents what the insurer would have paid, not what you, the consumer, actually paid out-of-pocket. So, if you have a $500 deductible and a reimbursement rate of 80%, you actually end up paying $625 out-of-pocket before the deductible is satisfied (i.e., 80% of 625 is 500). Annoying, but not so much if you know this going in. Highly annoying when you find out "somewhere down the line". I am "assuming" the insurers do it this way because the "real deductible" can vary, based on the consumer selecting different reimbursement %.

Reimbursement %
This is the "how much of what I pay are you going to reimburse me for?" number. I've seen values at 70%, 80%, 90%, and 100%. Of these, 80% and 90% seem the most common. Again, I balanced the rate against how I intend to use the insurance. 100% reimbursement is great. But, if you're only planning on using it in worst-case-scenarios, are you willing to pay the additional monthly premium for that 100%? Or, maybe trade lower monthly for a lower reimbursement?

"Rolling Pre-Existing"
Okay, I made that term up. I thought "pre-existing" sounded fairly straightforward. And, for the most part, it is. But, it seems that some insurance providers won't pay for the same condition twice in a rolling 12-month window. Under this scenario, if Condition-A is treated and reimbursed, it will not be reimbursed again until a minimum of 12-months lapse from the first occurrence .

Hereditary Conditions
Some insurers only cover hereditary under certain policies. One didn't cover it at all under their least expensive (read, the one they initially quote online) policy, only partially on their next-step-up policy (typically "capped" by condition), and then only on their full-blown policy with wellness included were hereditary conditions completely covered.

What am I Selecting?
Based on my decision to focus on catastrophic/worst-case scenarios, I am selecting a plan that...
  • Covers medical/illness only, I'll eat the wellness costs
  • Completely covers hereditary and congenital conditions
  • Allows me to select any vet
  • Reimburses based on %-of-actual-cost
  • Has a sizable, annual deductible
  • Reimburses at 80% of covered expenses
I am "accepting" that I will have out-of-pocket expenses for wellness care. I'm also accepting that, for "minor" issues, I will likely pay out-of-pocket. And, even in a scenario where the insurance kicks in, I am paying an additional 10% out-of-pocket over plans that reimburse at 90%. But, this approach allows me to "best" balance monthly out-of-pocket against "purpose and expectations".

Update on "What am I Selecting?"
I ended up going with my #2 selection. My #1 selection was based on coverage and cost in my locale. But, on closer reading, I discovered that coverage for hip dysplasia would not be available until after a 12-month waiting period. My #2 selection is more expensive (major reason it was #2 vice #1), but only has a 30-day waiting period until hip dysplasia is covered. And, this was waived.

YMMV. :)

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1,689 Posts
this is very informative, thank you for sharing!
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