Insurer Disclosure of Important Policy Provisions
Coverage for Selected Conditions
Summary Description of Claim Payment Determination
The allowable amount of the claim is determined by:
Reasonable and customary charges means typical fees of the cost that veterinarians charge in your geographic area based on available veterinary fee information and proprietary data. These R&C amounts are derived and confirmed from both internal and external data whereby a given procedure or treatment on a veterinarian bill is cross checked with the cost of that same procedure or treatment charged by other veterinarians in that geographic area.
Example of Claims Payment Formula
The deductible is subtracted from the covered amount. Once a deductible has been met, the remaining covered amount is reimbursed at the reimbursement percentage chosen at enrollment.
An example with a $1,300 covered amount, a $100 annual deductible, and a 90% reimbursement percentage.
$1,300 - $100 = $1,200
$1,200 x .9 = $1,080 (reimbursed amount)
The waiting period is the period of time specified in the policy that must pass before some or all of the coverage begins. The waiting period applies to the pet original start date and any coverage increases, but does not apply to your annual renewal, provided you maintain continuous coverage with us. The waiting period begins as of the effective date of the coverage period.
Waiting periods for coverage:
There is a fourteen (14) day waiting period per pet before we will cover an illness, except for IVDD (Intervertebral Disc Disease) including slipped or herniated discs secondary to IVDD where there is a 180-day waiting period.
There is a two (2) day waiting period per pet before we will cover an accident, except for cruciate ligament conditions where there is a 180-day waiting period.
There is a three hundred and sixty-five (365) day Waiting Period per Pet before We will cover a Pre-existing Condition.
This policy does not cover conditions related to pre-existing conditions prior to the waiting period.
Pre-existing Conditions including, but not limited to:
- Bilateral Condition, presenting on one side of the body. For example, a cruciate tear in the left leg that showed symptoms prior to the coverage period or during a waiting period, a subsequent cruciate tear in the right leg will be considered pre-existing.
- IVDD (Intervertebral Disc Disease) if diagnosed, treated, or showing symptoms prior to the coverage period or during the waiting period and any further episodes of IVDD or any future occurrence of this condition.
Other exclusions may apply. Please refer to the exclusions section of the policy for more information.
Terminology and Meaning
Congenital anomaly or disorder
Congenital means an illness, disease or condition that was present at or dated from the birth of your pet.
An abnormality that is genetically transmitted from parent to offspring and may cause illness or disease.
Any illness or injury which occurred, reoccurred, existed or showed symptoms, whether or not diagnosed by a veterinarian, prior to the original start date, coverage period, or during the waiting period. Pre-Existing Conditions are only eligible after three hundred and sixty-five (365) days of continuous coverage and only for Treatment that occurs after the three hundred and sixty-five (365) day Waiting Period.
means a period of time specified in the Policy that must pass before some or all of the coverage begins. The Waiting Period applies to the Pet Original Start Date and any coverage increases but does not apply to Your annual renewal, provided You maintain continuous coverage with Us. The Waiting Period begins as of the effective date of the Coverage Period.
|Maximum Allowable Limits|
|Spay/Neuter - Teeth Cleaning||$0||$150|
|Heartworm test or FELV screen||$25||$30|
|Blood, Fecal, Parasite Exam||$50||$70|
|Urinalysis or ERD||$15||$25|