Pet Insurance Glossary

Navigating insurance policies can be an intimidating thing. The insurance industry almost seems to have its own language, so having a reference guide handy can really make a difference when you’re attempting to find the best plan for your pet.

We’ve compiled a list of words that are commonly used in regards to pet insurance and provided each with a succinct definition to help you make an informed decision when it comes to your pet’s health and well-being.

Accident: Any unexpected and unintended event that causes injury.

Adjuster: A representative of the insurance provider who seeks to determine the extent of the insurer’s liability for loss when a claim is submitted.

Age: Your pet’s age, as confirmed by a veterinarian. Age may impact your monthly premium.

Agent: An individual who sells and services insurance policies.

Age-Related Deductibles: Older pets have a need for more medical attention, and as such, have a higher incidence of claiming. Some insurers increase the deductible amount as your pet ages so that they can continue to offer lower premiums to pets of all ages. The deductible is only applied during the years in which claims are made.

Annual: Periods of one year, or part of a year, starting with the date this Policy was first issued, or starting with the effective date of a change in Coverage Plan.

Annual Deductible: This is the amount you must pay each year before the insurance company starts paying.

Associated Condition: Any medical problem that is directly related to and caused by a primary medical Condition. This includes any medical Condition resulting from any Treatments for the Associated Conditions such as alternative therapies, diagnostic testing, medication and prescription diets.

Benefit: Compensation you receive, or are guaranteed to receive, from the insurance company for incurring costs specified in your pet’s insurance policy.

Benefit Period: The number of days for which benefits are paid to the named insured.

Benefit Schedule: This is the maximum amount of money the insurance company will reimburse based on predetermined listed fee structure. Companies that use this structure tell you ahead of time the specific amounts they will pay for certain diseases.

Bi-Lateral Condition: Any Condition affecting body parts of which your pet has two, one on each side of the body (examples: ears and eyes).

Breed: Some breeds of animals are more susceptible to certain illnesses than others.

Broker: Insurance salesperson who searches the marketplace in the interest of clients, not insurance companies.

Caps: Upper limits on the amounts of money an insurance company will pay under certain circumstances. These should be outlined in detail in your policy. There can be caps for accidents, diseases, surgeries, chronic conditions, wellness treatments, dental care and other categories. Often insurance companies also have annual caps and lifetime (the life of the insured pet).

Casualty: Liability or loss resulting from an accident.

Chronic Diseases: Chronic diseases are diseases of long duration and generally slow progression. They are usually not curable.

Claim: A request you make to the insurance company for payment of the benefits as provided by the policy.

Claim Form: The form you submit to the pet insurance company to request reimbursement for veterinary costs.

Clinical Signs: Changes in a Pet’s normal healthy state, bodily function or behaviour.

Co-Insurance: The percentage of Your claim that You must pay before any applicable Deductible is applied. Sharing in the financial risk ensures that you make informed, responsible decisions about your pet’s health and treatment.

Condition: All manifestations of Clinical Signs resulting from the same diagnostic classification or disease process, regardless of the number of incidents or areas of the body affected (example: all cancer is considered one Condition).

Co-Pay: A predetermined, flat fee the pet owner pays for pet health-care services, in addition to what insurance covers.   An example would be a $10 copayment for each office visit to the vet, regardless of the type or level of services provided during the visit. Copayments are not usually specified by percentages, but are stated in dollar amounts.

Coverage: The scope of protection provided under an insurance policy. In property insurance, coverage lists perils insured against, properties covered, locations covered, individuals insured, and the limits of indemnification. In life insurance, living and death benefits are listed.

Coverage Plan: The Coverage and Benefits as specified and defined in the Policy.

Covered Expenses: Treatment and procedures that are covered by the pet insurance policy. Not all treatments and procedures are covered. Let say you went to the vet for anal sac expression and treatment of a laceration on the foot. If the insurance policy states that it does not cover anal sac treatment but does cover laceration, the insurance would cover the expenses for treatment of the laceration, but not the anal sac treatment. The cost of the anal sac treatment would be paid 100% by you.

Customer: A policy holder.

Customer Card: A printed carrying card which holds pertinent customer and insurance information, for ease of use and accessibility. This should not be construed as a legal document or as proof as a customer.

Deductible: The amount of the veterinary bill you must pay before the insurance company starts paying.

Document of Insurance: The Policy page which identifies the Policy number, the insured, the insured. Pet, the Coverage Plan and the Period of Insurance.

Exclusions: Items or conditions that are not covered by the general insurance contract. Typically pet insurance companies have exclusions for some breeds, pre-existing conditions, and genetically transmitted conditions. Some exclusions have a time limit or dollar amount limit after which the exclusion is lifted and the company will begin paying for what it previously excluded.

Flea Control: Flea control is generally considered part of wellness benefits.

Guaranteed Renewable: A policy provision which guarantees the pet owner the right to renew coverage at every policy anniversary date. The company does not have the right to cancel coverage except for nonpayment of premiums by the policyowner; however, the company can raise rates if they choose provided they have specified this rate increase in the policy.

Heartworms: A common ailment frequently covered by pet insurance companies.

Illness: Sickness, disease and any changes to a Pet’s normal healthy state.

Insurer: The insurance company that underwrites the policy or assumes the risk.

Maximum Claimable Amount: The most You can claim for, as set out and explained in the Document of Insurance and the Schedule of Maximum Benefit Amounts. Any applicable Co-Insurance and Deductible may be applied to this amount.

Maximum Lifetime Payout: This is the maximum amount of money the insurance company will reimburse you during the lifetime of your pet. Once you reach this limit, you will not receive any more money and your policy will be terminated.

Maximum Payable Amount: The most an insurance company will pay, as outlined in the plan’s policy.

Maximum Payout Per Body System: This is the maximum amount of money the insurance company will reimburse for a body system, such as the digestive, musculoskeletal system, or nervous system. Once you reach this limit for a body system, you will no longer be reimbursed for an injury or illness relating to that body system.

Maximum Payout Per Incident: This is the maximum amount of money the insurance company will reimburse you for each new illness or injury. Once you reach this limit, that particular injury or illness will no longer be covered and you will not receive any more money for that particular injury or illness.

Maximum Payout Per Year: Also called Maximum Annual Payout, this is the maximum amount of money the insurance company will reimburse you each policy year. Once you reach this limit, you will not receive any more money for any injury or illness for that policy year.

MRI and CT Scans: Diagnostic tests and scans performed to determine the cause of an illness or injury are provided for in your benefits for covered conditions.

On-going Conditions: Unlike injuries, on-going conditions (like skin conditions, allergies, epilepsy) often require treatment over many years.

Per-Incident Deductible: This is the amount you must pay for each new illness or injury before the insurance company starts paying. This deductible is paid once for each new illness or injury. If a pet is hit by a car, that is considered one incident and has one deductible regardless of how many times the owner must return to the veterinarian.

Policy: The written contract between you and the insurance company of your pet insurance, including all clauses, riders and endorsements.

Policy Year: 12 months starting on the date your policy begins.

Pre-Existing Condition: A coverage limitation included in many pet health policies which says that certain physical conditions, either previously diagnosed or which would normally be expected to require treatment prior to issue of the policy, will not be covered under the new policy for a specified period of time.

Premium: The amount you pay monthly or annually for your pet insurance policy.

Reimbursement: The amount of money an insurance company pays you for vet fees you have already paid. You receive a reimbursement after you have filed a claim for reimbursement.

Renewal: The automatic re-establishment of an insurance policy at the end of term of the policy. This usually occurs when the policyholder pays another premium. Most renewals are automatic if you continue to pay the premium, but the cost of the premium may increase if there is a provision in the policy for rate increases tied to certain variable factors, such as inflation, increases in vet fees and increases in the cost of commonly prescribed medicines.

Requirements: Things you must do to remain insured (e.g. annual exams, submission of medical records, adherence to the vaccination recommendations, etc).

Routine and Preventative: Refers to preventive procedures such as vaccinations, annual exams, heartworm testing/medications, spaying/neutering, etc. These procedures helps keep your pet healthy and in turn reduces your veterinary bills.

Schedule of Maximum Benefit Amounts: The defined Coverage, benefits and limits applicable under the Policy.

Terms & Conditions (T&Cs): A document outlining all the restrictions and legally binding aspects of an insurance plan. It’s important to review your policy terms and conditions to ensure you have the right coverage for your pet.

Treatment: Veterinary care, hospitalization, dentistry, surgery, diagnostics, medication, nursing, specialist referral, medical devices, alternative therapies and behavioural therapies performed by a Veterinarian.

Underwriter: The individual trained in evaluating risks and determining rates and coverages for them. Also, an insurer. The underwriter is not always the insurance company itself. An insurance company may re-sell policies to underwriters.

Veterinarian: A physician or surgeon who is licensed to practice Veterinary medicine where that practice is located.

Veterinary Services: Veterinary care professional fees, hospitalization, dentistry, surgery, diagnostics, medication, nursing, specialist referral, medical devices, alternative therapies and behavioural therapies performed by a Veterinarian.

Veterinary Specialists: Veterinary specialists are board certified in a specific field of veterinary medicine such as internal medicine, surgery, dermatology, ophthalmology. Their certification gives them a higher level of expertise in their area of specialty than a general practitioner.

Waiting Period: The time you have to wait before coverage starts. If something happens to your pet during the waiting period, that condition will not be covered. There can be one waiting period for accidents/injuries and another for illnesses. There can also be waiting periods for certain injuries or illnesses like Anterior Cruciate Ligament Injuries and Intervertebral Disk Disease.

Wellness: Wellness plans often provide coverage for preventive treatments to prevent your pet from becoming ill as well as providing benefits in case they do become ill or suffer an accident or injury.

X-Rays: Veterinary medicine relies upon x-rays to help diagnose conditions. Many pet insurance companies cover this diagnostic procedure. Benefits may be available for MRIs, CT Scans and other advanced diagnostic procedures if medically necessary.

You, Your: The person(s) named in the Document of Insurance.

Your Pet: The pet named in the Document of Insurance.

Zoonotic: A word referring to any illness that originates from an animal that can be transferred to a human, so by protecting your pets you are protecting yourself and your family.