Pet insurance - Our guide

The Edgewood guide to Pet Insurance

With more and more clients approaching us with complaints, concerns, and misunderstandings regarding their pet insurance policies, we have put together a helpful guide with lots of information to help you decide which policy is best for you or how to manage your existing policy.

We are not legally allowed to recommend companies or insurers, or tell you what type of cover to buy, but we can explain what each policy type offers, detail the admin process from our end and give you some hints and tips to help you be in the best position should the worst happen.

The admin process

Our relationship with your insurer

Firstly, we need to clarify that we have no relationship with any of the insurance companies. We are not linked to them for payment or information by a central database and therefore we have no information regarding your policy other than information you provide us with.

A common misconception is that insurance companies deal with us directly for information and to make payments, but that is not the case. This misunderstanding may come from the set up with home and car insurance as typically the insurance company pay the enlisted company who carry out work directly and not the client. The client pays the excess to the insurance company and there is little other involvement. Pet insurance is different, for the most part you must pay for any outstanding amounts owed to Edgewood Veterinary Group, which you can then claim back from your insurance company with invoices and receipts. There are some exceptions which we look at below.

How do I claim on my insurance?

You need to request or download a claim form from your insurer. Some now have online portals where you can manage your claim from. You can then either complete the form yourself, provide your receipts and return it back to them or we have a claims administrator here, who will complete and process the claim on your behalf if you provide the claim form and details. This can be beneficial, especially with complex or ongoing claims as we have the ability to refer back to your pet’s history, detail claims in a more advantageous way and complete the form efficiently so claims are paid more promptly.

Do you charge to administrate my claim?

Yes, we have a blanket charge of £7.50 + VAT per claim. Considering the complexity of some of the claims, along with the time they take and the resources we must provide in order to have this facility, this is a fair price. This cost will not be reimbursed by your insurance company.

 

Pre-authorisations and direct claims

A pre-authorisation is where the insurance company guarantee payment of a particular procedure or course of treatment. If we have a pre-authorisation, we are normally happy to accept payment directly from the insurance company. It is worth mentioning, however, that not many insurance companies seem to offer this facility these days so if this is a set up you would like, you need to make sure it is offered on your policy.

A direct claim is when an insurance claim form is completed after treatment and a box is ticked to say that the insurance company will pay us directly when it has been authorised. Unless your insurance company has agreed to pay us for the procedure or operation via an agreed pre-operative authorisation, we do not accept direct claims. There are 3 reasons why we cannot accept direct claims.

1. We are unable to offer a credit facility legally as we are unlicensed to do so. Delaying payment (It can take an insurance company up to 4 months to pay us back) is indirectly offering credit or extended payment terms.
2. From a cash flow perspective, we are unable to finance our business and carry on employing our team and providing the services we offer, if we are not being paid on time. As above, with some claims taking up to 4 months to be paid, it would affect the way we run the business.
3. Unless pre-authorised, insurance pay outs are not guaranteed. Sometimes, after some months of discussion, an insurance company can refuse to pay out leaving us with an unpaid bill that a client may not be able to afford, but the responsibility does still lie with the owner.

Pet insurance – A guide

What does pet insurance cover?

This does all depend on the type of cover you have (there are 3 main types which we will look at later), how much cover you have on your policy to spend per year and what you animal is covered for (If your pet has any pre-existing conditions these usually will not be covered by the insurance company) Similarly, to human health insurance if you have suffered with a heart problem, your insurance company may say they will cover everything other than heart complaints so pre-existing conditions will not be covered. Even if you haven’t had an actual heart attack; just a consult or GP appointment with heart concerns, that might suggest an underlying issue. It is the same with pet insurance. Insurance companies use your pet’s history to see if the pet has a pre-existing condition or if they have been seen for a related issue in the past. This may, however insignificant it may seem, become an exclusion on the policy.

Pet insurance does not normally cover ad hoc or one-off visits. If it is a single isolated consultation for a check-up and medication the bill may not be enough to warrant claiming, especially as there is usually an excess on most policies (this will be covered in more detail later). If your consultations are part of an ongoing investigation, they can usually be claimed together at the end of the treatment as they are associated with the same condition.

Pet insurance does not cover food, flea and worming treatment or preventative health care like spaying and neutering. There are many exclusions on dental treatment so this may be something you are not, by default, covered for, unless it is an emergency or trauma related. This could be likened to that of car or home insurance where the maintenance is not covered by your policy, only damage and emergency situations.

What are the four main types of pet insurance on the market?

It is very important to understand that not all pet insurance policies are the same so the prices will differ hugely. As with many things in life, you do get what you pay for, so the policies at the cheaper end of the scale are more likely not to provide a decent level of cover with optimum benefits.

Lifetime policies

• Cover is provided up to a set amount per year and refreshed every year the policy is in place.
• There is no time limit on how long you can claim for each illness or injury as long as the policy is renewed each year without a break.
• This type of policy is ideal if your pet develops an ongoing condition such as epilepsy, diabetes or arthritis or has an accident that leaves them needing ongoing support.
• This policy will not cover any pre-existing conditions on an animal’s veterinary history before the start of the policy.

12 month/Limited or set time policies

• Cover is provided up a maximum amount per condition, per set period.
• There is either a 12 month or similar time limit in place and the pet will only be covered for this time.
• After the set period has expired, any condition identified or treated within that set period, will then be excluded from the policy
• If your pet develops an ongoing condition, it will only be covered for the set time period.
• This policy will not cover any pre-existing conditions on an animal’s veterinary history before the start of the policy.

Maximum benefit policies

• A set amount of cover is agreed and then provided over the lifetime of the pet per condition (for example £5,000)
• Once you have claimed up to the maximum amount the condition is then excluded from the policy and you must pay for the difference, or for the condition separately ongoingly.
• This policy will not cover any pre-existing conditions on an animal’s veterinary history before the start of the policy.

Accident only policies

• No cover for illness
• Provides a fixed sum for each accidental injury.
• Some policies have a 12-month limit meaning the injury will only be covered for 12 months.
• It often only covers a certain number of accidents.

 

What do we recommend?

We can see that lifetime policies are normally the most useful, as they do not expire either due to time or an upper limit per condition. When asked as to how much financial cover is required, all we can do is to take an example of a referral to a specialist practice for spinal surgery, then a figure of £12,000 is expected for a consultation, MRI scan and surgery.  Having £12,000 or more of cover per year is recommended.

What is an excess and how does it work?

Like with a lot of other types of policies in our life, an excess is also applicable in veterinary insurance. An excess is a set and pre-agreed amount of money that you need to either pay your insurance company in the event of a claim, or in some cases, the excess is deducted from your final pay out.

As the excess is agreed when you take out a policy, you should be mindful of what you are agreeing to, as the excess will be on every claim and depending on your policy, it can be on every separate condition. Some companies charge a percentage-based excess and some charge a percentage on top of the existing fixed excess.

Is pet insurance worth it financially?

On average our larger, more complicated operations and referral cases can reach around £6-7,000. The average cost of good pet insurance is £50-150 per month, though certain breeds can be more depending on their “risk” category for certain expected conditions. If you were to save £100 per month this would be £1200 per year leaving you around £5000 short if you were to need to claim.

You would need to save a considerable amount of money to meet the pay out that a good insurance company would provide. Insurance is a less stressful way of preparing for unforeseen circumstances, illnesses, and accidents, as when these occur the last thing you really want to be thinking about is where you might find additional money from. As long as you do your research well and take out a good policy, pet insurance can really support you as a pet owner.

How important is pet insurance for pet owners?

As a company, we would always recommend having good pet insurance in place. There is nothing more upsetting for us as vets than to know an animal needs a whole set of investigations as well as treatment based on these investigations, that the owner is unable to afford. Although there are animal charities that may step in to help, the criteria are rigid, and it certainly cannot be relied on especially considering there is no pet NHS and only private care exists for pets. However much we love them, they are a choice and not a necessity. Pet insurance allows vets to be able to provide the best care for an owner’s pet when they need it the most.

 

 

Is pet insurance the same as your PHC?

Pet insurance is a completely different product to our Pet Health Club. Our PHC is a monthly payment which pays for flea and worming treatments and yearly vaccinations, i.e., preventative treatment. It spreads the total cost, discounts it by 15% and then divides it into monthly payments. It also covers a yearly health check, unlimited nurse checks and offers discounted preventative treatments. It is not an insurance plan so will not cover you for any illnesses, accidents, or emergencies. The PHC and pet insurance work together in harmony to cover you for your pet’s needs.

Scenarios

We all agree that trying to predict what cover your animal will need, whether insurance is really worth it and how much things cost is overwhelming. This is especially pertinent when you have a brand-new puppy or kitten or a newly adopted friend, the last thing you are thinking out is how they may become ill or may get injured, but much like car insurance for example you cannot predict or avoid the day someone might drive into you, it is simply there to cover you, and adequately, should the worst happen. To try and help you visualise and understand what you need to prepare for, we have listed a number or scenarios we have seen where people have encountered problems by not preparing sufficiently.

• A client came in with their dog who unfortunately needed surgery. The estimated bill for the surgery and aftercare was around £12,000. This was okay though, because the owner was insured for £15,000 per year. Our vets were a little shocked, as its quite a high amount of cover but on further investigation it transpired that the £15,000 maximum was actually just £1,000 per condition. There was an £11,000 shortfall in the policy. We recommend a minimum annual cover of at least £6,000 to £7,000.
• We have recently had a 4-month-old puppy in with a broken leg. He was running around, and we think hit himself on something, causing a fracture. The cost to repair the fracture surgically was close to £5,000. Unfortunately, the owner was not insured, thinking that the dog was too young to need insurance. Insuring pets as young as you can, means there are no pre-existing conditions so you will get the best price. As per this scenario, pets are never too young to have accidents or even underlying health conditions that might surface a few months into their lives.
• We have seen a few very strange exclusions that have been written into certain insurance policies. On one occasion we noted, despite no pre-existing conditions a cat with a heart condition that required investigations, was not covered for cardiac (heart) or neurological (brain) conditions. Not being medically informed, you would be forgiven for not understanding that the exclusion of these were significant, but you absolutely must check what the standard exclusions are on any policy as it could mean that you are only partially covered or not covered at all.
• Be sure to keep your animals’ vaccines and flea/worming treatment are kept up-to-date. The last vaccine date is normally a question within the animals’ details that will be asked on taking out a policy. Even if the animal’s vaccine was late or it missed a vaccination and the disease that it is suffering from has nothing at all to do with the vaccine, your claim may be refused, based on the fact that you have not kept up with your pet’s basic preventative healthcare.
• Most policies do not cover any illness or injury within the first 14 days of taking out the policy. A client of ours found a lump on a cat she had recently rehomed just a week into her ownership. Thinking she was insured she went to make a claim only to be told that it was within the first 14 days, so she could not, not only that, but now that lump was classed as a pre-existing condition so would not be covered in the future.
• As your pet gets older you will notice that the premium starts to creep up, but some with companies the policy terms may change after a certain age. Some companies ask for what is called a “co-payment”; the company may have a co-payment clause for animals over the age of 8 or 10 and this means that you will be responsible for paying a percentage of the policy pay out. This can sometimes be in place of an excess, but some companies charge this on top of an excess. This is important to understand so you are financially prepared as your pet gets older.
• Although it’s something none of us really want to think about, be sure to check how your insurer deals with, and pays out for any end-of-life support for your pet. There are many exclusions which do not cover certain aspects of euthanasia or funeral/aftercare for example caskets, urns, or scatter tubes. As this is a very emotive time, be sure to understand what you can and can’t claim for so it’s not an additional upset at a time when you just need things to be organised and clear in your mind.
• Do your homework on breeds. No dog breed is equal when it comes to insurance. Premiums can rocket in relation to popularity and conditions that are associated with certain breeds. Before you decide on the breed you would like, do some research to check premiums, exclusions, and associated conditions.