What are pre-existing conditions and how does my pet healthcare coverage work for these events?

As any pet parent knows, pet medical insurance is an effective way to not only save you from surprise vet bills, but it can also help cover the costs of routine pet healthcare, including vet visits, checkups, vaccinations and even dental cleanings.

The same way that we as humans need help affording medical care, which is why we have medical aid or health insurance to protect our health (and our bank accounts), pet health insurance helps cover the costs of vet bills.

Something a number of pet parents have asked me about is whether or not pet insurers include cover for pre-existing conditions, and if they do, how does this cover work?

In this article, I break down everything you need to know about pets and pre-existing conditions. I also reached out to the Oneplan team to help me to better understand how their cover works for situations like these to leave you with an informed understanding of this popular topic.

What is a pre-existing condition?

I had a squiz through Oneplan’s policy wording document, and they outline the definition of a pre-existing condition as follows:

“Pre-Existing Condition” means a medical condition, or condition that presented Clinical Signs, that were in existence prior to this policy’s Inception Date, or in existence during the first three months during the waiting period or that was newly diagnosed within the first three months from the Inception Date of the policy, whether it was known or unknown to you.

Head’s up - this kind of condition existed before your policy began and it doesn’t mean that your pet was diagnosed with it, he or she could even have been showing the symptoms for it to be classified as pre-existing.

Basically, a pre-existing condition is an illness, injury or disorder that your pet develops (or starts to show symptoms of), before your pet insurance policy is effective.

While you’re here, check out this blog I wrote on the basic costs of pet ownership in South Africa.

Some real-world examples

Let’s look at an example…

While playing in the park, Bruno gets a bit boisterous and manages to break his leg. At the time of the accident, you had not yet decided on a pet insurance plan. Straight after this incident, you decide to purchase a pet insurance plan. However, this still means that the costs of tests, vet visits, surgery or any additional medical fees will be to your account. And as many pet parents know, these vet healthcare costs don’t come cheap. You are looking at a bill of tens of thousands of rands when surgery is involved.

Let’s look at another example…

Tabatha, your cat, seems to have a strange-looking lump on her stomach. As a new pet insurance policyholder (you purchased your plan 2 weeks ago), you brush off the issue and reassure yourself that your insurer will help cover the costs of this.

Explore more: Why price shouldn’t be your only priority: 6 major things to consider when looking for animal-friendly pet insurance

You take her to the vet and the lump is a cancerous tumour. Tabatha needs to have surgery and radiation to eliminate the cancer cells from her body. The costs of this are not something you can afford on your own. However, your insurer rejects your claim. This is because any conditions that present themselves in the first 3 months of your new policy will be excluded for a minimum of 12 months.

Moral of the story? The sooner you get pet insurance, the better.

Why is there a waiting period for pre-existing conditions?

You need to understand that insurance of any kind is not intended as a corrective measure but as a preventive and precautionary one.

For example, you wouldn’t purchase a home insurance policy to help you afford to cover the damage of a fire to your home, would you? No. The point of insurance is to help save you from surprise costs.

If a pet insurance provider covered all claims without any waiting periods, this would result in higher premiums for all their clients.

Immediate coverage for pre-existing conditions would result in an unsustainable scenario where pet parents ONLY purchase pet insurance policies to access immediate coverage for treatments and then cancel their plans shortly after.

At the end of the day, insurers still have their own bills to pay and mouths to feed, so to speak. And in order to keep premiums at an affordable rate, they need to create a sustainable system that allows for fair client treatment and coverage of events.

In the grand scheme of things, 12 months is not too long a time to wait considering the cost of ongoing vet fees for chronic conditions.

Another thing to keep in mind is that during this waiting period, you can still claim for other events that are unrelated to your pets pre-existing condition. For example, if your pet is currently undergoing cancer treatment but she is in need of her annual vaccine, depending on your chosen plan and coverage limits, you can still claim for these costs. The same goes for emergency care.

If you want any more information, I suggest you have a chat with the guys over at Oneplan, they are always happy to answer any questions you might have.

Until next time,

The Pet Insurance Team