Claims Process

Contents

How do I submit a claim?

To submit a claim, you’ll need a few important documents:-

A finalised paid invoice: This is from your vet and should detail the treatment your pet received and the amount you paid.
– Vet consultation notes: The clinical notes from your vet for a visit related to your pet’s illness or injury.
– Complete medical history: If you didn’t complete a pre-existing condition assessment when you started your policy, we’ll need a full medical history. Simply provide a list of vets your pet has visited, and we’ll handle collecting their medical records.

Note: If you already completed a pre-existing condition assessment at the start of your policy, only the paid invoice and vet consultation notes may be needed for claims.

How to submit your claim

You have a few easy options to submit your claim:

1. Your vet: Ask your vet to email the invoice and clinical notes directly to [email protected]. This is the quickest way to make your claim.

2. Email: Send your policy number and a copy of the paid invoice to [email protected]. We’ll contact your vet for the notes and notify you once the claim is lodged.

3. Petsy Portal: Log in to your account, select your pet’s policy, and click ‘New Claim’. You can upload a photo of your invoice and answer a few questions.

What happens next?

We usually process claims within 5-10 business days after we receive all required documents. Claims can be processed quicker if a pre-existing condition assessment was completed when you first set up your policy. We’ll keep you updated via email, so keep an eye on your inbox. To make sure reimbursements are processed quickly, please confirm that you have provided us with your correct bank details.

What happens during the claims process?

The Steps to Process Your Pet Insurance Claim

Understanding a Claim:

A pet insurance claim is how you apply to get reimbursed for vet bills that are covered by your policy.

After you submit a claim, our team checks it and reviews it based on the information provided. If approved, we’ll make the payment into your nominated bank account.

If your pet unexpectedly gets sick or hurt

1. Visit a Vet: If your pet seems unwell, take them to a vet. After the visit, you’ll get an invoice that lists what treatments your pet received and how much they cost.

2. Submit Your Claim:
– You can ask your vet to email us the invoice and clinical notes directly to [email protected]
– Or, you can send us a clear photo of the paid invoice. Make sure it includes important details like the vet’s contact info, the date, and what you paid for. We’ll reach out to your vet for a copy of the clinical notes.

3. We Process Your Claim:
We’ll check your claim and ask your vet for any extra information we need.
Our team will review all the information to make sure it is covered under your policy.
If everything looks good, we’ll approve your claim and send you the money.

Streamline your claims process by:
– Requesting a pre-existing condition assessment soon after you take out the policy
– Knowing what’s not covered like pre-existing conditions, routine check-ups, vaccinations and desexing
– Having all your vet visit records and invoices ready to go
– Making sure we have your current bank details for quick reimbursements
– Stay available in case we need to reach you for more information

How to Make the Most of Your Pet Insurance

Claims process & submitting claims

To make the most of your pet insurance, it’s important to understand the claims process with the provider you choose. Generally, after your pet receives treatment, you’ll need to pay the vet, then submit a claim with your insurer.

Common pitfalls to avoid

Understanding your pet insurance policy and the claims process can prevent disappointment later on. Common pitfalls include incomplete paperwork when submitting claims and not being aware of exclusions or limitations in your coverage. Being familiar with your policy details can help you avoid surprises and make the most of your insurance. Also, check with your insurance provider if they have options available to help streamline future claims.

If your claim is denied, it’s typically due to these reasons:

  • Submitting a claim within an exclusion period – Your pet isn’t covered the moment you buy your policy. Your policy has different exclusion periods that need to be passed symptom-free before coverage begins.
  • Submitting a claim for a pre-existing condition – Pre-existing conditions aren’t covered if any signs or symptoms of those conditions occurred before the exclusion periods ended.
  • Submitting a claim for a non-covered item – Pet insurance is designed to help with unexpected vet costs. Preventative, elective or routine treatments including regular health check-ups, vaccinations and desexing aren’t covered.

Setting Yourself Up for Pet Insurance Success

How to be prepared for emergencies

Emergencies can happen anytime, so it’s important to have a plan in place. Keep your vet’s contact information, a 24-hour emergency clinic contact details, and your pet insurance policy number in an easily accessible location. Ensure your policy covers emergency visits and have an emergency fund to cover upfront costs before your claim is processed.

Navigating vet visits with insurance

When visiting the vet, let them know you have pet insurance. Ask for detailed invoices and make sure you have all the necessary paperwork to submit a claim. Familiarising yourself with your pet insurance claim process so you’re across the information required to avoid delays.

After your pet has received treatment, you can usually ask your vet to submit the claim for you when you’re at the clinic, by providing your policy number or asking the clinic to submit the invoice or history through to your insurance provider.

Claims FAQs

What is a claim?

A pet insurance claim is a formal request made by a policyholder for reimbursement or payment for part of the vet bill. The claims team will review the claim request based on the information available, and if approved, send payment into your nominated bank account.

When does my policy start and when can I make a claim?

Policy Start Date:

- Your policy starts at 23:59 on the chosen start date.
- Coverage doesn’t begin immediately; there are exclusion periods that need to pass symptom-free before you can claim for treatment.

Exclusion Periods:

- 1 Day: Accidental Injury (except Specified Conditions)
- 14 Days: Illness (except Specified Conditions) and Dental Illness for pets under 1 year old
- 6 Months: Dental Illness for pets 1 year and older, Behavioural Conditions, and Specified Conditions

Specified conditions: A specified condition includes specific health issues, including cruciate ligament damage, intervertebral disc disease, hip dysplasia, patella luxation, elbow dysplasia, osteochondritis dissecans (OCD), cherry eye, entropion, ectropion, and lumps.

Making a Claim:

  • You can submit a claim for unexpected injuries or illnesses covered by your policy after the exclusion periods end.
  • Claims must be submitted within 90 days from the date of treatment to ensure timely assessment. If you have any questions about your coverage or claims, our team is here to help.

Does completing a pre-existing condition assessment help with future claims?

Yes! Traditionally, pre-existing conditions are only assessed when you make your first claim. By completing the assessment early, you’ll have a clear understanding of your coverage, and we’ll store your pet’s medical records on file. This helps us process future claims faster and more efficiently.

How long does it take for a claim to be assessed?

We usually assess claims within 5-10 business days after we receive all the necessary documents. You'll receive email updates about the progress and the outcome of your claim. If your claim is approved, we typically process the payment on the next business day.

Tip: To speed up the claims process, consider having a pre-existing condition assessment done for your pet soon after you take out your policy. This allows us to collect your pet’s medical history ahead of time, which can speed up processing your first claim. After this initial assessment, for any future claims, we'll often just need the invoice and clinical notes from your vet.

How do I add another invoice to an existing claim?

If you have additional invoices related to an existing claim, simply email them to us at [email protected]. Please make sure to include the claim number that these invoices should be added to.

Who assesses my claim?

Your claim is reviewed by a dedicated, Australian-based team of veterinary professionals, including veterinarians and vet nurse assessors. They carefully evaluate the details of your claim, focusing on the clinical notes and treatment details provided by your vet to ensure your claim is covered under your policy. Our expert team ensures that your claim is handled professionally and fairly.

Important terms

Exclusion Periods: These are times when your pet isn’t covered after you start a new policy or increase your coverage. They begin on your pet’s First Date of Cover and vary by condition. Insurance covers unexpected injuries and new illnesses only after these periods end.

The exclusion periods are:

• 1 Day Exclusion Period for Accidental Injury (except Specified Conditions)
• 14 days Exclusion Period for Illness (except Specified Conditions)
• 14 days Exclusion Period for Dental Illness for pets under 1 year old
• 6 months Exclusion Period for Dental Illness for pets 1 year and older
• 6 months Exclusion Period for Behavioural Conditions
• 6 months Exclusion Period for Specified Conditions

During the exclusion period, any signs or symptoms of a condition are considered pre-existing and won’t be covered. Claims made during this time won’t be covered, but once the periods end, we can cover new and unexpected injuries and illnesses.

Pre-existing condition assessment: This review of your pet’s vet history helps identify if there are any conditions not covered by the policy. Make sure your pet has visited a vet at least once. If they haven’t yet, you can contact us after their first visit.

Pre-approval: This is getting approval for a future claim before you get treatment, not after.

Cooling-off period: You have a 30-day cooling-off period to make changes to your policy if you change your mind. After that, there are some limits on when you can make changes (check your policy for details).

Waiver: Once your policy is set up, you can take the Waiver Form to your next vet visit to apply to reduce the exclusion period for Specified Conditions. Return the completed form to us within 14 days.

Specified conditions: means cruciate ligament damage, intervertebral disc disease, hip dysplasia, patella luxation, elbow dysplasia, osteochondritis dissecans (‘OCD’), cherry eye, entropion, ectropion and Lumps.

Pre-existing conditions: Refers to any injury, illness or health issues your pet had including signs or symptoms that appeared before the exclusion periods end. Treatment costs related to pre-existing conditions aren’t covered by the policy.

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Specified Conditions includes:

  • Cruciate ligament damage
  • Intervertebral disc disease
  • Hip dysplasia
  • Patella luxation
  • Elbow dysplasia
  • Cherry eye
  • Entropion
  • Ectropion,
  • Osteochondritis dissecans (‘OCD’)
  • Lumps

Lumps means the protuberance or localised area of swelling or unusual growth that can occur anywhere on or in the body including tumours, warts, cysts, growths, mucoceles, haematomas and abscesses.

You can apply to reduce the 6-month exclusion period for Specified Conditions by using our request for Waiver Form. Simply take this form to your next vet visit and submit the completed form back to [email protected] within 14 days of the visit.

Optional Extra Benefits

During the application process You will be provided with the option to include Optional Extra Benefits that cover certain conditions and Treatments which are not otherwise covered under the Policy.

The Optional Extra Benefits are:

Alternative Therapies, Behavioural Problems, and Dental Illness.

Examples of Alternative Therapies: Acupuncture, physiotherapy, hydrotherapy.

Examples of Behavioural Problems: Excessive licking, fur pulling, pacing and destructive chewing.

Examples of Dental Illnesses: Dental diseases, gingivitis, periodontal disease.