Understanding Pre-existing conditions

Why is it important to understand Pre-existing Conditions?

When you decide to purchase pet insurance for your pet, one of the most important things for you to think about is what conditions, injuries or illnesses they have had before the start of cover under the policy and what conditions occur during an applicable waiting period.

The reason it is important for you to think about this is because Petsy Pet Insurance, like most pet insurance policies, has an exclusion for Pre-existing Conditions, which means there is no cover for vet costs associated with the treatment of a Pre-existing Condition. And unlike private health insurance for humans, conditions that arose while being covered by one pet insurance provider is generally not covered by another provider if you switch cover.

Why does Petsy Pet Insurance not cover Pre-existing Conditions?

If Pre-existing Conditions exclusions didn’t exist, people could take out pet insurance or upgrade their cover only when they know or suspect that they might need cover, and then immediately make a claim. What’s more, these customers could then cancel (or downgrade) their cover after making a claim, only to repeat that cycle when new conditions arise. This would not only be unfair to other customers, but it would also contribute to increased premiums for all customers.

How does Petsy Pet Insurance define Pre-existing conditions?

Petsy Pet Insurance policy defines a Pre-existing Condition as follows:

Pre-existing Condition means an Injury, Illness, Dental Illness, Behavioural Problem or Specified Condition (including Bilateral Condition and other conditions that are related to, secondary to, or results of) that:

1. first occurred or showed symptoms of, or
2. was identified or investigated by a Vet, or
3. You were aware of or a reasonable person in the circumstances could be expected to have known about,
   

before Your Pet’s First Date of Cover, before a change of coverage became effective, or during any applicable Waiting Period.

Can you unpack the definition of Pre-existing Conditions?

There are three key parts to understanding Pre-existing Conditions.

1. What types of conditions may be Pre-existing?

Any condition can be a Pre-existing Condition, including those that we have specific definitions for. In addition, Pre-existing Conditions also include conditions that are:

• bilateral, for example, there could be an issue with your pet’s left knee and the same issue may be considered as a Pre-existing Condition for the right knee as well, that is, both sides. The reason for the bilateral link is because we know that when a condition affects one side of the body, it is highly likely the other side will also be affected; and
• related, secondary or a result of the initial condition, for example, if your pet has diabetes as a Pre-existing Condition, then cataracts would be considered a Pre-existing Condition as well. The reason we do this is that we know certain conditions have a high likelihood of triggering secondary conditions.
  

2. How might a condition be ‘known’

There are three ways that a condition may be known:

1. the condition has occurred or has shown symptoms, for example, your pet has had discharge from their eye; and/or
2. the condition has been identified or investigated by a vet, for example, your pet has been examined for diarrhoea or vomiting and additional testing was carried out, such as blood tests or your vet has noticed that your pet has an issue with their leg being extended which they note as possibly being hip dysplasia or something similar; and/or
3. you already knew (or a reasonable person in the circumstances could be expected to have known) that there is an issue, such as limping, or weight loss, but haven’t been to a vet yet.

3. When would a condition be ‘known’?

Conditions will be Pre-existing Conditions when they are ‘known’:

• before the cover starts for your pet under the policy (we call this your pet’s First Date of Cover and this is clearly stated on your certificate of insurance); or
• during an applicable waiting period. Refer to Petsy Pet Insurance Explained for more details about waiting periods; or
• before a change is made to increase the cover, such as an increase in the benefit percentage or adding of Optional Extra Benefits. This means, for example, if the benefit percentage was 80% and you decided to increase it to 90%, then for a condition that wasn’t Pre-existing Condition on the First Date of Cover but has become an issue before the benefit percentage is increased, you would only have cover for 80% of vet costs and not 90% for treatment of that condition.

How will I know what conditions will be considered Pre-existing Conditions for my pet?

At Petsy we value transparency. It is very important to us that we are as clear and upfront as possible about the cover available under your policy, and we, therefore, offer a Pre-existing Condition assessment that can be completed after you purchase a policy for your pet to help you understand what we consider to be a Pre-existing Condition and therefore excluded from cover.

In addition, we will also tell you whether any Pre-existing Conditions may be reviewed at a future date, the earliest future date you may request a review and any supporting information we will require at that time.  Note that exclusions are not automatically removed at the exclusion review date, and exclusions will only be removed if we are satisfied the medical evidence confirms the Pre-existing Condition has been successfully treated or resolved.

If a Pre-existing Condition is not reviewable, it will be permanently excluded from your cover.

If you decide not to get a Pre-existing Condition assessment completed straight after purchasing a policy, we will still do one at the time of your first claim based on a full assessment of your pet’s medical history. This will also include conditions contained in the medical history during an applicable waiting period.

Will a Pre-existing Condition assessment give me absolute certainty of cover?

While we put every effort into providing as much certainty as possible, the Pre-existing Condition assessment can only be completed based on the information available to us at the time. That means even if we haven’t listed a condition as a Pre-existing Condition, it may still be considered a Pre-existing Condition at a later stage if additional information becomes available. In that case, we may change what Pre-existing Conditions we list on your Certificate of Insurance.

For example, if your pet has a history of unexplained weight loss or appetite changes prior to the commencement of your policy and is subsequently diagnosed with a tumour or diabetes, this may be considered a Pre-existing Condition. Another example is, if your pet has symptoms of itchy skin or skin infection before your cover starts or during an applicable waiting period, which is subsequently diagnosed as an allergy, then the exclusion may be changed on your Certificate of Insurance to include associated ear allergies/infections as Pre-existing Conditions.

Also, if your pet has a symptom like diarrhoea before policy commencement or during a waiting period which then seems to be resolved and say, three months later it has another episode of diarrhoea, we may consider the two to be related if an underlying diagnosis is not reached or investigated.

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Pet Insurance may provide peace of mind for the times when your pet needs treatment for an injury or an illness. With a range of cover options available, take the time to consider what cover suits your pet’s needs and your budget.

If you’re looking for a way to better manage your pet’s vet bills and have questions, contact us or get a quick quote now.