Glossary of Terms used in Veterinary Pet Insurance Policies

For those not accustomed to reading insurance policies, the terms used in veterinary pet insurance policies can seem confusing. To help you to better understand the policies you are considering, here are some common terms used in many veterinary pet insurance policies.

Terms regarding WHAT a Veterinary Pet Insurance Company will (or will not) Pay:

Glossary of Terms used in Veterinary Pet Insurance PoliciesCo-Pay- Similar to human health insurance, veterinary pet insurance companies will often require some portion of the veterinary bill to be paid by the policyholder.
Deductible (annual or incidental)- The deductible is a dollar amount that the policyholder is responsible for paying. A deductible can be required based on the annual amount of veterinary care requested for reimbursement, or based on a per incident amount requested for reimbursement from a veterinary pet insurance company.
Maximums (lifetime, annual, and per incident)- A maximum is the highest level of reimbursement for veterinary fees that a veterinary pet insurance company is going to pay to a policyholder. Many times, maximums are determined for the life of the pet, on an annual basis, or on a per incident basis.

Terms regarding HOW a Veterinary Pet Insurance Company Calculates what they will (or will not) Pay:

Actual Veterinary Fees- Actual veterinary fees are the fees that an actual veterinary hospital has charged a policyholder for services rendered to a covered pet.
Benefit schedule- Some veterinary pet insurance companies will develop a listing of common veterinary services and decide what the services should cost the policyholder. Thus, companies using benefit schedules will base their reimbursed amounts on their list of fees. (Note that the benefit schedule may not coincide with the amount that your veterinarian will actually charge you for care).
Usual and Customary Fees- Some veterinary pet insurance companies will determine based on a policyholder’s residence, what typical charges are assessed by veterinarians for services in areas similar to the policyholders. These are the amounts that are used to determine what the veterinary pet insurance company will reimburse on a claim.

Terms regarding what a Veterinary Pet Insurance Plan will (or will not) Cover:

Congenital Conditions- A congenital condition is a medical condition that is present at the birth of the pet, even if it has not been identified yet.
Hereditary Conditions- A hereditary condition is a medical condition that was genetically passed down to the pet by his or her biological parents.

Important Organizations that Impact Veterinary Pet Insurance Companies:

AAHA American Animal Hospital Association
NAPHIA North American Pet Health Insurance Association
Above are a few of the terms that are commonly used in veterinary pet insurance policies. Understanding the benefits and limits to the policy that you are considering can make your subsequent experience with the veterinary pet insurance company more rewarding. When deciding to purchase a plan, be sure to ask the sales representative any questions about the policy that you might have!

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Angela Linvill

Angela has been the Hospital Administrator of a multi-specialty/ emergency/ and general practice veterinary hospital since 2005. She is also the Chair of the Contra Costa County Employer Advisory Council. Angela has a Masters of Science degree in Human Resource Management from Troy University. She is committed to helping pet owners make good decisions about the health care of their pets regardless of their financial situation.

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