Pet Insurance Glossary

Don’t get lost in the language, here are some common terms you might come across.

Agent –An individual who sells and services insurance policies.

Adjuster – A representative of the insurer who seeks to determine the extent of the insurer’s liability for loss when a claim is submitted.

Benefits – Money you receive, or are guaranteed to receive, from the insurance company for incurring costs specified in your pet’s insurance policy.

Benefit Period – The number of days for which benefits are paid to the named insured.

Broker – Insurance salesperson who searches the marketplace in the interest of clients, not insurance companies.

Caps – Upper limits on the amounts of money insurance companies will pay under certain cirumstances.  These are outlined in detail in your policy.  There can be caps for accidents, diseases, surgeries, chronic conditions, wellness treatments, dental care and other categories.  Usually insurance companies also have annual caps and lifetime (the life of the insured pet).

Casualty – Liability or loss resulting from an accident.

Claim – A request you make to the insurance company for payment of the benefits as provided by the policy.

Co-Pay – Copayment- A predetermined, flat fee the pet owner pays for pet health-care services, in addition to what insurance covers.   An example would be a $10 copayment for each office visit to the vet, regardless of the type or level of services provided during the visit. Copayments are not usually specified by percentages, but are stated in dollar amounts.

Coverage – The scope of protection provided under an insurance policy. In property insurance, coverage lists perils insured against, properties covered, locations covered, individuals insured, and the limits of indemnification. In life insurance, living and death benefits are listed.

Exclusions -Items or conditions that are not covered by the general insurance contract. Typically pet   insurance companies have exclusions for some breeds, pre-existing conditions, genetically transmitted conditions.  Some exclusions have a time limit or dollar amount limit after which the exclusion is lifted and the company will begin paying for what it previously excluded.

Guaranteed Renewable – A policy provision which guarantees the pet owner the right to renew coverage at every policy anniversary date. The company does not have the right to cancel coverage except for nonpayment of premiums by the policyowner; however, the company can raise rates if they choose, pprovided they have specified this rate increase in the policy.

Policy – The written contract between you and the insurance company of your pet insurance, including all clauses, riders and endorsements.

Pre-Existing Condition – A coverage limitation included in many pet health policies which says that certain physical conditions, either previously diagnosed or which would normally be expected to require treatment prior to issue of the policy, will not be covered under the new policy for a specified period of time.

Premium – The price of insurance protection for a specified risk for a certain period of time.

Reimbursement – The amount of money an insurance company pays you for vet fees you have already paid. You receive a reimbursement after you have filed a claim for reimbursement.

Renewal – The automatic re-establishment of an insurance policy at the end of term of the policy. This usually occurs when the policy holder pays another premium.  Most renewals are automatic if you continue to pay the premium, but the cost of the premium may increase if there is a provision in the policy for rate increases tied to certain variable factors, such as inflation, increases in vet fees and increases in the cost of commonly prescribed medicines.

Underwriter – The individual trained in evaluating risks and determining rates and coverages for them. Also, an insurer.  The underwriter is not always the insurance company itself.  An insurance company may re-sell policies to underwriters.