Pre-existing conditions and pet insurance
By Raúl Vaquerizo · Published · Editorial policy
Almost every pet insurance policy excludes pre-existing conditions. Under the NAIC Pet Insurance Model Act, which a growing number of states have adopted, a condition is pre-existing if, before the policy’s effective date or during a waiting period, any of these is true:
- a veterinarian gave medical advice about it;
- the pet was treated for it; or
- based on verifiable sources, the pet had signs or symptoms directly related to the condition being claimed.
That is why the single best way to avoid exclusions is to insure your pet while its vet record is still clean.
What the definition means in practice
- No diagnosis needed. Symptoms count. If your dog was limping and the vet noted it, a later knee diagnosis can be excluded even though nobody named the condition at the time.
- Waiting periods count too. Anything that shows up during the waiting period is treated as pre-existing. Under the model act, waiting periods for illnesses and orthopedic conditions not caused by an accident can be at most 30 days, and waiting periods for accidents are not allowed.
- The insurer has to prove it. The model act puts the burden of proving that a pre-existing exclusion applies on the insurer.
- Covered once, covered on renewal. A condition the policy has already covered cannot be treated as pre-existing when the policy renews.
Which states use this definition
At the time of our last review, 17 states had adopted the NAIC model or a substantially similar law: California, Delaware, Florida, Hawaii, Louisiana, Maine, Maryland, Mississippi, Montana, Nebraska, New Hampshire, New Jersey (for policies issued from 01/01/2027), Ohio, Pennsylvania, Rhode Island, Vermont and Washington. In other states, each insurer writes its own definition, which can be stricter. Each state page shows its status.
Curable vs incurable conditions
The model act defines terms but does not force insurers to exclude anything, and some insurers cover certain pre-existing conditions after a period without symptoms. For example, MoneyGeek reports that Pumpkin and ASPCA cover curable pre-existing conditions after 180 symptom-free days. Chronic conditions (the model defines one as a condition that can be treated or managed but not cured), such as diabetes, heart disease or arthritis, never go away, so once they are in the record a new insurer can keep treating them as pre-existing. Check each insurer’s wording.
Hereditary and congenital conditions are different
A hereditary disorder (passed from parents to offspring) or a congenital one (present from birth) is not automatically pre-existing: if it had no signs and no vet advice or treatment before coverage started, it does not meet the model definition. Whether a policy covers hereditary or congenital conditions is a separate question. Some policies exclude them, and in model act states insurers must disclose if they do. This matters for breeds with known inherited problems, such as polycystic kidney disease in Persian cats or breathing problems in flat-faced dogs.
How to avoid surprise exclusions
- Insure early, ideally as a puppy or kitten, before the first notes about recurring problems.
- Get the vet records in order. Insurers review them when you claim. Ask your vet to record clearly when a problem has resolved.
- Ask before you buy. If your pet has had any issue, ask the insurer in writing how it would treat it.
- Know the waiting periods and use the exam waiver the model act requires insurers to offer, if you are in a model act state.
- Think twice before switching insurers. A new insurer can treat anything your current policy has seen as pre-existing.
- Use the 15-day free look. In model act states you can return a policy within 15 days for a full refund if you have not filed a claim.
Related
- Is pet insurance worth it?
- Pet insurance for senior dogs
- Breed pages list the conditions each breed is prone to, so you know what to watch for before enrolling: dogs, cats.
Estimates only, not a quote. Not financial or veterinary advice. We are not an insurer, agent or broker. Prices come from public data and change by insurer, ZIP code, policy options and your pet's medical history. Always read the policy and ask your veterinarian about your pet's health. Full disclaimer.