Pre-existing conditions
“Pre-existing condition” means any condition for which any of the following are true prior to the effective date of a pet insurance policy or during any waiting period:

A veterinarian provided medical advice;
The pet received previous treatment; or
Based on information from verifiable sources, the pet had signs or symptoms directly related to the condition for which a claim is being made.

If you cannot provide medical records showing your pet’s annual health exam by a vet occurring within the twelve (12) months prior to the effective date of this policy, the first documented veterinary examination after the effective date of the policy will be used as the basis for determining any pre-existing condition(s).

In addition, the following injuries or illnesses diagnosed or treated prior to the end of the waiting period shall be considered pre-existing conditions:

Cancer and any subsequent cancer of that specific type, including diagnosis or treatment;
Intervertebral Disc Disease (IVDD) and any subsequent IVDD manifestation within that same location within the spine, including diagnosis or treatment;
Hyperthyroidism, as well as medications for any kidney, heart and high blood pressure conditions that may develop as a condition related to hyperthyroidism;
Masses or growths, regardless if benign or malignant. If the masses or growths were later determined to be cancerous, any cancer of that same type would be ineligible for coverage;
Orthopedic conditions occurring or showing clinical signs during the Orthopedic Waiting Period, even if the Accident Waiting Period is complete (for accident coverage);
Diagnosis or treatment of clinical signs of renal disease. Treatments and medications are not covered, as well as any related conditions that may develop. This includes, but is not limited to: vomiting, diarrhea, dehydration, constipation, blood pressure or pH issues, and cardiac complications. (However, for the purposes of this exclusion, temporary conditions that started prior to the end of the waiting period, or the condition manifests after the Original Start Date, and the condition has not shown any clinical signs for a period of twelve (12) months, and is considered cured, the condition shall no longer be considered a pre-existing condition);

Specific situations include, but are not limited to:

If your pet showed clinical signs of any dermatological condition prior to the end of the waiting period your pet must be free of any dermatological conditions for twelve (12) consecutive months before any dermatological conditions may be covered again; or
If your pet has been treated for undiagnosed vomiting and/or diarrhea prior to the end of your pet’s waiting period, your pet must be free of conditions with the same clinical signs for twelve (12) consecutive months before any conditions with the same clinical signs may be covered again.

Preventive care including, but not limited to: wellness exams or tests, preventive treatment, tests or diagnostic procedures, vaccinations, flea and other parasite prevention, spaying or neutering (including preventive sterilization surgery, such as for treatment for cryptorchidism, chimerism, or chromosomal abnormalities); [unless you purchase the optional Wellness Rider]
Illness unless directly caused by a covered accident under your policy.
Physical examination, including costs and/or fees for telephone consultation, unless you purchase the optional Office Visit and Exam Fees Rider;
Rehabilitation and physical therapy treatment(s), unless you purchase the optional Rehabilitation and Physical Therapy Rider;
Holistic and alternative medications, behavioral problems and any related treatment(s), training sessions or diagnostics, are excluded, unless you purchase the optional Alternative Care Rider;
Air ambulance and non-emergency ground pet ambulance transportation;
The cost of disposing of your pet’s remains, unless you purchase the optional Final Respects Rider;
The cost of boarding your pet, unless you purchase the optional Boarding Fees Coverage or as a part of a medically necessary treatment;
Costs of treatments arising from your decision to pursue a course of treatment other than that which was recommended to you by your veterinarian, unless specifically authorized by us prior to treatment. Examples include, but are not limited to:

Cost of treatments continued after a veterinarian has recommended a pet be euthanized for humane reasons;
Ignoring a veterinarian’s recommendation to amputate a leg, resulting in extra costs associated with treatment of necrosis; and
Ignoring a veterinarian’s recommendation to remove an eye, resulting in extra costs associated with chronic eye issues;

Treatment for any injury or illness deliberately caused by you, your family members, anyone living with you, or any other persons who have care, custody, or control of your pet;
Treatment for injury or illness caused by deliberate endangerment of your pet, such as organized fighting;
Treatment as a result of injury or illness due to a bilateral condition that has been determined to be pre-existing.
Any injury or illness that arises due to repetitive activity that results in your pet requiring repeated medical treatment. After three (3) separate but similar incidents of such claims within a thirty-six (36) month period, coverage for these injuries or illnesses would be considered or diagnosed preventable, such as, but not restricted, to foreign body ingestions, porcupine quills, fight/bite wounds/lacerations, motor vehicle injuries and poison ingestions.
Treatment for injury or illness caused by persistent neglect of your pet;
Treatment for any injury or illness resulting from commercial-use activities related to racing, personal protection, law enforcement or guarding, unless specifically authorized by us prior to the Original Start Date;
Veterinary treatment for dental illness as specified below:

If your pet has any signs or evidence of periodontal disease, periodontitis, gingivitis, resorptive lesion(s), or tartar prior to the Original Start Date or during any applicable waiting periods;
Toothbrushes, toothpastes, dental foods, chews, rinses or preventive dental care, including prophylaxis, at any time or for any reason;
Anesthetic or non-anesthetic deep cleaning at any time or for any reason; and
Removal of deciduous teeth.

Cosmetic, aesthetic, or elective surgery, and any complications arising from such surgery, including tail docking, ear cropping, de-clawing, or any other surgical procedure not related to injury or illness;
Natural supplements, vitamins, and all foods, whether prescribed or not.
Treatments for any illness for which a vaccine is available for your pet to prevent such illness and for which vaccination is both recommended by your veterinary provider and rejected by you.
Any administration fees charged by a veterinary provider or others, including chart set-up fee or for providing information which may be required by us;
Professional fees and services performed by a veterinary provider for his/her own pet;
Osteosarcoma or chondrosarcoma diagnosed or showing clinical signs within the Orthopedic Waiting Period.
Costs for any treatment for:

Genetic/chromosome testing;
Procedures to determine the suitability or categorization of your pet for breeding or genealogical purposes, including Penn HIP and OFA evaluations;
Costs resulting from breeding, pregnancy, whelping or queening. Costs arising from any treatment for reproduction purposes; or
Costs arising from cell-replacement therapies, except where deemed medically necessary by our medical director;

Costs for any treatment arising from:

Avian or swine flu or any mutant variation;
Intentional slaughter by, or under, the order of any government or public or local authority; or
Epidemics or pandemics as declared by the U.S. Department of Agriculture;

Costs for any treatment for your pet that is less than sixteen (16) weeks old arising out of a parvovirus infection, unless your pet has received a vaccination for parvovirus prior to reaching ten (10) weeks of age.
Costs for any treatment arising from a nuclear reaction, radiation, radioactive contamination, or the discharge of a nuclear device, whether controlled or uncontrolled, accidentally or otherwise;
Costs for any treatment arising from a chemical, biological, bio-chemical, or electromagnetic weapon, device, agent or material whether controlled or uncontrolled, accidentally or otherwise;
Costs for any treatment arising from war, invasion, acts of foreign enemies, hostilities (whether war is declared or not), civil war, rebellion, revolution, insurrection, military or usurped, strikes, riots, or civil commotion;
Costs or fees for time and travel expenses to a veterinarian’s premises or hospital;
Claims for veterinary charges, fees, or other related expenses exceeding eligible benefits or because such expenses are in excess of the fees usually charged by the provider being used; and experimental treatments, therapies and medications including any treatment for a cloned animal or utilizing a cloned animal.
Costs or fees for any loss if you have not complied with all conditions related to coverage set forth in this policy;
Costs or fees for bathing your pet unless a veterinarian certifies that bathing was medically necessary and that only a veterinarian or a member of veterinary staff should bathe your pet;
Costs or fees for any form of housing, including cages, either rented or purchased;
Costs or fees arising from any non-veterinary services, including but not limited to:

Federal, state or local taxes;
Waste disposal;
Government fees and surcharges;
Photocopying fees;
Bank fees and credit card charges;
Biohazardous waste fees;
OSHA fees; and
Maintenance fees;

Costs or fees for:

Obedience or training classes, including puppy classes;
Training devices correctional devices, or preventive products; or
The treatment of coprophagia or other eating disorders;

Costs or fees for grooming, dematting or grooming supplies;
Costs or fees for treatment for house calls, unless a veterinarian certifies them essential in an emergency;
Extra costs of fees for treating your pet outside of usual surgery hours, unless the treating veterinarian certifies that an immediate life-saving consultation is needed; or
Costs or fees for treatments or preventive treatments for parasites or conditions related to external parasites. Allowable charges may be eligible for coverage if there is no preventive medication for the parasite.

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