The decision to put a pet dog or cat on a health insurance plan bears multiple rewards. In South Africa, there are multiple pet health insurance products available – each with their own pros and cons.
Pet health insurance is the insurance against the potential risk of incurring medical expenses. Such insurance is funded by a group of individuals, i.e. pet owners, collectively pooling a predetermined amount (a premium) into a funding account (managed by a pet insurance company as a product or policy). This funding account then compensates a policy holder at the time of need (i.e. a claim). Apart from the premium, most insurance products will have an administration fee (or excess) deducted from the claim amount.
Each pet health insurance product has its own rules (referred to as the wording of the product) and will be underwritten by a larger insurance company. No product will be the perfect choice for all pets. These are the considerations for choosing the right health insurance product for your pet(s):
Type of pets covered (dogs vs. cats)
The first thing when it comes to choosing a pet health insurance product for pets is to make sure it covers the type of pet you want to insure. In South Africa, the majority of pet health insurance products provide cover for cats and dogs.
Type of cover
After speaking to your family veterinarian and doing some internet reading, pet owners should start to get an idea of what potential medical problems they need to provide for. The major cover types that are usually offered are full cover, accident cover and/or hospital cover. Some products might also provide for routine care cover for costs of vaccinations, sterilisations etc.
Although it makes more sense to cover your pet as a puppy/kitten, some owners will only appreciate the benefit of medical insurance at a more advanced age. As with humans, elderly pets are more at risk for certain medical conditions. Make sure your pet falls within the age restriction at the time of signing up for an insurance product. If a pet was signed up before the age restriction was reached, most policies will continue with lifelong coverage, but it is a good idea to make sure of this.
Breed, condition & treatment exclusions
Certain pet medical insurance products will have cover exclusions. It is better to know about these exclusions before a claim gets denied. Some breeds, conditions and/or procedures might only be partially covered or not covered at all.
Common breed exclusions to look out for are fighting dog breeds (e.g. Pitbull terriers) and large breed dogs (e.g. Great Danes). Exclusions for vaccine-preventable diseases, breeding-related and congenital conditions are often encountered. Common operations/procedures to enquire about are hip replacements (in for example large breed dogs), back operations (in for example Dachshunds) and teeth cleaning. Some policies will only cover treatments and procedures performed by registered veterinarians, while others might allow ‘alternative medicine’ service providers.
In an attempt to prevent fraud, some policies will only start with full coverage a certain period after signing up. This might be condition related. Waiting periods may vary from a wait until all initial vaccinations have been completed (in the case of puppies and kittens) to a couple of months (for breeding-related conditions).
Most pet medical insurance companies will not cover pre-existing conditions. It is not uncommon for insurance companies to enquire about the insured pet’s medical history from the family veterinarian. This can either be done at the time of signing up for the policy or at the time a claim is submitted. Previous conditions are a major consideration when moving from one policy/company to another.
It makes sense for insurance companies to ask for basic requirements to be met before a pet can be insured. Generally, pet medical insurance companies will promote responsible pet ownership. Having a microchip, up-to-date vaccinations and being spayed/neutered are some of the most frequent requirements you’ll see in the wording of pet medical insurance products.
Years of service & reputation
All pet medical insurance products are underwritten by an insurance company. Although competition and innovation from newcomers are always welcome, years of service and public perception also need to be considered when choosing a product.
Although not necessarily a great indicator on the quality and value of a pet insurance product or company, a scale-tipper might be value-added services, offerings and payouts. Some pet medical policies might have an informative medical expert available for telephonic consultations while others might have innovative offerings such as a ‘credit card’ or an app. Value-added payouts might be in the form of lost-and-found reward payments, coverage for boarding and for cremation services.
After it has been established what policies will fit your pet’s needs, it comes to the financial aspects of medical insurance. The monthly premium is the amount of money you will pay each month towards the policy. Although not always the case, higher monthly premiums mean better benefits and payouts (see later). It is also known that some pet insurance products have hidden fees, so read or enquire about the fine print.
Even though a premium is paid, most insurance products will also require an excess to be paid at the time of a claim (see below). Some policies offer multi-pet discounts.
Excess & adminitration charges
Most insurance products will have some sort of excess payable at each claim. This can be seen as some form of administration fee. The excess will either be a set amount if the claim is below a certain value or calculated as a percentage of the total amount. An example would be a minimum excess of R300 or 10% of the total claim amount (whichever is the highest). Usually the excess is deducted from the value of the claim before it is paid out.
Prompt payments are the buzzwords when it comes to payout time. Most, but not all, insurance companies will not make payments to the (veterinary) service provider directly, but to the policy holder. It is important to get some sort of measurable commitment from the insurance company regarding the payout time. Some policies will make sure payments are, for example, within 48 hours, while others might promise within 30 days from submitting a successful claim.
The maximum claim payment value is probably among the first facts insurance companies will use as marketing. Although it is very important, the quality of the pet insurance product is not always determined by the payout value. There is also a difference between payout and successful payout. Higher payout values mean better medical and financial coverage, but are most often linked to higher monthly premiums and sometimes higher excess values.
Simple payout values can either be in the form of a yearly limit or a maximum value per claim. More complex payout systems are also in use, where the payout value is calculated per procedure within the invoice structure (e.g. 80% towards taking radiographs, etc.).
There are many factors owners need to consider before choosing the most appropriate medical insurance for their pets. No pet medical insurance product will fit everyone’s needs. By knowing what to look for and making informed product comparisons, pet owners will find the most appropriate option that suits their pet’s needs… and their pocket.