What is pet insurance? 

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The main aim of pet insurance is to reduce the veterinary (vet) bills and expenses when your pet is unwell. It is similar to health insurance for humans which helps to cover all types of medical costs. 

The way pet insurance works is that you pay a premium, which can be by regular payment depending on your preference (i.e. weekly, fortnightly, monthly or yearly). When your pet is unwell and requires attention from a vet, you will need to pay for the vet on the day but canlater, claim back a portion of the cost of these services from your insurance provider.

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Types of pet insurance​

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Just like health insurance policies for humans, each pet insurance policy is different and has different types of coverage.  There are three main types:

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1. Accident only;

2. Accident and illness; and

3. Comprehensive

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Each of these plans will cover different things, with 'Accident only' covering the most limited circumstances, and 'Comprehensive' covering a broader range of circumstances. 

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When deciding what type of policy to take out for your pet, you should consider the size of your animal, activity level, history, location and breed.  It is always recommended to read the fine print, as some policies may not cover what you need. For example, if you have an active smaller dog prone to knee/ACL injuries, treatment for this specific injury can sometimes be excluded.  Always be sure to check the terms and conditions.​​

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What is covered?

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Most pet insurance policies cover the larger expenses that you might incur when going to the vet, like surgery. Some do cover the smaller expenses like vaccinations, and others can cover the cost of only part of any veterinary visit.  This will all depend on what policy is selected and what the fine print says.  

Always be sure to check the 'exclusions' of a policy, as certain items that you specifically may want, could be excluded.   Please be aware that generally, if your pet has an existing illness or injury, it will not be covered under an insurance policy.  This is a reason pet-owners often take out insurance when their pet is young, but this will evidently cost more.

 

 

What is usually covered

Item

Example

Specified accidental injury

A bone fracture, snake bite or lacerations

Illness

Cancer treatments, ingestion of a foreign object or ear infections

What is not usually covered

Item

Example

Pre-existing conditions

(a) Any condition that your pet has prior to the commencement of your insurance policy or within the applicable waiting period.

(b) A condition that you were aware of, or a reasonable person in your circumstances would have been aware of, irrespective of whether the underlying condition has been diagnosed in your pet

Dental care

Teeth cleaning or dental disease

Preventative, election and routine items

Food, vaccinations, microchipping and desexing.​

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Who to choose?

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Always do your research before proceeding with an insurance provider.  Choose an insuranceprovider who is familiar with animal injuries and illnesses, and who understands the costs associated with pet ownership.

Some other matters you may wish to consider and be aware of when selecting a policy and provider:

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1. Waiting (also called exclusion) periods:  how long after taking out the policy can you utilise the benefits;

2. Exclusions: what is and is not included in the policy;

3. Reimbursement rate:  this is the amount a pet insurance provider will pay you back for the cost of the care;

4. Deductibles/Excess: this is the amount you will pay yourself before the insurance provider will begin covering the cost of your pet's care.  This will be detailed in your policy documents and usually, the higher the premium paid, the lower the deductible/excess will be.  For example, your pet insurance may have a $100 excess. This means that if your pet's treatment costs $500, you will pay $100 and yourinsurance provider will pay $400. If you or your pet is not at fault, and another person or insured animal is involved in an incident, it may be possible for there to be no excess paid by you, so long as the insurance provider can recover this cost from someone else.

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How to submit a claim? 

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Prior to your first claim on your pet insurance, you must be aware of the potential waiting periods before you may be able to claim certain expenses.  These can range from two weeks for certain visits to the vet and up to six months for cruciate ligament or other surgery.  It will depend on your policy and insurance provider. In some cases, it may be possible to ask your insurance provider to waive the waiting period. Once the waiting period is over the steps to making a claim are as follows:

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Step 1: Visit the vet

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Visit the vet for the medical issue your pet is having.  In Australia, most insurance providers allow for visits at any vets, so you will have flexibility around which vet to choose. 

You will be required to pay the vet's bill. Ensure you keep the receipt to claim from your insurance provider later. 

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Step 2: File a claim

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You should always notify your insurance provider as soon as possible. 

Using your relevant insurance provider's website, you will proceed with filing the claim.  The website should point you in the direction of how to find the form to do this.  Most insurance provider's offer a paper option, but you will need to check as not all do.

Be sure to understand what the timeframe is for filing a claim. This will be detailed in your chosen insurance policy.  Once this timeframe has elapsed, you will no longer be able claim.

You will be required to complete a form to provide specifics of the medical incident and assistance obtained from the vet.  This usually includes:

• (a) A receipt from the bill paid for the vet visit;

• (b) Any relevant vet consultation notes;

• (c) Medical history of your pet;

• (d) Specific information about your pet's needs;

• (e) If there is another insured person or animal involved, be sure to obtain photos, contact details, witness statements and any other relevant information the insurance provider may need.

This information will be used to assess your claim. 

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Step 3: Reimbursement

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Once your claim has been assessed you will be told it is either accepted or not accepted. If it has been accepted, you will receive the reimbursement amount within the set timeframe specified in your insurance policy. 

Reimbursement is usually by way of a credit into the bank account that your insurance premium is taken from by direct debit, otherwise it may be a cheque in the mail.

Any claim involving the liability of a third party (i.e. your pet was attacked by another pet)will take longer than a standard claim to assess as it is likely the claim will be sent to the legal team. Keep as much documentation as possible in relation to any type of event where there is another party involved or if you are not at fault.   

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If your claim is not accepted, you may wish to make a complaint or seek a review.

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Step 4: Dispute Resolution

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If you are not satisfied with the claims process or the decision an insurer has made, you can make a complaint by phone, in person, or in writing. 

A complaint should include the following information: 

1. The word 'complaint' in the heading or subject line

2. Your name, contact details, and the date that you are making the complaint

3. An explanation of the problem, including a timeline of the events if necessary

4. Copies of all relevant documents and relevant claim reference codes or numbers (usually provided by the insurance provider from the outset of the claim process).

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An internal complaint will frequently be handled informally by the insurance provider at first.  If an informal complaint does not resolve your issues, you may make a formal complaint. The complaint will then be dealt through the insurer's 'internal dispute resolution' process.  

 

If you are still not satisfied, you can contact the Australian Financial Complaints Authority (AFCA) to make a complaint and get free, independent dispute resolution. A complaint can be made:

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• (a) online (acfa.org.au);

• (b) by email (info@afca.org.au); or 

• (c) on the phone (1800 931 678). 

 

You should provide the AFCA with copies of all the relevant documents, including details of any complaints made directly to the insurance provider.

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A decision made by the AFCA is generally binding on the insurance provider if you approve of the decision made. If you are unsatisfied with the decision, it may be appropriate to seek legal advice. ​