Coverage & Restrictions
It’s standard in the pet insurance industry for certain things to be covered—and not covered—under a policy. And it’s important to know both before making a decision on what will work best for you and your pet.
The Healthy Paws plan is designed to help cover the cost of unexpected accidents and illnesses you can’t plan for—like when your pup eats a toy instead of playing with it, or your cat is diagnosed with diabetes. You can choose up to a 90 percent reimbursement of your vet bills for these unplanned incidents, and there are no caps on per-incident, annual or lifetime payouts.
Exact coverage varies from state to state, but here is a general idea of what is covered with a Healthy Paws insurance plan:
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Illnesses & accidents, including stomach issues, skin issues, pain, ear infections, eye conditions, growths, CCL rupture, urinary tract infections, heart conditions and more
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Hereditary conditions passed down to your pet from their parents, including elbow dysplasia, cherry eye, intervertebral disc disease and more
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Congenital conditions developed in utero, including congenital heart disease, conditions of the nervous system, liver disease and more
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Chronic conditions, including allergies, diabetes, obesity, inflammatory bowel disease, glaucoma, arthritis, kidney disease and more
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Cancer, including diagnostics, chemotherapy, radiation, lab tests, ultrasounds, X-ray, surgery, hospitalization, prescription medications, alternative therapy and rehabilitation
- Diagnostic treatment
- X-rays, blood tests & ultrasounds
- Surgery
- Hospitalizations
- Prescription medications
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Emergency care, including care at any licensed pet hospital or emergency vet facility
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Specialty care, including orthopedic, oncologists, internal medicine experts, ophthalmologists, neurology, radiology and cardiology
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Alternative treatments, including acupuncture, chiropractic, hydrotherapy, physical therapy, laser therapy, massage and more
Here are some of the most common things that are not covered under the Healthy Paws’ plan:
- Wellness and preventative care
- Examination fees
- Pre-existing conditions
- Conditions occurring within the policy waiting period
- Preventative dental care
- Behavioral treatment
- Non-FDA treatment or supplements
- Prescription diets
- Day care and boarding
For a full list of coverages and exclusions for your state, you can view and download a copy of the Healthy Paws pet insurance policy on their website.
Waiting Period
Healthy Paws’ 15-day waiting period is pretty standard in the industry. Your policy goes into effect at 12:01 a.m. the day after you enroll your pet, and the waiting period is 15 days after your policy effective date. You may submit claims for any accidents and illnesses that occur after the 15-day waiting period.
The waiting period for hip dysplasia varies from state to state. In some states, there is a 30-day waiting period from the policy effective date for hip dysplasia not resulting from an accident. But in most states, the waiting period for hip dysplasia is 12 months for pets age five or younger. Hip dysplasia is not covered for pets six years of age or older.
Exam Requirements
In most states, a full nose-to-tail physical exam of your pet by a licensed vet is required in order to be eligible for coverage with a Healthy Paws plan. The timing of this exam depends on your pet’s age at the time of enrollment:
- Age 5 and below: Exam within 12 months
- Age 6 and up: Exam within 30 days
If you recently adopted your pet, double-check whether they had a clinical exam by a licensed vet—some adoption organizations will have this information on file, which you can submit to fulfill the exam requirement.
If you live in a state that does not require a clinical examination for coverage eligibility, you can opt to submit an exam in order to speed up the claims review and payout process.