Pet insurance glossary
The jargon insurers use against you — translated.
- Annual Limit
- The maximum amount your insurer will pay out per policy year. Can be a fixed dollar amount (e.g., $5,000) or unlimited.
- Bilateral Condition
- A condition that can affect both sides of the body (e.g., both knees, both hips). Many insurers exclude the second side if the first was treated before coverage.
- Congenital Condition
- A condition present at birth (e.g., heart defects). Coverage varies by insurer.
- Curable Pre-Existing Condition
- A pre-existing condition that can be fully resolved (e.g., UTI, ear infection). Some insurers cover these after a symptom-free period (12–18 months).
- Deductible
- The amount you pay out of pocket each year (annual) or per condition (per-condition) before insurance reimburses any costs.
- Department of Insurance (DOI)
- Your state's insurance regulator. Where you file a complaint if your insurer wrongly denies a claim.
- Exam Fee Coverage
- Whether the insurer reimburses the office visit fee in addition to treatment. Not standard with all carriers.
- Explanation of Benefits (EOB)
- The document your insurer sends explaining what they paid, what you owe, and why anything was denied.
- Hereditary Condition
- A condition passed down genetically (e.g., hip dysplasia in Labradors). Most modern plans cover these unless explicitly excluded.
- Per-Condition Limit
- A cap on how much the insurer will pay for a specific condition over its lifetime.
- Pre-existing Condition
- Any injury, illness, or symptom that occurred before your policy's effective date or during the waiting period. Insurers define this broadly — even a notation in your pet's medical records can qualify.
- Reimbursement Percentage
- The percentage of your eligible vet bill the insurer pays back after your deductible (commonly 70%, 80%, or 90%).
- SOAP Notes
- Structured veterinary medical notes: Subjective, Objective, Assessment, Plan. Often required as supporting documentation for appeals.
- Unauthorized Practice of Law (UPL)
- Practicing law without a license. PetClaim helps you prepare documents — we don't represent you legally.
- Vet Direct Pay
- A feature where the insurer pays the vet directly so you don't have to front the full bill. Available with Trupanion and Pets Best at participating clinics.
- Waiting Period
- The time between when your policy starts and when coverage actually begins for accidents (often 2–5 days), illnesses (typically 14 days), and orthopedic conditions (often 180 days).