Enrolled on or after October 31, 2016
INSURER DISCLOSURE OF IMPORTANT POLICY PROVISIONS
Please read below for important information to help you understand our coverage. Keep in mind, we will not reduce coverage or increase premium due to claims history.
We use certain terms in our policy documents and want to make sure you understand how they are used. Following are some common DEFINITIONS:
Pet insurance – means an individual or group insurance policy that provides coverage for Veterinary expenses.
Pre-existing condition – means any condition for which a veterinarian provided medical advice, the pet received treatment for, or the pet displayed signs or symptoms consistent with the stated condition prior to the effective date of a pet insurance policy or during any waiting period.
Reimbursement percentage – means co-insurance.
Veterinarian – means an individual who holds a valid license to practice veterinary medicine from the Veterinary Medical Board pursuant to Chapter 11 (commencing with Section 4800) of Division 2 of the Business and Professions Code or other appropriate licensing entity in the jurisdiction in which he or she practices.
Waiting Period – means the period of time specified in a pet insurance policy that is required to transpire before some or all of the coverage in the policy can begin.
Coverage for the following conditions will be EXCLUDED.
Pre-existing condition: – Pre-existing conditions are not covered by our plans.
Other exclusions apply. Please refer to the exclusions section of the policy (What Is Not Covered) for more information.
There are WAITING PERIODS that apply before certain coverages are effective. A 14 day illness waiting period and a 5 day accident waiting period applies to the first policy period. Diagnosis and treatment for ligament and knee conditions are subject to a 180 day waiting period on all policies. Conditions that occur during a waiting period are considered pre-existing.
Reimbursement of covered expenses is subject to the annual policy limit you select at enrollment and is listed on your declarations page. Behavior conditions are subject to their own sublimit based on the policy purchased, refer to https://www.prudentpet.com/sample-policy/ for details.
Please continue reading for information on Claims, Deductibles, Reimbursement Percentage, and Deductible.
We offer a choice of annual deductible options. The annual deductible applies to each policy period. We subtract that deductible amount from the covered expenses after calculating your reimbursement percentage.
We offer a choice of reimbursement percentage options. You are responsible for your portion of the covered expenses in addition to any amounts not covered by the policy. We then pay our portion of the covered expenses subject to the annual limits.
Determination of Claim Payouts
Our coverage provides reimbursement up to the applicable annual limit for the actual costs for covered expenses that you incur during the policy period, the deductible is subtracted from the reimbursement amount.
If added as an endorsement, preventive benefits are paid according to the schedule of benefits provided with the policy, if applicable, and are not subject to a deductible or reimbursement percentage.