Pre-Existing Condition

A pre-existing condition is any condition your pet showed signs of, was diagnosed with, or was treated for before your pet insurance policy’s waiting period ends.

Pets with pre-existing conditions can still get pet insurance, they just won’t be covered for diagnostics or treatments related to those conditions. A Lemonade pet insurance policy, for example, covers eligible accidents and illnesses that occur after your policy’s waiting periods (we’ll dive deeper into this below).  

Let’s get into the nitty gritty of how pre-existing conditions work, and how they could impact your pet insurance coverage.

Here’s what we’ll discuss:

• What’s a pre-existing condition?
• Does pet insurance cover pre-existing conditions?
• How do insurance companies determine pre-existing conditions?
• Example of how a pre-existing condition can affect your pet’s pet insurance coverage
• Why Lemonade pet insurance is (arguably) still worth it, even if your pet has a pre-existing condition
• What if a pre-existing condition is cured?
• Will a lapse in coverage impact my pet’s pre-existing conditions?

What’s a pre-existing condition?

A pre-existing condition refers to any kind of health issue related to things like accidents, illnesses, and behavioral conditions your pet developed before your waiting period was up on your insurance policy. It doesn’t mean pet insurance companies won’t insure your pet, it just means your plan won’t cover costs that were directly caused by or relate to any ailment they had in their medical history before they signed up for a pet insurance policy.

Depending on when you sign your pet up for pet insurance, they may have already experienced some health issues. Here’s a list of just a few of the most common pre-existing conditions in dogs and cats, and how much annual treatment for these conditions costs on average. 

Common pre-existing conditions in dogs:

Common pre-existing conditions in cats:

Of course this isn’t an exhaustive list, and any medical condition a pet could experience before their policy’s waiting period ends can be considered pre-existing. These figures are provided as rough estimates to illustrate potential expenses for pet owners if such conditions aren’t covered by insurance.

That’s just one of the reasons it’s so worthwhile for pet owners to get pet insurance coverage early in their dog or cat’s life, to potentially avoid these types of exclusions. At Lemonade, for example, you can buy a policy for your puppy or kitten from two months old.

Does pet insurance cover pre-existing conditions?

Probably not.

Your policy explains that any diagnoses, treatments, or symptoms of a condition listed in your pet’s medical record before they were actively insured can indicate a pre-existing condition. Since pre-existing conditions are excluded from a pet health insurance policy, you won’t be able to receive reimbursement for care relating to anything traced back to that initial finding.

So while treatment for diabetes is covered under a basic policy, you’ll only be reimbursed for eligible costs if your pet is diagnosed with diabetes after your policy was already active.

How do insurance companies determine pre-existing conditions?

A pre-existing condition is determined by your pet’s medical history. So any signs or diagnoses of an illness that show up before your policy waiting periods are up would be considered a pre-existing condition.

Certain breeds are prone to certain illnesses. If you know your cat is more likely to develop a hereditary condition like asthma because she’s a Siamese, should you assume it will be considered a pre-existing condition? Not exactly. It depends on whether signs or symptoms of those conditions were present before your insurance policy and applicable waiting periods.

Your pet may not show signs of these medical conditions at birth, or in the first few years of their life. But if you wait until they develop symptoms to get insured, the condition probably won’t be covered in your policy, which is a pretty big game-changer for pet owners struggling with vet bills related to a chronic condition.

Example of how a pre-existing condition can affect your pet’s pet insurance coverage

Let’s say it’s your birthday, and your wife chooses to celebrate the best way possible: She brings home a 2-month-old pug! You name him Romeo. It’s in your best interest to get Romeo a pet insurance plan as soon as possible, so if and when he develops a condition common to his breed—like pug encephalitis or a luxating patella—you’ll be covered for the related costs of that care (minus your deductible, of course).

If you wait to see Romeo limping before getting insured, you’ll be out of luck. That limp would be noted in his medical record, and a luxating patella confirmed later would be considered a pre-existing condition. That means you won’t be covered for any medicine or orthopedic surgery related to it.

Why Lemonade pet insurance is (arguably) still worth it, even if your pet has a pre-existing condition

As a rule of thumb, you never want to wait until you need insurance to get it… that’s not how it works. You have to already have a policy in place in order for it to be worth it. But pet health insurance coverage could still be worth the cost for pet parents, even if your biggest costs today are related to treating your pet’s pre-existing conditions. The only way to truly know if it’s worth it for you and your four-legged friend is to get a pet insurance quote.

Let’s go back to the example of Romeo. While luxating patella would be considered a pre-existing condition, he could still develop respiratory infections, urinary tract infections, heart disease, or another hereditary condition like pug dog encephalitis.

If you got Romeo insured before he showed signs of that last condition, you’d be covered for the related costs, which are daunting: steroids, antibiotics, and the $5,000 in veterinary care, including the diagnostics and hospitalization it would take to diagnose Romeo in the first place. And if you have one of Lemonade’s Preventative Care Packages, you’d be covered for the costs of Romeo’s preventative and routine wellness care, including his annual exam, vaccinations, and more.

Insurance is all about being able to handle unexpected costs. When it comes to your pet’s healthcare, that could include some pretty devastating surprises—like a cruciate ligament tear, or even cancer. So even if you have some conditions excluded because they’re considered pre-existing, a pet health insurance policy means being ready for tomorrow’s unknowns. Considering the risks of your dog or cat being diagnosed with a second or third big health crisis, a pet health insurance policy is an investment in your fur fam’s health that’s worth it.

What if a pre-existing condition is cured? 

Certain medical conditions which aren’t chronic, may be considered “cured” in some states, once your pet meets specific criteria. If your pet’s condition or injury was pre-existing, for instance, your insurance policy might indicate that it must be treated and resolved to include no further recurring symptoms or treatment for 12 consecutive months to be considered “cured”. Treatments may include any ongoing medications and even prescription diets. 

Keep in mind that knee or ligament conditions and chronic medical conditions—like arthritis, allergies, asthma, cancers, and endocrine diseases—cannot be cured. That means the symptoms of these conditions can be managed with treatments like medications, diet, and even physical therapy, but the condition itself is not curable. 

Going back to our example above, what if Romeo develops diarrhea and subsequently tests positive for roundworms before you signed him up for insurance? Roundworms would be considered a pre-existing condition once Romeo’s policy is in effect. But, once he’s treated, his symptoms resolve, and he tests negative for roundworms, the clock for the curable criteria starts. If Romeo stays roundworm free for 12 months from that time, roundworms may be considered “cured” on Romeo’s policy. 

But let’s say Romeo was diagnosed with Medial Luxating Patella (MLP) during exams as a puppy before having insurance coverage. Romeo might not need any treatment in the first couple years of his life, but once he’s a bit older, heavier, and more active he might require surgical intervention. So even though Romeo might not need treatment for his MLP for a year or two of puppyhood, it would still be considered a pre-existing condition, and not cured.

Of course, it’s always best to check the details of your policy to determine if your pet’s pre-existing conditions may be considered cured. 

Will a lapse in coverage impact my pet’s pre-existing conditions?

In short, yes. A lapse in coverage, which is when there’s a break or interruption in your insurance policy, can lead to significant drawbacks.

If coverage lapses and you re-enroll later, any conditions that your pet developed during the lapse period may now be considered pre-existing, making them ineligible for future coverage. Plus, re-enrolling after a lapse means that your policy’s waiting periods will likely restart, which could leave you facing high costs for treatments that were previously covered.

Picture this: Romeo develops a skin allergy after your policy’s waiting period ends and receives treatment covered by your insurance policy. After a couple years of insuring Romeo, you decide to take a break because he’s in pretty good health. A couple months pass and Romeo develops a cherry eye, so you decide to sign him up for insurance again. 

That same skin allergy that was previously covered will likely be considered a pre-existing condition by your insurer now, meaning that any further treatments for this allergy won’t be eligible for coverage under the new policy. Plus, Romeo’s cherry eye that he developed during the lapse will also be considered pre-existing.

That’s why it’s crucial to maintain continuous insurance coverage to ensure your pet’s health is consistently protected.

A few quick words, because we <3 our lawyers: This post is general in nature, and any statement in it doesn’t alter the terms, conditions, exclusions, or limitations of policies issued by Lemonade, which differ according to your state of residence. You’re encouraged to discuss your specific circumstances with your own professional advisors. The purpose of this post is merely to provide you with info and insights you can use to make such discussions more productive! Naturally, all comments by, or references to, third parties represent their own views, and Lemonade assumes no responsibility for them. Coverage and discounts may not be available in all states.