What a standard accident and illness plan covers
The most common type of pet insurance is an accident and illness plan. It covers veterinary costs that result from unexpected injuries, such as a broken bone or swallowed object, and from diagnosed illnesses, such as infections, cancer, diabetes, or allergies.
Covered expenses within those categories typically include diagnostic tests (bloodwork, X-rays, MRIs), hospitalization, surgery, prescription medications, specialist consultations, and follow-up care. Some plans also include hereditary and congenital conditions, such as hip dysplasia in certain dog breeds, though this varies and is often subject to breed-specific exclusions or higher premiums.
If you are still in the early stages of figuring out pet ownership costs overall, the annual pet care cost breakdown is a useful reference for putting insurance premiums in context.
Enroll while your pet is young and healthy
Waiting until a health problem appears means that condition will be excluded as pre-existing. Enrolling a puppy or kitten early gives you the widest coverage window. Even if premiums feel hard to justify when a pet is healthy, the exclusion risk of delaying enrollment is real.
What is almost always excluded
Pre-existing conditions sit at the top of every exclusion list. If your pet showed symptoms of a condition before the policy start date, or during a waiting period, that condition will not be covered. This applies even if a formal diagnosis came later.
Routine and preventive care is also excluded from standard plans. Annual wellness exams, vaccinations, flea and tick prevention, heartworm testing, and dental cleanings are not reimbursable under a base accident and illness policy. Cosmetic or elective procedures, breeding costs, and pregnancy-related expenses are similarly excluded across virtually all policies.
Some plans exclude specific bilateral conditions, meaning if one knee shows signs of a problem before enrollment, the other knee may also be excluded, even if it is currently healthy. Reading the exclusions section of any policy before purchasing is the only reliable way to know what applies to your specific pet.
~$67/mo
Average dog accident and illness premium
According to the North American Pet Health Insurance Association (NAPHIA), the average monthly premium for dog accident and illness coverage was approximately $67 in 2023.
~$32/mo
Average cat accident and illness premium
NAPHIA reported the average monthly premium for cat accident and illness coverage at approximately $32 in 2023.
Over 5.6M
Pets insured in North America
NAPHIA's 2024 State of the Industry report indicated more than 5.6 million pets were insured across the United States and Canada.
Wellness add-ons and what they include
Many insurers offer a wellness or preventive care add-on for an extra monthly cost. These riders typically reimburse a fixed dollar amount per service rather than a percentage of the bill. Common covered services include annual exams, core vaccinations, heartworm tests, flea and tick preventives, and spay or neuter procedures.
Whether a wellness add-on is financially worthwhile depends on what preventive services your pet already receives and what you currently pay for them. Adding up your actual annual preventive costs and comparing that to the add-on premium is a straightforward way to evaluate it. See why vet bills keep climbing and how to manage them for broader context on controlling pet healthcare costs.
The policy details that change your actual payout
Three variables determine how much you actually receive from a claim: the deductible, the reimbursement percentage, and the annual limit. A higher deductible lowers your monthly premium but means you absorb more cost per incident. Reimbursement percentages of 70%, 80%, or 90% apply after the deductible, so a $2,000 surgery claim with an $200 deductible and 80% reimbursement returns $1,440.
Annual limits range from a few thousand dollars to unlimited, depending on the plan. A low annual limit is less of a concern for a young, generally healthy pet but can fall short quickly if a pet develops cancer or requires orthopedic surgery. Some chronic conditions require ongoing treatment for years, and a per-incident deductible structure means the deductible resets for each new condition, not just each policy year.
If you are bringing a pet home for the first time and weighing whether to enroll immediately, the guide for first-time pet owners covers how insurance fits into the broader setup budget.
Per-incident vs. annual deductibles
Some policies apply the deductible once per policy year regardless of how many claims you file. Others apply it once per condition, per year. For pets with multiple health issues in one year, an annual deductible structure generally costs less out of pocket. Check which type a policy uses before enrolling.
Frequently Asked Questions
No. Standard pet insurance policies exclude conditions that were diagnosed or showed symptoms before coverage began. Some insurers distinguish between curable and incurable pre-existing conditions, potentially reinstating coverage for a curable condition after a symptom-free period, but this varies by policy.
You pay the vet directly, then submit a claim with itemized invoices. The insurer reimburses you for covered costs after subtracting your deductible and applying your chosen reimbursement percentage, typically 70%, 80%, or 90%. Reimbursement usually takes several days to a few weeks.
Routine and preventive care, including vaccines, flea prevention, and annual exams, are generally not covered by standard accident and illness plans. Many insurers offer a separate wellness add-on for an additional monthly premium that covers a defined list of preventive services.
Most policies include waiting periods of a few days for accidents and 14 days or more for illnesses. Orthopedic conditions often have waiting periods of several weeks to six months. Any condition that appears during a waiting period is treated as pre-existing.
An annual limit is the maximum dollar amount the insurer will pay in a policy year. If your pet requires surgery, hospitalization, or ongoing treatment for a chronic condition, costs can exceed a low annual limit quickly. Some plans offer unlimited annual coverage at a higher premium.
Premiums rise with age and insurers may decline coverage for very senior pets, depending on species and breed. An older pet with no existing diagnoses can still benefit from coverage for new acute conditions, but comparing the annual premium against realistic out-of-pocket risk is worth doing carefully.
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