The most reliable way to compare pet insurance is to set aside the monthly premium until you have compared what each policy actually pays. Put every candidate policy’s wording on the same terms: covered care, exclusions, waiting periods, deductible, reimbursement formula, limits, and fee caps. Then request quotes built from identical pet and coverage details, and weigh price last. The National Association of Insurance Commissioners (NAIC) consumer guidance on pet insurance follows this order, and it is the order this guide uses.
Start with the type of policy, then read the covered-care section
Policies are usually described as accident-only, accident-and-illness, or accident-and-illness with a wellness benefit. These labels are a starting point only. NAIC’s pet insurance guidance notes that included and excluded services can differ between policies in the same category, so the label does not tell you what will be paid for a given problem.
Accident-only coverage
Accident-only policies are built around injuries. Confirm in the covered-care section whether any illness-related treatment, such as infections, diagnostics, or medication for a condition, is included. Do not assume it is covered because the policy is a pet insurance policy.
Accident-and-illness coverage
This category is broader, but it still carries exclusions and waiting periods. Read the exclusions list line by line, especially for hereditary, congenital, chronic, or behavioral conditions, and for routine preventive care.
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Wellness benefits
A wellness benefit is typically an optional add-on for routine care such as exams, vaccinations, or preventive testing. Treat it as a separate product. It is not a substitute for accident-and-illness coverage, so compare what it pays against what it costs, and compare the illness coverage on its own.
Work out what the policy will actually pay
A reimbursement percentage, such as 80 or 90 percent, does not tell you the amount you will receive. The payout depends on several clauses that interact with each other.
Deductible and copay
Confirm whether the deductible is annual or applies per condition, and whether it is subtracted before or after the reimbursement percentage is applied. Ask whether the policy has a copay in addition to the deductible. NAIC’s consumer questions specifically ask for both amounts.
Benefit schedule and usual-and-customary fee limits
Some policies pay against a benefit schedule, a list of amounts for specific procedures, rather than the full bill. Others limit reimbursement to a usual-and-customary fee, meaning the amount the insurer considers typical for that service in your area. Either can reduce the payment below the amount you were charged. Ask for the exact calculation basis in writing.
Annual and lifetime limits
Annual limits reset each policy year. Lifetime limits do not. Check whether a cap applies per condition, per year, or across the life of the policy, and whether a limit tied to a particular condition ends the benefit for that condition after it is reached.
A hypothetical calculation
The example below is hypothetical. It uses invented numbers to show the order of operations, not a representative claim or a result from any insurer.
- Assume a bill of $400 for an eligible treatment, a $250 annual deductible that has not yet been met, and an 80 percent reimbursement rate, with a $5,000 annual limit.
- Subtract the deductible: $400 minus $250 equals $150.
- Apply the reimbursement rate: $150 multiplied by 0.80 equals $120.
- Check the result against the limit. $120 is below $5,000, so it stands.
- The owner pays the remaining $280 out of pocket.
This example leaves out whether the bill exceeds a usual-and-customary fee, whether any part of the treatment is excluded, whether the deductible is annual or per condition, and whether the claim is paid to you or to the veterinarian. Each of those can change the result, so run the same steps with the figures in your own policy.
Check waiting periods and pre-existing conditions before buying
A waiting period is the time after a policy starts before certain coverage takes effect. NAIC lists waiting periods among the provisions that should be disclosed. Because a condition that appears during the waiting period may be treated differently from one that appears after it, ask the insurer how signs and symptoms are handled, not only when the diagnosis is made.
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- How the policy defines a pre-existing condition, and whether that definition matches the one used for chronic conditions.
- Whether symptoms noticed during the waiting period count against a later claim.
- Whether a condition that is resolved but recurs is treated as new or as pre-existing.
- Whether the waiting period restarts after a lapse or a change of plan.
Choose a veterinarian and understand the claim process
Check whether you can use any licensed veterinarian or whether the policy requires a network provider. A policy that allows any veterinarian gives you more flexibility, but it does not by itself mean the reimbursement is higher. Ask whether any fee limit applies regardless of which clinic you choose.
NAIC states that most pet insurance policies reimburse the policyholder, while some companies pay the veterinarian directly. This means you may need to pay the bill first and submit a claim afterward. Before you buy, confirm the following with the insurer:
- Whether payment goes to you or to the clinic, and whether that varies by policy.
- What documents the claim requires, such as an itemized invoice, medical records, or a completed claim form.
- How quickly claims are paid, and whether the insurer’s timing is stated in the policy or only in marketing materials.
Make premium quotes comparable before you compare prices
NAIC says premiums can depend on the animal’s species, breed, sex, age, location, selected coverage, and deductible. Quotes from different insurers are only comparable when these inputs are the same. A quote that uses a higher deductible or a lower reimbursement rate will look cheaper for reasons unrelated to the quality of the coverage.
| Quote input | Why it must match across quotes |
|---|---|
| Species and breed | Changes the risk assumptions the insurer uses to set the price. |
| Sex and age at enrollment | Affects the premium and, in some policies, the terms that apply later. |
| Location (ZIP code) | Premiums can vary by geography, and reimbursement may be tied to local fee levels. |
| Coverage type | Accident-only, accident-and-illness, and wellness add-ons are priced differently and cover different things. |
| Deductible and reimbursement rate | A higher deductible or lower reimbursement rate lowers the premium but raises the amount you pay per claim. |
| Annual or lifetime limit | A lower limit can reduce the premium while leaving you exposed for a large claim. |
NAIC’s guidance does not establish a current average premium, and no published figure should be treated as the price for your pet. Requesting quotes with the same inputs is the only way to see the real difference between offers.
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Use one table per candidate policy so every axis is recorded in the same format. The categories below follow NAIC’s consumer checklist and the disclosure topics in its model law.
| Comparison axis | What to record | Where to find it |
|---|---|---|
| Covered care and exclusions | Included services, excluded conditions, and any routine-care exclusions | Policy’s covered-care and exclusions sections |
| Pre-existing condition definition | Exact wording, and how chronic conditions are handled | Definitions section of the policy |
| Waiting periods | Length by coverage type, and how symptoms during the period are treated | Policy’s effective-date or waiting-period section |
| Deductible | Type (annual or per condition), amount, and whether it applies before reimbursement | Declarations or benefit summary |
| Reimbursement method | Percentage, benefit schedule, or usual-and-customary basis | Benefit or payment section |
| Limits and fee caps | Annual and lifetime limits, per-condition caps, and any fee limit | Limits section and written confirmation from the insurer |
| Veterinarian choice | Any licensed vet, or network required | Provider or veterinarian section |
| Premium under identical inputs | Quoted monthly or annual amount with the input set recorded | Written quote |
| Claim process | Whether you pay first, required documents, and payment timing | Claims section and insurer’s stated procedure |
| Renewal treatment | Whether premiums or terms can change at renewal, and based on what | Renewal or premium-change section |
| Optional wellness benefits | What it pays, annual limit, and cost | Separate wellness schedule, if offered |
If a policy does not state a value for one of these rows, record it as “not stated” and ask the insurer before you buy rather than assuming the answer.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.Questions to ask the insurer before you buy
NAIC’s consumer guidance suggests asking the following. Request the answers in writing or confirm that they appear in the policy.
- Can I choose any veterinarian?
- What is the deductible and copay?
- Does the policy cover annual wellness exams?
- Are prescription drugs covered?
- Is there a waiting period before coverage becomes effective?
- If my pet has a pre-existing or chronic condition, how is it covered or excluded?
- How long do you take to pay claims?
- Are there renewal, end-of-life, or lost-pet benefits, and what do they cover?
- Do office-fee limits apply, and does my pet need an exam before enrollment?
- What is the exact basis used to calculate reimbursement?
State rules and the NAIC model law
The NAIC Pet Insurance Model Law, a 2021 model text, sets out provisions that states may adopt. It is not binding in every state. Its disclosure provisions cover waiting periods, deductibles, coinsurance, annual or lifetime limits, certain exclusions, and whether claim history, age, or geography can affect premiums or coverage. The model text also refers to the claim-payment basis, benefit schedules, and usual-and-customary fee limitations.
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The model law states that a disclosure must cover:
“Any policy provision that limits coverage through a waiting or affiliation period, a deductible, coinsurance, or an annual or lifetime policy limit.”
Check your state insurance department’s website and the policy documents for the rules that apply where you live, and confirm which version of any state law governs the policy you are considering.
Market context: the most recent published figures
The NAIC’s 2022 article on its pet insurance model act, citing the North American Pet Health Insurance Association (NAPHIA), reported approximately $2.8 billion in total in-force premiums in 2021 and over 4.41 million insured pets across North America. These are 2021 figures. They describe the size of the market at that time, not current prices, current enrollment, or what a particular pet will cost to insure.
Use the worksheet and questions above to evaluate any specific policy, rather than relying on market totals.
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