Pet Insurance Terms & Definitions
Understanding insurance terms is an important step when shopping for pet insurance. See some of the most commonly used insurance terms and definitions below.
A sudden event involving an external force, or any otherwise unexpected or unforeseen incident known to have occurred, which causes an injury to your pet and is independent of all other conditions.
Accident and Illness Coverage
Under this type of pet insurance coverage, you will get both accident and illness coverage. This means your pet will get the coverage benefits of an accident-only policy, plus coverage for veterinary care and treatments for eligible illnesses such as cancer, allergies, and diabetes. Some accident and illness plans, such as Furkin, include coverage for hereditary and behavioural conditions, too!
Accident-only coverage reimburses you only for a portion of the veterinary costs of accident-related care for your pet. Accident-only coverage will not cover illnesses, breed-specific health problems, or the cost of routine or preventive veterinary care.
Actuaries are individuals that measure the likelihood of certain future events or risks. For example, insurance premiums are set by specialized mathematicians called actuaries. Actuaries use large amounts of historical data and formulas to predict the future claims expected to be covered by an insurance policy. They will typically focus on the data that is most likely to impact future claims expectations. For pet insurance, these factors include things like pet age, breed, gender, and geographic location. The end result of this work is the premium that members pay based on their specific pet’s demographics.
Actuaries are required to pass an extensive course of education, testing, and continuing education. These guidelines and accreditation are governed by organizations such as the Society of Actuaries, American Academy of Actuaries, and Canadian Institute of Actuaries.
In the context of insurance coverage, adverse selection refers to situations where applicants try to purchase insurance coverage when they have substantially higher risk within their pet's demographics than what is known or expected by the insurance company. One of the reasons pet insurance companies don’t typically cover pre-existing conditions is to avoid the potential adverse selection of pet owners who wait until their pet develops expensive conditions before enrolling in coverage. The impact from this would be higher premiums for all members as there would be a disproportionate number of claims expected from the pets with these higher than average risks. This could lead pet parents with average risk pets to seek out less expensive policies or skip buying pet insurance at all. (It is recommended to enroll in pet insurance as soon as possible to get the most out of your coverage and avoid any exclusions due to pre-existing conditions.)
Alternative therapies can be used instead of or together with traditional medical practices. They are often used or done instead of a more intrusive medical treatment. Acupuncture, chiropractic services, veterinary orthopedic manipulation (VOM), hydrotherapy, massage therapy, physiotherapy, and laser treatments provided by, or under the direct supervision of, a licensed veterinarian are all examples of alternative therapies.
Annual Coverage Limit
The amount of pet insurance coverage available for eligible claims in a policy year. With a Furkin Pet Insurance Policy, for instance, you will have an annual coverage limit of $20,000 per year.
Annual Policy Period
Annual policy period is each 12-month period that begins at 12:00 AM on the date your policy comes into effect (effective date) and ends at 11:59 PM on the day before the policy anniversary date.
Any medical condition or complication arising from another condition for which your pet showed signs or symptoms that are directly related to, and caused by, the primary medical condition.
Any condition which, when viewed within the context, frequency and intensity of the behaviour, is considered to be a change in the normal behaviour of your pet. This change in behaviour, resulting from factors such as anxiety or fear, may result in destructive, self-destructive or aggressive patterns of behaviour. Behavioural conditions could lead to injuries which occur as a result of your pet’s behaviour.
Any condition affecting body parts of which your pet has two of, one on each side of their body. Some examples include: cruciate ligaments, hip dysplasia, ear or eye problems.
A breed is a group of domesticated animals with defined characteristics, appearances and behaviours that are closely related. Some examples of dog breeds are Labrador Retriever, Bulldog, Poodle and Beagle. Some examples of cat breeds are Ragdoll, American Shorthair, Sphynx cat and Exotic Shorthair.
Breed-specific conditions are health conditions that are a result of a smaller gene pool for a specific breed. To maintain a specific dog or cat breed, animals must be mated with another dog or cat of the same breed. This limits their offspring’s gene pool, potentially putting them at a higher risk of inheriting common breed-specific health risks. For example, large dogs, like German Shepherds, are at an increased risk of developing hip dysplasia. After many generations of German Shepherds being bred, their offspring’s potential to develop hip dysplasia still remains because their gene pool is only made up of German Shepherds, who are all at risk for hip dysplasia due to their specific size and build.
Certified Applied Animal Behaviourist
A Certified Applied Animal Behaviourist (CAAB) is an individual who has been certified by the Animal Behaviour Society (North America) “ABS-NA” as having met the minimum standards of education, experience and ethics required by a professional animal behaviourist as set forth by the ABS-NA.
Claim (Reimbursement Request)
An application for reimbursement of pet health expenses. These are submitted to your pet insurance provider.
A form that pet owners submit to their insurance provider for reimbursement of expenses related to eligible accidents and illnesses. You can find Furkin Pet Insurance Claims Forms on our Members Page.
A claims adjuster reviews and evaluates pet insurance claims to determine the amount of money to reimburse to a policyholder based on what the insurance company policy covers, subject to the member's chosen annual policy limits, deductibles, and coinsurance.
The portion (percentage) of your claim for which you are responsible for paying. For example, a Furkin Pet Insurance policy with an 80% reimbursement level would have a 20% coinsurance, meaning Furkin covers 80% of eligible expenses and you are responsible for paying 20% on all eligible expenses.
All manifestations of clinical signs resulting from the same diagnostic classification or disease process, regardless of the number of incidents or areas of the body affected or whether they are masked or controlled by treatment or medication. For example, arthritis in your pet’s legs, back, and neck is all considered one condition (i.e. arthritis).
A congenital condition is a medical condition with which a pet has been born with, but may not manifest or present until later in life. An example of a congenital condition that is evident at or close to birth would be a cleft palate. An example of a congenital condition that may not be evident for many months after birth would be a portal shunt (which is a liver vascular concern that usually requires treatment). Congenital conditions are eligible for coverage with Furkin Pet Insurance, as long as they have not already manifested or shown signs prior to the issuance of an insurance policy.
Contract (also called Policy)
The legal contract between an insurance company and policyholder. In addition to providing the details of your coverage, your policy outlines your obligations and responsibilities – things you must do to ensure your pet’s coverage is maintained.
Your contract typically includes your policy document, your declaration page (as amended from time to time), the statutory conditions and any document attached to the policy when issued, as well as any amendments agreed or provided in writing after the policy is issued. It is important to keep all policy documents together in a safe place.
A declaration page is a summary of the essential policy terms and costs related to the insurance policy. It contains information such as the policy number, your name and information, your pet’s name and information, the coverage plan, and policy effective date, and the other information listed on page 7 of our sample policy.
A fixed amount which is deducted from your claim after your co-insurance amount has been applied. This amount is applied annually when you make a claim, and is deducted from the amount you are reimbursed. All Furkin Pet Insurance policies offer a choice of three annual deductibles depending upon the age of the pet. You can learn how this works on page 10 of our sample policy.
Any condition for which a veterinarian recommends any form of treatment for the teeth and/or gums, including, but not limited to, scaling, polishing, extractions, orthodontic and endodontics, whether due to illness or trauma.
Ingestion of a food item, such as the ingestion of human food, rotting food or garbage, which causes an illness or injury, or ingestion of a non-food item which does not require active treatment in order for it to pass through or be ejected from the gastrointestinal system.
The consequences of dietary indiscretion are considered to be an illness under a Furkin Pet Insurance policy. If your pet has multiple incidents of dietary indiscretion (three or more), then this condition may be subject to an exclusion under our policy.
In the context of pet health, this refers to guidance or direction provided to a veterinary health team member by a licensed veterinarian who is in the same building as the team member providing the service in question.
When you apply for insurance coverage for your pet, your policy effective date is the date your policy comes into effect.
These are conditions that are covered under your policy and not stated as exclusions or not covered by the policy. For example, hereditary and congenital conditions are both examples of eligible conditions with Furkin Pet Insurance.
An exam fee is the base cost of a veterinary appointment or an examination for your dog for either a wellness exam or sick visit exam. Exam fees do not include any services, treatments, diagnostic or lab costs and/or prescriptions that were provided during the appointment. With Furkin Pet Insurance, sick visit exam fees are covered!
An illness, injury or other condition that is not eligible for coverage under a policy, whether temporarily or permanently, either because the condition is not eligible under the terms and conditions of the policy or because the condition existed prior to the policy effective date or the expiry dates of the applicable waiting periods. Whether an exclusion is a temporary exclusion (see temporary exclusion) or permanent exclusion (see permanent exclusion) would be determined by the individual circumstances of that condition in that pet.
Foreign Body Ingestion
An incident in which your pet has ingested a non-food item which will not pass through or be ejected from the gastrointestinal system without the assistance of veterinary treatment (e.g. medical or surgical intervention). Foreign body ingestion will be considered an accident under a Furkin Pet Insurance policy, unless it is the result of a known behavioural problem which is pre-existing. For example, if your dog has existing separation anxiety prior to enrolling with pet insurance and swallows a foreign material in the process of destroying household furnishings, then the ingestion of this foreign material would be excluded from coverage due to being a pre-existing condition.
Any intentionally dishonest act – such as providing information you know to be false - done for the purposes of receiving payment, better coverage, or gaining something else of value from your insurance provider. Any fraud discovered by Furkin Pet Insurance immediately voids your policy agreement and permits us to terminate your coverage. Serious acts of fraud may also lead to legal action, police involvement, or may be subject to reporting requirements.
Hereditary conditions are medical conditions that have, at least in part, a genetic basis and as such can be passed from one pet generation to the next. Some hereditary problems can be obvious either at birth or a young age, such as components of the Brachycephalic Syndrome in certain dog breeds or cryptorchidism (which occurs when one or both testicles do not descend into the scrotal sac within a couple of weeks after birth). Others, however, may not be evident for months or years, such as hip dysplasia. Hereditary conditions are eligible for Furkin Pet Insurance coverage, as long as they were not noted on a thorough physical exam prior to the issuance of an insurance policy.
Sickness, disease and any changes to your pet’s normal healthy state. Under a Furkin Pet Insurance policy, the definition of illness does not include behavioural problems or dental problems, as those are treated differently based on condition.
Damage to one or more parts of your pet’s body as the result of an external unexpected event that is not related to an illness condition.
This is the maximum amount an insurance company will reimburse you during the life of your pet. A lifetime limit can be on total reimbursement or on a per-condition basis. Furkin Pet Insurance does not have any lifetime limits.
An accident or illness that requires immediate life-saving treatment prescribed by a licensed veterinarian.
Required care that a veterinarian prescribes and performs that is directly related to the resolution or control of the medical condition being treated.
Any medicine legally prescribed and recommended by your veterinarian and approved by an applicable governmental authority for use by veterinarians.
A multi-pet discount is a discount offered by some insurance companies when you insure multiple pets within the same household. With Furkin Pet Insurance, we offer an automatic 5% multi-pet discount making enrollment just a bit easier to afford for our larger fur families.
Per-condition policies are also known as benefit limited or maximum benefit policies. These policies impose a maximum benefit per condition. So, if your pet develops an ongoing illness such as diabetes or dermatitis, once that maximum is reached, that condition will then be excluded from further claims. Furkin Pet Insurance does not have any per-condition limits.
An abnormal health state, condition or other limitation ineligible under a Furkin Pet Insurance policy regardless of subsequent treatment.
Pet Insurance Agent
Pet insurance agents are certified to explain and offer insurance coverage policies for an insurance company. Furkin Pet Insurance has a team of caring pet insurance agents within our Care Team committed to helping pet parents get answers to all their questions and enroll in or maintain coverage.
Refers to a thorough examination of your pet conducted by a licensed veterinarian of all of the body systems visible and palpable externally. Utilizing direct inspection, palpation, percussion and auscultation your veterinarian would determine the condition of the eyes, ears, nose, teeth, gums and mouth, skin and haircoat, gastrointestinal system, musculoskeletal system, abdomen, urogenital system, heart and lungs, as well as an opinion of your pet’s body condition score. As a result of this examination, your veterinarian would note all normal and abnormal conditions in your pet’s medical records. In addition to the actual physical exam, your veterinarian would also be expected to record a history from you about your pet’s activity, diet and any changes from your pet’s normal condition.
A chemical substance that when ingested in inappropriate amounts can cause injury or death. Examples of a poison include warfarin, strychnine, metaldehyde, prescription drugs or illicit drugs, as well as specific plants that are identified and known to be toxic (e.g. lilies).
Under Furkin Pet Insurance coverage, a poison does not include dietary indiscretion, such as the ingestion of human food, rotting food or garbage.
Policy Anniversary Date
The first anniversary of your policy effective date and each anniversary thereafter.
Policy Effective Date
The date by which your contract with your pet insurance company comes into effect. The waiting period applies after the policy effective date. This date is set out on your declaration page.
The specific policy number your insurance provider uses to identify you and the coverage you have for your pet. The policy number appears on your declaration page.
Each 12-month policy period that ends at 11:59 PM the day before the Policy Anniversary Date.
A condition which first occurred or showed clinical signs before your pet’s coverage started or within the policy waiting period, with or without a confirmed diagnosis. Pre-existing conditions include conditions for which a veterinarian provided medical advice, about which relevant clinical signs were noted in the medical records, or were previously treated by a veterinarian or associated with treatments provided through a shelter, breeder, or other resources, including the pet owner. Pre-existing conditions would include those conditions that have occurred in the past, even if not presently being manifested clinically, as the condition is being controlled through the use of appropriate diet or medication.
Your insurance premium is the monthly payment you make to your insurance company to keep your policy active and your coverage in place. Your monthly insurance premium is set by an actuary and depends on various factors such as the geographic location of your pet, age, and breed.
The percentage of a covered claim that your pet insurance provider will pay.
Renewal is the continuation of your policy coverage upon the policy anniversary date. This is typically on a yearly basis and automatic as long as you stay current on paying your premiums, haven’t canceled your plan, and have maintained any provisions set forth by your pet insurance company's policy, such as following the recommended advice of your veterinarian. With Furkin Pet Insurance, you can cancel at any time.
The reproductive system is the set of organs, glands, and tissue responsible for producing offspring. In either female dogs or cats this is viewed to include the ovaries, uterus, uterine tubes, cervix, vagina and mammary glands. In male dogs or cats, the reproductive system includes the testicles, prostate gland, vas deferens, and penis. Learn more about spaying and neutering.
Routine or Preventive Care
Veterinary treatment that is for prevention or early detection (when no signs or evidence exist) of illness or diseases, including but not limited to: annual wellness check ups, vaccinations, titer tests, genetic or DNA tests, routine or baseline diagnostic tests, and internal or external parasite prevention.
Conditions that by law must be included in your contract.
An abnormal health state, condition or other limitation that is ineligible for coverage for a period of time, that may become eligible under your policy, provided that a veterinarian certifies that your pet has completely recovered.
Medical care that is provided for your pet as the result of an illness or injury.
An underwriter is a professional who measures risk and financial conditions associated with insurance policies. Furkin Pet Insurance policies are underwritten by Omega General Insurance Company and are distributed by Canada Pet Health Insurance Services, Inc.
Vaccines are preparations used to help protect your pet from harmful diseases before your pet comes into contact with them as set out and recognized by the Canadian Veterinary Medical Association.
A medical professional who is properly licensed and in good standing in the jurisdiction in which your pet is receiving treatment, who is acting within the scope of their license.
The waiting period is the length of time after your policy effective date that must elapse before there is coverage for an accident, illness, or other event. The waiting periods for accidents and illnesses begin at 12:00 a.m. on the policy effective date. Full coverage begins when the waiting periods have expired. There is no coverage for an accident or other event that occurs before the expiry of the applicable waiting period. There is no coverage for an illness, if the onset of the illness is before the expiry of the applicable waiting period, or if there are clinical signs or symptoms during those durations, even if the treatment for the accident or illness occurs after the expiry of the applicable waiting period. Waiting periods are set out on your declaration page.
Wellness Coverage (or Wellness Plan)
Wellness coverage (or wellness plans) are separate pet health plans that pet owners can purchase as an add-on to their pet insurance coverage that include coverage for certain routine and preventive costs. Some examples of services covered under a wellness plan are vaccinations, dental cleanings, and annual check-up exams.