A standard accident and illness pet insurance policy covers: unexpected injuries, illnesses, hereditary and congenital conditions, cancer, dental illness (not dental cleaning), and most prescription medications. It does not cover routine wellness care, pre-existing conditions, or elective procedures — unless you add a wellness rider.
This guide breaks down exactly what's covered, what's excluded, and how the three plan types differ — so you know what you're actually buying before you file a claim.
The Three Plan Types: What Each Covers
| Plan Type | Covers | Excludes | Monthly Cost (dog) |
|---|---|---|---|
| Accident Only | Injuries, trauma, toxin ingestion, broken bones, lacerations | All illnesses: cancer, diabetes, infections, hereditary conditions | $10–$18/mo |
| Accident + Illness | Everything above + illnesses, hereditary conditions, cancer, dental illness, chronic disease | Pre-existing conditions, routine wellness care | $22–$70+/mo |
| Accident + Illness + Wellness | Everything above + vaccines, annual exams, dental cleanings, flea/tick prevention | Pre-existing conditions | $35–$90+/mo |
For most pets, accident and illness is the baseline recommended plan. Accident-only plans are significantly cheaper but exclude the claims that generate the largest bills — cancer, orthopedic conditions, chronic disease. A urinary blockage in a male cat ($750–$3,000) is an illness. IVDD in a Dachshund ($4,500–$7,000 surgery) is a hereditary condition. Neither is covered under accident-only.
What Accident and Illness Plans Cover: Full Breakdown
Injuries and Accidents
- Broken bones, fractures, dislocations
- Lacerations, bite wounds, trauma
- Eye and ear injuries
- Toxin ingestion, foreign body ingestion
- Ligament tears (CCL/ACL) — classified as injury at most providers
- Burns, electric shock
Illnesses
- Infections (bacterial, viral, fungal)
- Digestive disorders, vomiting, diarrhea requiring vet care
- Urinary tract infections and blockages
- Respiratory illness
- Skin conditions (allergies, hotspots, mange)
- Eye infections and conjunctivitis
- Ear infections
Hereditary and Congenital Conditions
Most major providers cover hereditary and congenital conditions as long as they were not present or showing symptoms before enrollment. This includes:
- Hip dysplasia, elbow dysplasia
- IVDD (intervertebral disc disease) — critical for Dachshunds, Corgis, French Bulldogs
- Brachycephalic obstructive airway syndrome (BOAS) — English and French Bulldogs
- Heart conditions (HCM in cats, DCM in dogs)
- Degenerative myelopathy (DM) — common in German Shepherds
- Osteochondrosis (OCD)
- Polycystic kidney disease (PKD) — Persians, British Shorthairs
Exception: Some providers require a waiting period of 6–14 days for orthopedic conditions; others (Healthy Paws) have a 12-month orthopedic waiting period. See our waiting periods guide for a full comparison.
Cancer
All major accident and illness providers cover cancer treatment, including:
- Chemotherapy
- Radiation therapy
- Surgery for tumor removal
- Diagnostic imaging (CT, MRI, ultrasound)
- Prescribed cancer medications
Cancer treatment averages $5,000–$12,000. For Golden Retrievers (60% lifetime cancer risk) and Boxers (40%+ risk), cancer coverage is often the most financially significant coverage element in an accident and illness policy.
Dental Illness
Accident and illness plans cover dental illness — conditions that require treatment due to disease or injury:
- Tooth fractures (from chewing hard objects, trauma)
- Tooth resorption (cats)
- Stomatitis (feline)
- Periodontal disease requiring extraction
- Oral tumors
Not covered under standard plans: routine dental cleanings (prophylactic), cosmetic dental work. Dental cleanings require a wellness add-on. See our dental coverage guide for a full provider breakdown.
Chronic and Ongoing Conditions
Once a condition is diagnosed and covered (i.e., it was not pre-existing), most providers continue covering treatment at each policy renewal:
- Diabetes (insulin, monitoring)
- Hypothyroidism / hyperthyroidism (medication)
- Chronic kidney disease (CKD) — management medications
- Inflammatory bowel disease (IBD)
- Epilepsy (seizure medications)
- Allergies (ongoing treatment)
Key distinction: Trupanion is often cited as the best provider for chronic conditions because it does not apply a per-incident deductible — you pay your deductible once per condition for the life of the policy, not annually.
Prescription Medications
Prescribed medications are covered when treating a covered condition — including long-term prescriptions for chronic conditions. What is not covered: prescription food and dietary supplements (even if prescribed), over-the-counter medications, supplements, probiotics.
Diagnostic Tests
- Blood work, urinalysis, fecal tests
- X-rays, ultrasound
- CT scans and MRI
- Biopsies
- ECG/echocardiograms
Surgery and Hospitalization
- Emergency surgery
- Specialist referrals (board-certified surgeons, oncologists, neurologists)
- Hospitalization and ICU care
- Anesthesia
- Post-surgical follow-up care
Alternative and Rehabilitative Therapies
Many providers cover alternative therapies when prescribed by a vet for a covered condition:
- Physical therapy / hydrotherapy (Embrace, Pets Best, ASPCA, Fetch)
- Acupuncture (Embrace, Fetch, Pumpkin)
- Chiropractic care (Embrace, Fetch)
Lemonade, Healthy Paws, and Spot have more limited alternative therapy coverage. Always confirm with the specific provider before assuming coverage.
What Pet Insurance Does NOT Cover
| Excluded Item | Why Excluded | Can It Be Added? |
|---|---|---|
| Pre-existing conditions | Conditions diagnosed or symptomatic before enrollment | No (curable conditions: sometimes after waiting period) |
| Routine wellness care (vaccines, exams) | Predictable, budgetable expenses | Yes — wellness add-on |
| Dental cleanings / prophylaxis | Preventive, not illness treatment | Yes — wellness add-on |
| Prescription food / special diets | Even when prescribed (e.g., kidney diet) | No |
| Elective procedures | Declawing, ear cropping, tail docking | No |
| Breeding costs | Pregnancy, whelping, caesarean sections | No (some providers: yes with rider) |
| Grooming | Non-medical | No |
| Behavioral training | Some providers cover behavior therapy; training excluded | Behavior therapy: sometimes included |
What Wellness Add-Ons Actually Cover
Wellness riders (available from Pets Best, Embrace, ASPCA, Lemonade, Pumpkin, and others) add coverage for preventive care:
| Wellness Item | Typically Covered | Notes |
|---|---|---|
| Annual wellness exam | Yes | Usually 1 per year |
| Core vaccines (rabies, DHPP/FVRCP) | Yes | Full or partial reimbursement |
| Flea, tick, heartworm prevention | Yes | Up to annual limit |
| Dental cleaning (prophylaxis) | Yes | Usually once per year |
| Spay / neuter | Yes (at some providers) | Pets Best EssentialWellness: yes; Lemonade: no |
| Heartworm test | Yes | Annual |
| Bloodwork / urinalysis (routine) | Sometimes | Depends on provider and tier |
| Microchip | Sometimes | Embrace: yes; ASPCA: no |
Wellness add-ons typically cost $9.99–$26/month and cap annual reimbursements at $100–$650 depending on the tier. The ROI depends on how consistently you use preventive care. See our wellness plans comparison for provider-by-provider details.
Pre-Existing Conditions: The Most Important Exclusion
Every standard U.S. pet insurance policy excludes pre-existing conditions — any illness, injury, or symptom that existed before your policy's effective date (or sometimes before your waiting period ends). This is the single most impactful exclusion for most pet owners.
What counts as pre-existing:
- Any condition with a formal diagnosis before enrollment
- Any condition with documented symptoms in your vet records before enrollment — even without a diagnosis
- Any condition noted in passing during a routine vet visit ("owner reports occasional limping")
Curable vs. incurable: Some providers (ASPCA, Embrace, Pets Best) will reconsider coverage for curable pre-existing conditions (e.g., a UTI, ear infection) if your pet goes symptom-free for 12–24 months. Incurable conditions (cancer, diabetes, hip dysplasia) remain excluded permanently.
For a full breakdown of how each provider handles pre-existing conditions, see our pre-existing conditions guide.
Does Pet Insurance Cover Spaying, Neutering, and Vaccines?
Standard accident and illness plans do not cover spaying, neutering, vaccines, or routine wellness procedures. These are considered preventive and budgetable — the opposite of the unexpected events insurance is designed for.
To get coverage for spaying, neutering, and vaccines, you need a wellness add-on. Providers offering this include:
- Pets Best EssentialWellness: covers spay/neuter ($150 limit), vaccines, flea/tick prevention — from $16/month
- Embrace Wellness Rewards: flexible $250–$650/year pool covering spay/neuter, vaccines, dental cleaning — from $9.95/month
- ASPCA Wellness: covers annual exam, vaccines, dental cleaning — $9.95–$24.95/month
- Pumpkin Preventive Essentials: flat $18.95/month, covers vaccines, flea/tick, dental cleaning
See our full guide on pet insurance that covers spaying, neutering, and vaccines.
Frequently Asked Questions
What does pet insurance cover?
Accident and illness pet insurance covers unexpected injuries (broken bones, lacerations, foreign body ingestion), illnesses (infections, urinary issues, skin conditions), hereditary conditions (hip dysplasia, IVDD, BOAS), cancer (chemo, surgery, radiation), dental illness (fractures, tooth resorption, periodontal disease requiring extraction), and prescription medications for covered conditions. It does not cover pre-existing conditions, routine wellness care, dental cleanings, or prescription food.
Does pet insurance cover everything?
No. Even the most comprehensive accident and illness plan excludes pre-existing conditions, routine wellness (vaccines, exams, dental cleanings), prescription food, and elective procedures. A wellness add-on expands coverage to include preventive care. No pet insurance policy covers everything — but a well-chosen accident and illness plan with a wellness rider covers the vast majority of real-world vet expenses.
Does pet insurance cover dental?
Accident and illness plans cover dental illness — tooth fractures, tooth resorption, stomatitis, periodontal disease requiring extraction. They do not cover routine dental cleanings (prophylaxis). To cover dental cleanings, you need a wellness add-on. See our dental coverage guide for which providers cover the most dental treatments.
Does pet insurance cover hereditary conditions?
Yes — most major providers cover hereditary and congenital conditions as long as the condition was not present or symptomatic before enrollment. This includes hip dysplasia, IVDD, BOAS in brachycephalic breeds, HCM in cats, and similar breed-specific conditions. Exceptions: some providers impose 6–14 day orthopedic waiting periods; Healthy Paws has a 12-month orthopedic waiting period.
Does pet insurance cover cancer?
Yes. All major accident and illness providers cover cancer treatment including surgery, chemotherapy, radiation, and related diagnostics. Cancer is typically one of the most expensive covered conditions ($5,000–$12,000+ per diagnosis). Providers with unlimited annual benefits (Healthy Paws, Trupanion) are often recommended for breeds with elevated cancer risk (Golden Retrievers, Boxers).
What is not covered by pet insurance?
The main exclusions across all standard plans: pre-existing conditions (anything diagnosed or symptomatic before enrollment), routine wellness care (vaccines, annual exams, dental cleanings), prescription food and supplements, elective or cosmetic procedures (declawing, ear cropping), and breeding-related costs. Behavioral training is typically excluded, though behavior therapy for diagnosed anxiety may be covered at some providers.