How to Understand Pet Medical Insurance Policy Structure

It is important to know and understand what is covered by a pet medical insurance policy, what is not covered and how the policy is structured.
As policies vary in the cover they provide and do not provide, so their structures vary. However, there are some standard sections which all policies contain although their sequencing in the policies
may vary.
1.Table of Content or Index
This lists the various sections of the policy
2.What is ABC Pet Policy
This describes what the policy is and is not e.g.:ABC Pet Policy is a medical insurance product and this policy a contract of insurance (not a medical aid)It describes in very broad terms what is covered e.g.:ABC Pet Policy is designed to cover the unexpected, unforeseen and fortuitous veterinary fees/expenses/costs
3.What is covered by ABC Pet Policy
This clause describes in more detail the scope of the cover provided e.g.:Depending on the Plan selected, your policy entitles you to emergency treatment, consultation, examination, pre-hospital and in-hospital Veterinary fees/expenses/costs as well as any surgery, X-rays, medication, nursing and other care provided by a Vet or Vet Practice as defined by this policy, less any excess shown on your Certificate of Insurance or Rates and Benefits Schedule.
4.Definitions
These are the key words used in the policy and their meaning in the context of the policy wording.
5.General ConditionsThese are conditions applicable to the whole policy and all its options or plans. The conditions/clauses are wide
ranging but can described as “conditions precedent to liability”.
6.General Exclusions, Exceptions and Limitation
This is probably the most important section of the policy. It is very important to know what you are NOT covered for. Please remember, if your claim falls under the treatments/conditions/expenses specified under “What is Covered” but is not specifically excluded, then it must be covered. It is up to the underwriter to clearly state their intention as to what is covered and what is not.
7.Claims Procedure
This section usually contains two sub-sections i.e.
8.Premium Payment, Renewal and Cancellation
This section describes the:
Premium payment options and the conditions related thereto. Remember: No Premium, No Claim Payment
Renewal procedures and conditions applicable to both parties.
Cancellation procedures and condition applicable to both parties.
9.About the Insurer
This give you the full name, address and all contact details of the insurer/underwriters of the policy. This information MUST be revealed to you.
10.Know your Rights
This section describes your rights in terms of the prevailing regulations.
It also provides you with the contact details of the FAIS Ombudsman,
the Short Term Insurance Ombudsman and the Fraudline. Make use of them
if you have grounds to believe you insurer has in any way treated you unfairly.
As policies vary in the cover they provide and do not provide, so their structures vary. However, there are some standard sections which all policies contain although their sequencing in the policies
may vary.
1.Table of Content or Index
This lists the various sections of the policy
2.What is ABC Pet Policy
This describes what the policy is and is not e.g.:ABC Pet Policy is a medical insurance product and this policy a contract of insurance (not a medical aid)It describes in very broad terms what is covered e.g.:ABC Pet Policy is designed to cover the unexpected, unforeseen and fortuitous veterinary fees/expenses/costs
3.What is covered by ABC Pet Policy
This clause describes in more detail the scope of the cover provided e.g.:Depending on the Plan selected, your policy entitles you to emergency treatment, consultation, examination, pre-hospital and in-hospital Veterinary fees/expenses/costs as well as any surgery, X-rays, medication, nursing and other care provided by a Vet or Vet Practice as defined by this policy, less any excess shown on your Certificate of Insurance or Rates and Benefits Schedule.
4.Definitions
These are the key words used in the policy and their meaning in the context of the policy wording.
5.General ConditionsThese are conditions applicable to the whole policy and all its options or plans. The conditions/clauses are wide
ranging but can described as “conditions precedent to liability”.
6.General Exclusions, Exceptions and Limitation
This is probably the most important section of the policy. It is very important to know what you are NOT covered for. Please remember, if your claim falls under the treatments/conditions/expenses specified under “What is Covered” but is not specifically excluded, then it must be covered. It is up to the underwriter to clearly state their intention as to what is covered and what is not.
7.Claims Procedure
This section usually contains two sub-sections i.e.
- Your obligations as the claimant – what you must do, the information and proof you must provide, etc. Watch outfor the time bars and prescription periods!
- The insurance company’s obligations – in terms of settlement periods, etc.
8.Premium Payment, Renewal and Cancellation
This section describes the:
Premium payment options and the conditions related thereto. Remember: No Premium, No Claim Payment
Renewal procedures and conditions applicable to both parties.
Cancellation procedures and condition applicable to both parties.
9.About the Insurer
This give you the full name, address and all contact details of the insurer/underwriters of the policy. This information MUST be revealed to you.
10.Know your Rights
This section describes your rights in terms of the prevailing regulations.
It also provides you with the contact details of the FAIS Ombudsman,
the Short Term Insurance Ombudsman and the Fraudline. Make use of them
if you have grounds to believe you insurer has in any way treated you unfairly.
If you have any other questions relating to Pet Medical Insurance, Munro would love to hear from you. Just click here to go to the Q & A Page or visit Genricpet's website. www.genricpet.co.za