Will Pounce cover my pet’s pre-existing conditions?
Taking the pain out of pre-existing conditions – Upcoming change for Pounce Customers
To help pet parents get the most from their pet insurance policies, we’ve recently made some changes to how pre-existing conditions are handled for all Pounce pet insurance policies. This applies to claims with a veterinary treatment date from 1 December 2020.
What is a pre-existing condition?
A pre-existing condition refers to any health condition (diagnosed or otherwise) that your pet has shown signs of before the purchase of a pet insurance policy (or its applicable waiting period), meaning the condition will not be covered under the policy.
Not all pre-existing conditions are created equal. To help pet parents claim for more eligible conditions, from 1 December 2020, pre-existing conditions are now assessed depending on whether they are considered a temporary or a chronic condition.
A temporary pre-existing condition is a pet health condition that usually resolves with treatment and is removed from your policy as an exclusion automatically if your pet hasn’t shown signs of that condition for 18 months or more prior to your claim treatment date.
A chronic pre-existing condition is a pet health condition that requires ongoing care or is more prolonged in nature, so if your pet displays one of these conditions prior to the purchase of a pet insurance policy or its waiting period, it will never be coverable under the policy.Some of these conditions include:
- • Cruciate ligament conditions
- • Intervertebral disc disease
- • Hip dysplasia
- • Elbow dysplasia
- • Patella luxation
- • Endocrine diseases
- • Any other chronic condition
An important reminder that these exclusions only relate to pre-existing conditions. If your pet requires treatment after the purchase of a pet insurance policy and its waiting period, all conditions outlined in the policy’s Product Disclosure Statement will be eligible for cover for the life of the policy.
Let’s take a quick look at some examples to help differentiate the difference between a temporary pre-existing condition (which can be removed as an exclusion after the 18 month asymptomatic period), and a chronic pre-existing condition (which will always be excluded if pre-existing).
Before taking out a pet insurance policy, your pet Bella has a case of Gastroenteritis (a tummy upset). The condition is treated and Bella recovers. Following the surprise episode, you decide to purchase a pet insurance policy for Bella to help with future, unexpected Vet visits.
Two years later, Bella has another unrelated case of Gastroenteritis. Can you claim for this condition?
Yes! The Gastroenteritis is considered a temporary condition, given that it resolved with treatment, it’s not on the list of excluded conditions in the policy’s Product Disclosure Statement (PDS) and the two episodes were not related. There was also more than 18 months between each condition.
Archie’s Luxating Patella
You’ve noticed your pet Archie is limping a little on his rear leg. Your Vet diagnoses him with a Luxating Patella (a dislocating kneecap).
15 days ago, you took out pet insurance for Archie, meaning you’re currently mid-way through the policy’s waiting period for this condition. That means treatment for this condition is not covered by your policy given it arose during the applicable waiting period, as outlined in the policy’s Product Disclosure Statement (PDS).
Two years later, Archie requires surgery for the Patella Luxation. Can you claim for this condition?
No. You and your Vet were both aware of this condition during the pet insurance policy’s waiting period, so it’s not eligible for cover (as outlined in the policy’s PDS). Patella Luxation is also defined as a chronic condition in the policy’s PDS, so as a result it remains ineligible for cover two years later.
Max’s Demodex Mites
Your puppy Max had Demodex Mites 18 months before having a pet insurance policy, which resolved with treatment from your Vet.
Two years later, Max is diagnosed with a new case of Demodex Mites. Can you claim for this condition?
Yes! The first episode of demodex mites was a temporary condition that resolved with treatment, and it’s not considered an excluded condition in the policy’s Product Disclosure Statement (PDS). Max also didn’t show signs, symptoms or abnormality in relation to the condition for more than 18 months.
Daisy’s broken leg
You first got pet insurance for Daisy when she was just 10 weeks old. Now at age three, Daisy broke her leg, and needs emergency treatment by your Vet. Can you claim for this condition?
Yes! As your selected pet insurance policy provides cover for accidents like broken bones (as outlined in your Product Disclosure Statement (PDS)) and the policy’s waiting period has passed, the condition isn’t considered pre-existing (i.e. known to you or your Vet prior to the commencement of your policy), and you’ve renewed your policy continuously each year without a break in cover, you’re able to claim for Daisy’s broken leg.
Please note that some of the examples above may not always apply to your level of Cover. Please refer your Policy Booklet for covered conditions and any general exclusions.
Want a pre-existing condition reviewed on your policy?
All temporary pre-existing conditions are automatically removed from your pet insurance policy as an exclusion if your pet hasn’t shown signs or symptoms of that condition for 18 months or more, so there’s nothing more for you to do.
A chronic pre-existing condition is a pet health condition that requires ongoing care or is more prolonged in nature, so if your pet displays one of these conditions prior to the purchase of a pet insurance policy or its’ waiting period, it will never be coverable under the policy.
If you would still like to have a pre-existing condition on your pet insurance policy reviewed, you can do so anytime. Simply complete the pre-existing condition policy review form found here, with your Vet and we’ll take care of the rest.
Where can I find the details of these changes in my Product Disclosure Statement?
We’ll be issuing new Product Disclosure Statements that outline all of these new terms shortly. You’ll find this available on our website here.
How long do I have to submit a claim after my pet had treatment?
We have recently made a change to our claims procedure. You no longer need to submit your claims within 90 days of treatment. There is no time limit to submitting a claim for your pet.
Can I visit any Vet?
Yes, you can visit any vet (other than yourself) that is licensed to legally practice as a veterinarian in Australia. Please note, although it is rare, if expenses incurred by you with respect to the Treatment significantly exceed what is reasonable and expected, having regard to the circumstances in which the Treatment was provided, then claim payments may be adjusted to the amount of reasonable and expected expenses.
If your Pet requires treatment, you can seek a claim pre-approval, whereby we can provide you with the details of your claim reimbursement. To request a pre-approval, simply call us on 1300 457 046.
Can I continue to insure my pet as they get older?
Yes. As long as your pet is insured with us under the Standard, Premium or Indoor Cat policy before the age of 9, or under the Basic policy before the age of 6, and there is no break, lapse or change in the level of coverage, you’re able to continue insuring your pet as they get older.
Please note for Basic and Indoor Cat plans your benefit percentage will reduce to 65% when your pet turns 8 (upon renewal).
Are there any age limits for the insurance?
Standard, Premium and Indoor Cat Cover
Your pet must be over the age of 8 weeks and under the age of 9 years when cover commences for our Standard, Premium or Indoor Cat cover.
Unless you tell us otherwise, your cover will continue to renew after the age of 9 (as long as there is no break, lapse or change in the level of coverage and your payments are up to date).
Your pet must be over the age of 8 weeks and under the age of 6 years when cover commences for our Basic cover.
Unless you tell us otherwise, your cover will continue to renew after the age of 6 (as long as there is no break, lapse or change in the level of coverage and your payments are up to date).
What is not covered?
Like most insurance policies, we have excluded some conditions. This is to help keep your premiums low. Pounce Pet Insurance does not cover things such as behavioural problems, elective procedures, food and diets, grooming, pregnancy and any pre-existing conditions that your pet showed clinical signs of before you took out the insurance, or during the Waiting Period.
How do I make a claim?
When you take out a Pounce Pet Insurance policy, you will be able to register for our secure pet portal, customer.pouncepetinsurance.com.au where claiming is easy. Simply upload a copy of your vet's tax invoice and consultation notes. If it is your first claim you will need to attach a full veterinary history. You can access a claim form from here. Alternatively you can call 1300 457 046.
Does Pounce cover hereditary and congenital defects?
Yes. Provided symptoms or clinical signs of these defects were not present prior to the commencement date of your policy or during the policy Waiting Period.
Does Pounce insure pets other than cats and dogs?
We love all animals, but at this stage we only offer insurance for dogs and cats.
Who is Pounce Pet Insurance?
Pounce Pet Insurance is distributed and promoted by Insurance Australia Limited (IAL) trading as Pounce Pet Insurance ABN 11 000 016 722, (AFSL 227681). It is issued by The Hollard Insurance Company Pty Ltd (Hollard) and administered by PetSure (Australia) Pty Ltd.
I already have a wonderful vet. Can my pet still visit them?
Absolutely. With Pounce Pet Insurance, you have the freedom to choose any licensed vet in Australia.
Are ongoing conditions covered for the life of my pet?
Yes. As long as you continue to renew your policy with us each year with no break in cover, we will continue to provide cover for chronic, recurring or lifelong conditions such as diabetes or arthritis. Benefits for these conditions, like any other, are subject to the annual policy limits and exclude Pre-existing Conditions.
What Waiting Periods apply?
Waiting Periods do apply for illnesses and certain conditions.
How do you calculate my premium?
Your premium is calculated using a combination of factors about you and your pet. These factors can affect the premium amount up or down depending upon whether we believe it increases or decreases the risk to us, such as the cover you have chosen, the benefit percentage applicable to the cover you have chosen, where you and your pet permanently live, your age and the species, breed, gender of your pet, the current age of your pet, the age you first insured your pet, and other factors related to our cost of doing business.
Factors that are taken into consideration for renewal premium calculation include your pet’s age, breed, location, duration for which your pet has been insured, claims history, as well as data relating to the health of pets that are a similar age and breed. Each year we review premiums based on these factors to ensure we can accommodate the costs of possible treatment up to your annual benefit limit, in the event that your pet becomes injured or ill.
Will my premium increase every year?
Yes, your premium will increase each year. This is for two main reasons:
Reason #1: Just like humans, the older our pets get, the more likely they are to have health hiccups. Cats and dogs age faster than we do, which means that their likely veterinary treatment costs go up rapidly each year too. As a result, the cost of insuring your pet will also increase as they get older.
Reason #2: Advancements in Veterinary Treatments.
The overall cost of medical treatment for pets has increased in recent years due to the increased availability of medical treatments and technology-enabled services and ongoing demand for these services. The treatment options and advancements in technology are providing us with great opportunities to give our pets a great quality of life for longer.
While this is great news for the care of our pets, these treatments come at a significant cost. Year on year treatment costs increase, and this is factored into the cost of pet insurance.
Please see ‘How do you calculate my premium’ for more information about calculation of premiums.
Will my premium increase even if I don’t submit claims?
Every year, we review the cost of everyone’s insurance with regards to a combination of factors as well as claims inflation across all our insured pets. Increases in our claims costs due to increases in the range of available veterinary procedures, or due to an increased take-up of those services, impacts everyone’s premiums.
Your premium takes into account the average cost of care for pets like yours. To provide an example of this, a pet parent with a three-year-old French Bulldog will be affected by the trends we see in our data from hundreds of three-year-old French Bulldogs that we insure, as well as the specific claims history of their own pet.
Is my premium calculated the same way as my Private Health Insurance?
No. Pet insurance does not work like health insurance. Health insurance is ‘community rated’, which means that everyone pays the same premium for their health insurance regardless of their individual health status, age or claims history. This is not the case for pet insurance.
Health insurance providers are able to community rate health insurance because there are many other factors at play in the human health care system, such as Medicare and government rebates and subsidies, which is not the case with veterinary care and pet insurance.
Pet insurance claim reimbursements are paid for purely by the premiums received by those who insure their pets. In order for each person to pay a fair price for their pet insurance, premiums vary depending on your and your pet’s risk factors.