Refer to your pet insurance policy document to confirm which insurance company underwrites your plan.
For policies underwritten by National Specialty Insurance Company (NSIC), refer to the below California Insurer disclosure:
Please read Your Policy carefully for complete information on the coverage provided. If there is any conflict between the Policy and this notice, the provisions of the Policy will prevail.
Exclusions
Pre-Existing Conditions
- We do not cover Pre-existing conditions. Pre-existing conditions means:
- A Medical Condition that first occurred or showed Clinical Signs before the effective date of the Policy, as shown on the Declarations Page, or showed Clinical Signs during the Waiting Period.
Congenital Anomalies or Disorders
- We do not cover costs or fees for any conditions or disorders present at, and existing from, the birth of Your Pet where Clinical Signs were apparent prior to the effective date of the Policy, as shown on the Declarations Page, or prior to the expiration of the Waiting Period.
Other exclusions may apply. Please refer to the exclusions section of the Policy for more information.
Waiting Period
There is a 15-day Waiting Period from the Pet Policy Effective Date for Injury and Illness and additional Waiting Periods may apply based on additional types of coverages You elect to purchase. Please refer to the Waiting Periods listed on the Declarations Page of Your Policy for more information.
Deductibles
The Deductible is the amount, whether annual or per incident, You are required to pay, per Pet, for Treatments covered by Your Policy before We begin to reimburse You. Your Deductible is shown on the Declarations Page of Your Policy.
Copayments
The Copayment is the percentage of Your Claim for which You are required to pay after any applicable Deductible amount is applied. Your Copayment is shown on the Declarations Page of Your Policy.
Annual and Lifetime Policy Limits
Your Policy contains an Annual Benefit, which is the most We will pay during a Policy Period as shown on Your Declarations Page. Your Policy also contains a Lifetime Benefit, which is the most We will pay during the lifetime of Your Pet, as shown on Your Declarations Page.
Payment of Claims
Reimbursements are based on Your actual veterinary bill. We determine the total of the covered treatments and multiply that by Your reimbursement level determined by Your Copayment. Thereafter, We subtract Your remaining annual Deductible, if any. We provide the following as an example:
| $1,200 | Covered Treatments |
| X 100% | Your reimbursement level based on Your Copayment |
| $1,200 | |
| -$100 | Your remaining annual Deductible |
| $1,100 | Reimbursable Amount |
Benefits Schedules
The below benefit schedules may apply to the coverage afforded under Your Policy, however, whether You choose to purchase certain additional coverages offered will determine whether certain benefit schedules apply. Please consult Your Policy and any endorsements for a complete explanation of Your potentially applicable benefits schedules.
| Coverage | Benefit Schedule |
|---|---|
| Emergency Ambulance Transportations | $100 |
| Anesthetic Removals | No more than two (2) |
| Mortality Benefit | Endorsement Limit |
| Cremation & Burial | $250 |
| Expenses | |
| Replacement Cost | $150 |
| Prescription Drug | 50% of the Costs of Meds |
| Prescription Drug | 50% of the Costs of Meds |
Changes to Your Coverage
Your coverage, Copayments and Deductibles may change due to Your Pet's claims experience. Premium increases may be based on Your Pet's claims experience.
Please refer to Your Policy and any attached Endorsements carefully for complete coverage details.
For policies underwritten by Independence American Insurance Company (IAIC) (NAIC #26581) or United States Fire Insurance Company (USF) (NAIC #21113), refer to the following California Insurer disclosure:
Independence American Insurance Company
[Administrative Mailing Address: P.O. Box 2330, Buffalo, NY 14240]
CALIFORNIA INSURER DISCLOSURE OF IMPORTANT POLICY PROVISIONS
Underwriter, Producer, Brand Information
Insurance is underwritten by Independence American Insurance Company (NAIC #26581. Newcastle, DE). Insurance plans are marketed and produced by Wagmo Insurance Agency, LLC (NPN: 19405740, CA license 6001900). Insurance is administered by PTZ Insurance Agency Ltd. (NPN: 5328528) (California residents only: PTZ Insurance Agency Ltd., d.b.a. PIA Insurance Agency Ltd. CA license #0E36937). Wagmo Insurance is the brand name.
Independence American Insurance Company
11333 North Scottsdale Road, Suite 160, Scottsdale, AZ 85254
(855)281-1108
California Department of Insurance
300 Spring Street, 14th Floor, Los Angeles, CA 90013
(800) 927-4357
The California Department of Insurance should only be contacted after discussions with the insurer, or its agent or other representative have failed to produce a satisfactory resolution.
Please read below for important information to help you understand our coverage. Your coverage starts on the effective date listed on the Declarations Page.
We use certain terms in our policy documents and want to make sure you understand how they are used. Following are some common DEFINITIONS:
Chronic condition means a condition that can be treated or managed, but not cured.
Congenital anomaly or disorder means a condition that is present from birth, whether inherited or caused by the environment, which may cause or otherwise contribute to illness or disease.
Hereditary disorder means an abnormality that is genetically transmitted from parent to offspring and may cause illness or disease.
Orthopedic refers to conditions affecting the bones, skeletal muscle, cartilage, tendons, ligaments, and joints, including elbow dysplasia, hip dysplasia, intervertebral disc degeneration, patellar luxation, and ruptured cranial cruciate ligaments. Orthopedic does not include cancers or metabolic, hemopoietic, or autoimmune diseases.
Pet insurance means an individual or group insurance policy that provides coverage for Veterinary expenses.
Pre-existing condition means any condition for which a veterinarian provided medical advice, the pet received treatment for, or the pet displayed signs or symptoms consistent with the stated condition prior to the effective date of a pet insurance policy or during any waiting period.
Reimbursement percentage means co-insurance.
Renewal means to continue coverage with either the insurer which issued the policy or an affiliated insurer for an additional policy period upon expiration of the current policy period pursuant to Section 660(e) of the California Insurance Code.
Veterinarian means an individual who holds a valid license to practice veterinary medicine from the Veterinary Medical Board pursuant to Chapter 11 (commencing with Section 4800) of Division 2 of the Business and Professions Code or other appropriate licensing entity in the jurisdiction in which he or she practices.
Veterinary dental care means the prevention, diagnosis, and treatment of conditions, diseases, and disorders of the oral cavity, the maxillofacial region, and associated structures.
Veterinary expenses means the costs associated with medical advice, diagnosis, care, or treatment provided by a veterinarian, including, but not limited to, veterinary dental care, the cost of drugs prescribed by a veterinarian, and services provided under the supervision of a veterinarian.
Waiting period means the period of time specified in a pet insurance policy that is required to transpire before some or all of the coverage in the policy can begin.
Coverage for the following conditions will be EXCLUDED.
Pre-existing condition: Pre-existing conditions are not covered by our plans. However, If your pet's pre-existing condition is curable and has been cured and free from treatment and symptoms for a period of 180 days it is a new occurrence.
Ligament and Knee conditions are considered orthopedic illnesses and are bilateral and related, regardless of cause; meaning an occurrence on one side of the body affects both sides of the body. Treatment for ligament and knee conditions is excluded on the Accident Only policy, and on the Accident and Illness policy if there was an occurrence prior to enrollment or during an applicable waiting period.
Coverage for Hereditary and Congenital Conditions may be excluded.
Other exclusions apply. Please refer to your Declarations Page for any applicable exclusion endorsements, the exclusions section of the policy (What Is Not Covered), and the applicable exclusion endorsements for more information.
Waiting Periods
There are WAITING PERIODS that apply before certain coverages are effective. For Accident and Illness policies, a 14-day illness coverage waiting period applies to the first policy period. Any illness, congenital anomaly or disorder, hereditary disorder and orthopedic illness that occur during or before a waiting period are considered pre-existing and excluded from coverage.
You may elect at your cost to pursue a Waiting Period Health Assessment. If you and your pet meet the requirements of the Waiting Period Health Assessment, then the waiting period may be modified. A copy is available online or by calling customer service.
In order for us to modify the waiting period, you must meet each of the following requirements:
- A qualifying exam of your pet by a veterinarian that includes an assessment of all body systems and parts;
- results of the exam need to be documented at the time of exam on our completed Waiting Period Health Assessment Form;
- the qualifying exam may occur within 3 days prior to or 7 days after your initial policy effective date; and
- the Waiting Period Health Assessment form must be provided to us within 30 calendar days of your qualifying exam.
If the Waiting Period Health Assessment requirements are met, the waiting period will be waived to either the policy period effective date or the day after the qualifying exam, whichever is later. This waiver does not alter the pre-existing conditions exclusion.
Policy Limits
Reimbursement of covered expenses is subject to the annual policy limit listed on your Declarations Page.
Please continue reading for information on Claims, Deductibles, and Reimbursement Percentage.
Deductible
We offer a choice of annual deductible options. The annual deductible applies to each policy period. We subtract that deductible amount from the covered expenses before calculating your reimbursement percentage.
Reimbursement Percentage
After the deductible is met, you are responsible for your portion of the covered expenses in addition to any amounts not covered by the policy. We then pay our portion of the covered expenses subject to the annual limits.
Determination of Claim Payouts
Our coverage provides reimbursement up to the applicable annual limit for the actual costs for covered expenses that you incur during the policy period, after subtracting your deductible and applying the reimbursement percentage, listed on the Declarations Page.
Premium Increases Due to Pet Age and Geographic Location
Insurance plan premiums will increase as the covered pet gets older. Insurance plan premiums may increase or decrease due to the policyholder's geographic location. We will not reduce coverage or increase premium due to claims history.
Preventive Care Optional Insurance Endorsement
Independence American Insurance Company offers an optional insurance endorsement that provides preventive care benefits. This endorsement is elective and may be purchased at the time of policy issuance or renewal, subject to applicable underwriting and eligibility criteria.
Individuals who have purchased a separate, non-insurance wellness product that provides preventive care or similar benefits are not eligible to purchase this optional preventive care endorsement, to avoid duplication of benefits and ensure consistent application of coverage.
Reimbursements are up to the lower of the amount listed or charged. Some benefits are specific, as noted. Preventive benefits are paid according to the schedule of benefits provided with the policy, if applicable, and are not subject to a deductible or reimbursement percentage. See below for a list of available benefits.
| Benefit | Basic | Prime |
|---|---|---|
Dental Cleaning | $100 | $0 |
Dental Cleaning OR Spay/ Neuter | $0 | $150 |
Wellness Exam | $50 | $50 |
FVRCP Vaccine/ Titer (cats) DHLPP Vaccine/ Titer (dogs) | $20 | $25 |
Rabies Vaccine/ Titer OR FIP Vaccine/ Titer (cats), Lyme Vaccine/ Titer (dogs) | $20 | $25 |
Fecal Test | $20 | $25 |
FELV Test (cats) Heartworm Test (dogs) | $20 | $25 |
Deworming | $20 | $25 |
Health Certificate | $0 | $25 |
Flea/ Heartworm Prevention | $0 | $25 |
FELV Vaccine/ Titer (cats) Bordetella Vaccine/ Titer (dogs) | $0 | $25 |
Blood Test | $0 | $25 |
Urinalysis | $0 | $25 |
