Pet Insurance and Pre-Existing Conditions: What Gets Covered

What counts as a pre-existing condition?

A pre-existing condition is any illness or injury your pet showed signs of before the policy started or during a waiting period. The NAIC Pet Insurance Model Act, a template law for state regulators, uses three tests. A condition is pre-existing if, before the effective date or during a waiting period:

1. a vet gave medical advice about it,
2. your pet was treated for it, or
3. verifiable records show signs or symptoms directly related to it.

The third test catches people out. Forbes Advisor gives the example of a vet noting a limp without diagnosing the cause. If the limp later turns out to be a ligament tear, the insurer can treat the tear as pre-existing.

A waiting period is the time after you buy a policy before certain claims are covered, often 14 days for illness. Anything that first appears during that window also counts as pre-existing. Our waiting periods guide compares those windows by insurer.

Curable vs incurable pre-existing conditions

Curable conditions can heal completely. Incurable conditions last for life and can only be managed. That split decides whether a past problem can ever be covered.

Curable (may be covered later)	Incurable (stays excluded)
Urinary tract and bladder infections	Allergies
Ear infections	Diabetes
Respiratory infections and kennel cough	Cancer
Vomiting and diarrhea	Arthritis
Broken bones that have healed	Chronic kidney disease
	Hip dysplasia, epilepsy, heart disease

Examples come from NerdWallet and Forbes Advisor. Forbes Advisor also lists intervertebral disc disease, bilateral conditions and hereditary conditions like hip dysplasia as incurable for insurance purposes.

Insurers decide what counts as cured, not your vet. Some state outright that knee and ligament conditions, and chronic conditions, can never count as cured.

Which insurers cover curable pre-existing conditions?

Many do, once your pet has stayed free of symptoms and treatment for a set time. The main split is 180 days versus 12 months.

Symptom- and treatment-free period	Insurers	Source
180 days	ASPCA, Hartville, Pumpkin, Spot	NerdWallet, Forbes Advisor, ASPCA
180 days	Pets Best	Forbes Advisor
12 months	Embrace, Figo, Lemonade, Prudent Pet	NerdWallet, Forbes Advisor
365 days (excludes orthopedic and long-term medication cases)	Healthy Paws	Healthy Paws
Not covered	Trupanion	Forbes Advisor

Lemonade’s wording is that in most states it can cover temporary pre-existing conditions or injuries that resolve without recurrent symptoms or continued treatment for at least 12 months.

Healthy Paws spells out its own limits. Conditions can lose pre-existing status after 365 days with no signs and no treatment. It gives parasitic and respiratory infections as examples, and excludes orthopedic conditions and those that need long-term medication.

NerdWallet notes one outlier: AKC can cover incurable conditions as well as curable ones after 12 months, in some states. Rules like these change, so confirm the current wording in the sample policy before you buy.

How insurers check: the medical records review

Insurers find pre-existing conditions by reading your pet’s vet records. This is sometimes called the look-back: the insurer looks back over a set period of history.

When that happens varies. Forbes Advisor reports that Embrace reviews records before enrollment, ASPCA does not require a vet exam to start, and Pets Best may request records after you file a claim. NerdWallet says insurers typically want a recent vet checkup to set a baseline of your pet’s health. Lemonade does not need records to sign up, but asks for the last 12 and a half months of records to pay claims.

A records review after a claim is the riskier version for you. You might pay premiums for months before learning an old note excludes the problem you are claiming for. Ask any insurer, in writing, how it would treat a specific past condition before you rely on the policy.

The model law adds a protection in states that adopt it: the insurer has the burden of proving that the pre-existing condition exclusion applies. It is not up to you to prove the condition is new.

Bilateral conditions: why one bad knee can exclude both

A bilateral condition is a problem that can affect both sides of the body, such as both hips, knees, elbows or eyes. Many insurers treat the two sides as one condition. If one side had problems before enrollment, both sides can be excluded.

NerdWallet notes that policies may exclude paired body parts on both sides if one side was affected before the policy began. Healthy Paws applies this to cruciate ligaments: lameness or a tear on either side before enrollment excludes both knees.

Cruciate ligament tears are the classic example. Some insurers also treat any sign of a cruciate problem during the orthopedic waiting period as pre-existing. If you own a large breed like a German shepherd or golden retriever, enrolling before any limp shows up protects both knees.

What state law says about pre-existing conditions

State law mainly controls how pre-existing conditions are defined and disclosed, not whether they must be covered. The NAIC adopted its Pet Insurance Model Act in 2022. States that adopt it get the three-part definition above, plus these rules:

• Insurers must clearly disclose if a policy excludes pre-existing, hereditary, congenital or chronic conditions.
• The insurer carries the burden of proving a pre-existing condition exclusion applies.
• Waiting periods cannot be applied again when you renew existing coverage.

The model does not force insurers to cover curable conditions. It also does not set the 180-day or 12-month windows; those are each insurer’s own choice.

The NAIC’s Summer 2026 adoption chart lists more than 20 states with the model or related activity such as laws or bulletins. They include California, Florida, Ohio and Washington, and New Jersey from January 1, 2027. Details differ from state to state, so treat the model as a guide, not a guarantee.

How to get the most coverage if your pet has a history

The best protection is to enroll before problems appear. A pet with a clean record has nothing to exclude. That is the main argument for insuring a puppy early, before hereditary problems show up.

If your pet already has a history:

• Get records together first. Ask your vet for the full history so you know what an insurer will see.
• Match the rule to the condition. For a past infection, a 180-day curable rule may restore coverage sooner than a 12-month one.
• Ask about specific conditions in writing. Name the condition and ask whether, and when, it could be covered.
• Keep the policy you have. A pet diagnosed with a chronic illness usually keeps coverage only by staying with the same insurer.
• Remember the rest of the body. Pre-existing allergies do not stop coverage for a future broken leg.

For older pets, where histories are longest, see our guides to senior dogs and senior cats. An accident and illness policy still covers everything new.

Bottom line

Pet insurance excludes pre-existing conditions, including any symptom noted in your pet’s records before coverage started. Curable conditions can become eligible again after 180 days or 12 months free of symptoms and treatment, depending on the insurer. Incurable conditions, chronic illnesses and often both sides of a bilateral problem stay excluded. Enroll while your pet is healthy, and get any insurer’s answer on a past condition in writing.