What is in a pet insurance policy

When you buy a policy, you choose the plan type, the limit, the deductible and the reimbursement rate. The policy also sets what is covered, the waiting periods, how claims are paid, the fees and the age limits. This guide takes them in order. The factors for IAIC, the insurer behind Pumpkin, Spot and ASPCA, come from rate manual FL_20260724. It was approved in filing 26-024273 and has been in force in Florida since 1 October 2026.

Plan type

Accident only. Swallowed objects, wounds, fractures, poisoning. It costs $15–25 a month. For a purebred dog it is nearly useless: the expensive problems are illnesses, not injuries.
Accident and illness. Injuries and illnesses. This is pet insurance in the usual sense.
Wellness. Vaccines, dental cleaning, routine tests. Under Florida law this is not insurance but a separate program, and the insurer cannot require you to buy it with a policy. You pay $20–40 a month and get back a known $300–500 a year. It is an installment plan, not insurance.

Annual limit

The annual limit is the most the insurer will pay in a policy year: $5,000, $10,000, $20,000 or unlimited. Lifetime limits and per-condition limits exist but are less common.

An unlimited policy costs tens of percent more than one with a $10,000 limit, but only an unlimited policy protects you from a catastrophe. The large cases are the ones that go past $10,000: a week in intensive care, cancer with surgery and chemotherapy, two serious episodes in one year. At IAIC the factor for an unlimited policy is 1.804 and for a $5,000 limit 0.883, so an unlimited policy costs about twice as much. If you want catastrophe protection, save on the deductible and the reimbursement rate, not on the limit.

Deductible

The deductible is the amount you pay yourself before the insurer starts to reimburse. There are two kinds:

Annual. It resets every policy year, usually at $100–1,000. Pumpkin, Spot, Pets Best, Lemonade, Embrace and Healthy Paws work this way. With a $1,000 deductible you will probably pay for two or three minor visits a year yourself. But the insurer will cover a large bill almost in full.
Lifetime per condition. Only Trupanion works this way. You pay the deductible once for each diagnosis, for the life of the pet. With one chronic illness this pays off: you pay once, and the insurer reimburses 90% for the rest of the pet’s life. In a bad year with three different diagnoses it does not: you pay three deductibles instead of one.

The deductible moves the price more than anything else. At IAIC the factor for a $1,000 deductible is 0.564 and for $250 it is 1.090: a $1,000 deductible makes the policy almost half as expensive. For catastrophe protection this is the right choice: paying $1,000 yourself on a $15,000 bill will not change whether you treat.

Reimbursement and exam fees

After the deductible, the insurer pays 70, 80 or 90% of the bill; Trupanion offers up to 100%. At IAIC the factor for 80% is 0.769 and for 90% it is 1.0: giving up 10 points of reimbursement saves 23% of the price. On a $20,000 bill you pay $2,000 more yourself; on small bills, little.

Many policies do not cover exam fees, the charge for the visit itself: $70–150 at a regular clinic, $150–250 at a specialist or an emergency room. Trupanion never covers them. At Pets Best they are an option in the Elite plan, at Lemonade a paid Vet Visit Fees add-on, and at Pumpkin and Spot they are included. For a chronic patient with a dozen visits a year, exam fees come to $1,000–2,000.

What is covered

A standard policy today covers:

all new illnesses and injuries;
diagnostics: lab tests, X-rays, ultrasound, MRI, CT;
surgery, hospital stays, medications;
hereditary and congenital conditions: dysplasia, intervertebral disc disease (IVDD) in Dachshunds and French Bulldogs, heart disease in Cavalier King Charles Spaniels;
cancer;
chronic illnesses, for life, as long as the policy has no gaps.

Where policies differ:

Item	How it varies
Dental illness (periodontal disease, extractions)	In Trupanion’s base policy with no limit, if regular dental care is kept up; Embrace caps it at $1,000 a year; at Lemonade only as a paid $1,000-a-year add-on; in the base policy at Pumpkin and Spot. Dental cleaning is covered nowhere
Prescription food	Trupanion 50% for up to 60 days; Pumpkin with limits; Lemonade and Pets Best no
Rehabilitation, physical therapy, acupuncture	Paid options at Trupanion and Lemonade; included in Pets Best Elite; in the base policy at Pumpkin and Spot
Behavior (anxiety, medication)	Usually an option or a sublimit; at Trupanion within the Recovery and Complementary Care option
Euthanasia, cremation	Euthanasia for a covered illness usually yes; cremation and memorials rarely, an option up to $500 at Lemonade
Breeding, pregnancy, whelping	Excluded everywhere
Preventive care, vaccines, spay and neuter	Excluded; wellness only
“Preventable” conditions	Trupanion excludes illnesses it considers the result of missed preventive care, such as a tooth abscess in a cat whose teeth were never cleaned
Bilateral conditions (both sides of the body)	If a ligament in one leg tore before the policy, many policies also exclude the other leg

Waiting periods

A waiting period is the time after purchase when the coverage does not yet work. Since 2025 Florida law limits it. There can be no waiting period for injuries. For illness and for orthopedic conditions not caused by an injury (dysplasia, cruciate ligament) it can be at most 30 days. The policy must also let you waive the wait with a vet exam. In other states you can find 6 months for orthopedic conditions and 12 months for cruciate ligaments or dysplasia.

Waiting periods in Florida:

Pumpkin and Spot: 14 days for illness, orthopedic conditions included;
Pets Best and Lemonade: 14 days for illness and 30 for ligaments;
Healthy Paws: 15 days for illness and 30 for dysplasia;
Fetch: 15 and 30 days;
Trupanion: formally no waiting period, but coverage starts some time after enrollment, not on the same day.

Keep in mind: the insurer will treat anything that shows up during the waiting period as a pre-existing condition, one the pet had before the policy. More on the laws in the guide to state laws.

How claims are paid

Usually the insurer reimburses you: you pay the clinic, send the bill to the insurer and get the money in 2–14 days. Trupanion can pay the clinic directly at checkout (VetDirect Pay), but only at participating clinics, and many do not participate. Pets Best can pay the clinic on request after it approves a claim. Pumpkin reimburses faster than usual. On a large bill the difference is real: either you find $12,000 on a credit card or you pay nothing. If you have no room on a credit card, direct payment to the clinic is a real help. If you do, it is only a convenience.

Fees and discounts

Paying monthly costs $2–3 per payment, or $24–36 a year: $2 at IAIC and Pets Best, $3 at Lemonade. Many insurers give a discount if you pay for the year up front.
Enrollment fee: $15 at Pumpkin.
Multi-pet discount: 5–10%. Pumpkin gives 10% per dog, Pets Best 5% on all pets, Lemonade 10% per policy; Trupanion gives none.
Partner discounts (through an employer, Costco, Progressive): 5–10%. At Lemonade discounts stack up to 20% in total, at Pets Best up to 12%.
“Healthy pet” discount at Pumpkin and Spot in Florida: 10% at renewal if there were no claim payments in the year. Only owners who did not use the insurance get it: after the first claim payment it is gone.
Military and veterinary staff: 5%.

Age at enrollment

Some companies do not take older pets: Trupanion and Healthy Paws enroll pets under 14, and Healthy Paws also narrows the reimbursement options with age. The minimum age is usually 6–8 weeks. Breeders and puppy buyers should know about the go-home-day offer: Trupanion, AKC Pet Insurance and others cover a puppy for free if you activate the policy on the day it moves to its new owner. The puppy’s medical history then starts with a clean slate.

How these choices add up to a price is in how pet insurance is priced. What to ask before buying is in how to choose.

Sources

Florida Statutes §627.71545, Pet Insurance Act (ch. 2025-11).
Florida OIR, IRFS: IAIC 26-024273, approved manual FL_20260724 (limit, deductible and reimbursement factors).
Florida policy forms and disclosures: Pumpkin PET-P-20000-FL, Trupanion TRU (D) 00012 FL, Healthy Paws PI-59918, Fetch GPTM 050 FL 1125 A, Lemonade and Pets Best sample policies.
Trupanion: FAQ pages and policy terms.