Dental cover with strings: tartar before the start, required cleanings, $1,000 caps

Dental illness is covered, with strings. Trupanion and Figo pay only if the vet checks your pet’s teeth every year and you get any recommended cleaning, at your own cost. Nationwide, Figo and Trupanion exclude dental-illness treatment with no end date if there was any tartar before the policy started. Embrace pays no more than $1,000 a year for dental illness. None of these policies pays for a cleaning; only optional wellness add-ons do.

How it works

There are four kinds of limits. One insurer can have several at once.

1. Required care. Dental illness cover is conditional. A vet must examine the teeth once a year, and the owner must follow the vet’s advice, including getting a recommended cleaning. Miss the exam or the cleaning, and the insurer can refuse dental-illness claims. This is how Trupanion and Figo work. Pets Best’s Washington form has a different condition for periodontal disease: from age three, a cleaning under anesthesia at least every 13 months.
2. The cleaning itself is not insured. A cleaning (prophylaxis) means scaling and polishing the teeth. Trupanion, Figo, Embrace, Pets Best and Healthy Paws do not pay for it. Embrace does not pay even when the cleaning is the treatment for a dental illness. At Nationwide, only the optional wellness add-on pays for a cleaning, up to a limit.
3. Signs before the policy. If the pet had tartar, gingivitis or other signs of tooth or gum disease before the policy started or during the waiting period, some insurers exclude treatment of dental illness altogether: not just what was there, but any future dental illness. Nationwide goes further and excludes any treatment for oral health. At Nationwide, Figo and Trupanion this exclusion has no end date. At Embrace it is temporary. At Pets Best such signs rule out endodontic treatment and extractions.
4. A cap and a short list. Embrace pays no more than $1,000 per policy year for dental illness. For gum disease (periodontal disease) that starts after the waiting period, Pets Best pays only for endodontic treatment (such as root canals) on canine and carnassial teeth and for extractions. Trupanion limits costs for teeth other than canines and carnassials to the estimated cost of an extraction. Healthy Paws does not pay for extracting teeth because of dental disease.

At Nationwide, Figo and Trupanion this is not the usual pre-existing condition exclusion but a separate dental clause. So general rules on cured conditions may not help: Figo’s cured-condition rule (365 consecutive days without symptoms or treatment) lifts only the general pre-existing exclusion, not the dental clause. Embrace is different: its dental clause is written as a pre-existing condition rule.

The state laws we checked do not undo these clauses. Pennsylvania’s law says outright that it does not limit the types of exclusions. Washington’s law allows “other exclusions”. In Washington and other states with NAIC-model laws, an insurer may not require a vet exam to renew a policy. But here the exam and the cleaning are conditions for paying claims, not for renewal. Texas and Illinois have no pet insurance law at all.

Examples

Trupanion, Texas

Section 7, “Dental coverage”, opens with a list of things the owner must do:

“Your Pet’s teeth must be Examined by a Veterinarian at least once every 12 months.”

“You must follow Your Veterinarian’s advice about dental care and if recommended, Your Pet must undergo Dental Prophylaxis … within the recommended timeframe. If Your Veterinarian does not provide a recommended timeframe, then the specified treatment must be completed within 3 months of the date of the recommendation.”

The policy does not pay for the cleaning itself. The list of what is not covered (7.C) includes “Dental Prophylaxis at any time or for any reason.”

The same list (7.C.I) has its own clause on earlier signs. Treatment for dental illness is not covered if the pet “has any signs or evidence of periodontal disease, periodontitis, gingivitis, tartar, stomatitis, or resorptive lesions prior to the Policy Enrollment Date or during any applicable waiting periods.” No end date is written. Under 7.C.VI, costs for teeth other than canines and carnassials “will be limited to the estimated extraction cost.”

If the teeth were not examined in the 12 months before the policy started, dental cover starts only at the first exam after the start. Anything found there is excluded: “any Illnesses or Injuries found at such an Examination or signs prior to such an Examination will not be eligible for dental coverage” (7.A.II).

What the policy does not say: whether one missed exam ends dental cover for good or only during the lapse. The clause is written as a condition for payment, so a dental-illness claim can be refused.

Trupanion’s sample-policy page has no entry for Texas, so the site serves the general 2019 sample. The 2023 sample (served for Florida, Washington and other states) and the Pennsylvania form TRU (D) 00001.1 PA (V01.202309) have the same Section 7, with different time limits: “every 365 days” and “within 90 days”. Their 7.C.I looks only at signs before the policy Effective Date, without the waiting period.

Texas has no pet insurance law. State rules (28 TAC) treat pet insurance as non-regulated inland marine, so policy forms are not filed for approval. More on the Texas page.

Source: Trupanion, sample policy “Medical Insurance for the Life of Your Pet”, TRU (D) 00001 (V10.201902), section 7.A, p. 11; 7.C, p. 12.

Figo, Texas, Pennsylvania and Illinois

The care condition. In Figo’s Texas policy, dental illness cover depends on following the vet’s advice:

“To receive Dental Illness Coverage, You must follow Your Veterinarian’s advice regarding dental care, including but not limited to, an annual dental exam and any related Treatment recommendations.”

The condition is wider than exams and cleanings: “any related Treatment recommendations”. It is repeated in the conditions (Part II): “An annual dental exam and, if recommended, prophylaxis (defined as ultrasonic scaling and polishing of the teeth)”. And the exclusions (Part IV) leave out the cleaning itself: “preventive dental care, including prophylaxis, at any time or for any reason”.

Signs before the policy. Exclusion 19.a in the Pennsylvania policy:

“If Your Pet has any signs or evidence of periodontal disease, periodontitis, gingivitis, resorptive lesion(s), tartar or stomatitis prior to the Original Start Date or during any applicable Waiting Periods”

If so, all treatment for dental illness is excluded. By the definition in Figo’s Illinois policy, “Dental Illness is an Illness affecting the teeth and/or gums.” The exclusion has no end date. The clause does not require a vet record: “any signs or evidence” is enough. Figo’s cured-condition rule (365 days) lifts only the general pre-existing exclusion, not this clause. Accidental injuries to the teeth are not caught by 19.a, which speaks only of illness.

Next to it, 19.b and 19.c exclude “preventive dental care, including prophylaxis, at any time or for any reason” and “Open or closed deep cleaning at any time or for any reason”.

The same 19.a–c wording is in Figo’s policies for Arizona, Indiana, Washington, Texas and Illinois. The annual-exam condition is also in the Illinois and Arizona policies.

Pennsylvania’s law (40 Pa.C.S. ch. 47) does not limit the clause: §4703(c)(1) says the law does not prohibit or limit the types of exclusions. The insurer must prove that a pre-existing condition exclusion applies (§4706(a)(2)). But 19.a is written as a separate exclusion, and in our reading that burden may not reach it. More on the Pennsylvania page.

Sources: Figo, policy IAIC_FPI_POL_AI_TX_1025, Texas, Part II Conditions and Part III Coverage, p. 4; Part IV Exclusions, p. 5; Figo, policy IAIC FPI POL PA 0424, Pennsylvania, Part IV, exclusion 19, p. 9; Figo, policy IAIC FPI POL IL 1025, Illinois, Part I Definitions, Part IV Exclusions.

Embrace, Texas, Pennsylvania and most states

The $1,000 cap. Embrace’s V6 terms (which its site serves for Texas, Pennsylvania, Arizona, California, Florida, Illinois, New Jersey and Washington):

“We will reimburse you for eligible Veterinary Treatment expenses caused by Dental Illness, in excess of the Deductible amount, subject to Reimbursement Percentage requirements and a $1,000 Annual Maximum sub-limit, for all Treatment(s).”

The sub-limit sits inside the policy’s overall annual maximum. It applies to dental illness only. Accidental dental injuries fall under the general annual maximum, and endodontic treatment for injuries is covered for adult canines, upper 4th premolars and 1st molars. Embrace’s disclosure of important provisions says the same: “There is a $1,000 Annual Maximum sub-limit for all Treatment(s) for Dental Illness.”

Never the cleaning. From the exclusions:

“Dental prophylaxis procedures are not covered by this policy, even when done as a Treatment for a Dental Illness.”

Signs before the policy: a temporary exclusion. Here Embrace is gentler than Nationwide, Figo and Trupanion:

“If any dental Clinical Signs are Pre-existing Conditions, including but not limited to gingivitis, dental tartar, periodontal disease or plaque, then periodontal disease and Dental Illnesses will not be covered until after the Clinical Signs have received the recommended Treatment and the exclusion has expired.”

So the owner first pays for treating those signs. V6 does not say how long the exclusion lasts after treatment. The 12-month rule for temporary conditions in the same part is the likely candidate; that is our inference. The clause applies only if the signs meet Embrace’s definition of a pre-existing condition.

Embrace pays for cleanings only through Wellness Rewards. That is a separate program, not insurance; its list includes “Preventative Dental Cleaning”.

For Kansas, New Mexico and South Carolina the site serves the V5 terms. They also have the $1,000 dental illness sub-limit and exclude cleanings.

In Pennsylvania the clause on earlier signs is written as a pre-existing condition rule, so the insurer must prove it applies (40 Pa.C.S. §4706(a)(2)). More on the Embrace page.

Sources: Embrace, Pet Health Insurance V6 terms, Part III Coverage and Part IV Exclusions (no page numbers); Embrace, Insurer Disclosure of Important Policy Provisions, INDPP (01/23), p. 1.

Pets Best, Texas, Illinois and other states (IAIC form)

Section 6.A.1 in the IAIC-PB10001-ILL samples for Texas and Illinois (insurer: Independence American, IAIC):

“Your Pet must be free of any signs or symptoms of Periodontal Disease prior to the Policy Effective Date or during any Waiting Period. If your Pet is diagnosed with Periodontal Disease after the Policy Effective Date and any Waiting Period, we will only cover costs related to endodontic Treatment for canine and carnassial teeth and extractions.”

What follows from this:

• Endodontic treatment (such as root canals) on other teeth is never covered (6.B.2). Extractions are covered on any tooth.
• If there were “any signs of Periodontal or dental disease” before the policy started or during the waiting period, neither endodontic treatment nor extractions are covered: “Endodontic Treatments and extractions are not covered” (6.B.1). Section 6.A.2 covers treatment of teeth broken in an accident, but 6.B.1, as written, makes no exception for injuries.
• Cleanings are always excluded: “Prophylaxis (defined as scaling, cleaning, and polishing of the teeth) or associated fees … administered at any time or for any reason” (6.B.3). Open or closed root planing is excluded too.

The same 6.A.1 wording is in Pets Best’s samples for Arizona, New Jersey, Pennsylvania and Florida and in the IAIC sample for Washington. Texas and Illinois have no pet insurance law. More on the Pets Best page.

Sources: Pets Best, Accident and Illness sample policy, IAIC-PB10001-ILL, Texas, section 6.A, p. 8; 6.B, p. 9; Pets Best, the same sample for Illinois, section 6.A, p. 8; 6.B, p. 9.

Pets Best, Washington (APIC form), New York and California

For Washington, Pets Best’s policy page links a sample from a different insurer, American Pet Insurance Company (APIC), and its condition is stricter. Section 8.A.1:

“Beginning at three years of age, your Pet’s teeth must have been cleaned and examined under general anesthesia by a Veterinarian in the thirteen months before the date of service for the Periodontal Disease claim.”

Section 8.A.2: any periodontal disease found at that exam must be treated before periodontal cover starts: “Any Periodontal Disease found during the examination described in subsection (1) must be treated before Periodontal Disease coverage becomes available for your Pet.”

The policy pays neither for the cleaning nor for what goes with it (8.E.2):

“Prophylaxis (defined as scaling, cleaning, and polishing of the teeth) or associated fees (including, but not limited to: anesthesia, pre-anesthetic blood work, and fluids)…”

In practice, the owner of a pet aged three or older pays for a cleaning under anesthesia at least every 13 months to keep periodontal cover. Strictly, the insurer counts 13 months back from each date of treatment.

Section 8.E.1: any sign of dental disease before the policy started or during the waiting period rules out endodontic treatment and extractions: “Endodontic treatments and extractions will not be covered if your Pet has any signs of dental disease prior to the Policy Effective Date or during any Waiting Period.”

The Washington amendatory endorsement (APIC-PBI0004-AE-ILL-WA) does not change section 8. Washington law bars requiring a vet exam as a condition of renewal (RCW 48.205.050(3)). But here the cleaning is a condition for paying claims, not for renewal, so there is no clear conflict. The law allows “other exclusions” (RCW 48.205.040(1)(b)). The law’s definition of a pre-existing condition is narrow: signs “directly related to the condition for which a claim is being made” (RCW 48.205.020(6)). Section 8.E.1 is not tied to that definition: it is written as a stand-alone exclusion, and we found nothing in the law that overrides it. More on the Washington page.

The same 13-month rule is in the current APIC sample for New York and the current California IAIC sample (IAIC-PBI0001-ILL 02/2023). The newer IAIC-PB10001-ILL form (Arizona, Texas, Pennsylvania, Illinois, New Jersey, Florida) does not have the 13-month rule. It keeps the cleaning exclusion and the exclusion for earlier signs of dental disease (see above).

Source: Pets Best, Accident & Illness sample policy, Washington, APIC-PBI0001-ILL (12/2015), section 8.A, p. 16; 8.E, p. 17 (booklet page numbers).

Nationwide, Pennsylvania

Section 13.M excludes:

“Veterinary expenses arising out of or related to any treatment for oral health, including but not limited to dental disease, malocclusions and deciduous teeth, where clinical sign(s) (including, but not limited to, tartar, gingivitis, pulp exposure, periodontal disease, or halitosis) were present prior to the effective date of the policy or during the waiting period”

The exclusion has no end date. It is wider than Figo’s: “any treatment for oral health”. In our reading it can catch dental injuries too. The waiting period is 14 days.

Nationwide pays for a cleaning only under the optional Wellness Level 2 coverage: up to $250 per policy term, and that limit is shared with spay/neuter. Nothing is paid in the first 90 days (§15.B). A cleaning linked to an illness or a pre-existing condition is not paid either: “Routine dental prophylaxis/teeth cleaning is covered if it is not associated with a medical condition or a pre-existing condition” (§9).

The same 13.M wording is in Nationwide’s forms for Arizona (VS-G-15 9-24 NCC), California (VS-G-15-CA 11-20), Texas and Florida. Pennsylvania law does not limit the clause (§4703(c)(1), see the Figo example). More on the Nationwide page.

Source: Nationwide, Modular Pet Insurance Coverage Form VS-G-15-PA (9-24), Pennsylvania sample, §13.M, p. 8; §9, pp. 5–6; §15, p. 10.

Healthy Paws, Illinois

Healthy Paws has no separate dental clause on earlier signs; its general pre-existing condition rules apply. But for every pet, whatever its history, it excludes extracting teeth because of disease. From the preventive care exclusions (II.3.d):

“Dental health care, however if injury to teeth is caused by an accident, we do cover the cost of extraction and/or reconstruction of damaged teeth.”

And the definition of “Dental Health Care” (V.10) includes extractions: “This includes cleaning, brushing, scaling, polishing, extractions and reconstructions.”

Healthy Paws’ website says other dental-illness treatment, such as root canals or stomatitis, can be covered. But the same page lists among its exclusions: “Routine care. Includes brushing, cleanings, and extractions and reconstructions due to dental disease.” Extraction is a common treatment for dental disease, and Healthy Paws does not pay for it unless there was an accident.

The Illinois amendatory endorsement LD-50818 (09/19) does not change these items. The same exclusion and definition are in the Westchester forms for California, Delaware, Hawaii, Louisiana, Massachusetts, Maryland, Maine, Mississippi, Montana, Nebraska, New York, Pennsylvania and Washington, and in the ACE sample for Florida. Illinois has no pet insurance law. More on the Healthy Paws page.

Sources: Westchester Fire Insurance Co., Pet Health Insurance Policy LD-50812 (07/18), Healthy Paws sample, II.3.d, p. 2; V.10, p. 5 (linked from the Illinois documents page); Healthy Paws, dental health page.

What it looks like for an owner

1. Your dog is insured with Pets Best in Washington and is over three. Its last cleaning under anesthesia was 15 months ago.
2. The vet finds periodontal disease and treats it.
3. There was no cleaning in the 13 months before the treatment. Under section 8.A.1 the periodontal claim is not covered.
4. To avoid this, the dog needed a cleaning under anesthesia every 13 months. The policy pays for none of it: not the cleaning, not the anesthesia, not the bloodwork before it.

Embrace carries a different risk: in a policy year it pays no more than $1,000 in total for dental illness. Everything above that is yours. If the treatment included a cleaning, that part is not paid at all.

At Nationwide, Figo and Trupanion one note of “tartar” before the policy started is enough. Treatment of dental illness is then excluded with no end date, and at Nationwide, any treatment for oral health.

There are no dollar amounts in this example. The documents we read give no prices for cleanings or dental treatment, and we will not make them up.

What to do

• Before buying, read the whole dental section. Search for “Dental Illness”, “prophylaxis”, “periodontal”, “tartar”, “sub-limit” and “Things you must do”. Look at the exclusions, the conditions and the coverage section: Figo spreads its dental rules over all three.
• Budget for cleanings. Trupanion, Figo, Embrace, Pets Best and Healthy Paws do not pay for them. Of what we read, only add-ons pay for one: Nationwide’s Wellness Level 2, up to $250 a policy term shared with spay/neuter and not in the first 90 days; and Embrace’s Wellness Rewards, which is not insurance.
• If you have Trupanion or Figo, have the vet check the teeth at least every 12 months. Ask for the recommendation and its timeframe to be written in the medical record. Get the cleaning within that time; at Trupanion, with no timeframe recorded, within 3 months (90 days in the 2023 form). Keep the invoices.
• For Trupanion, check the date of the last dental exam. If it was more than 12 months ago, dental cover starts only at the first exam after the policy starts, and anything found there is excluded.
• If you have Pets Best in Washington, New York or California, look for the 13-month cleaning rule in the dental section of your policy. If it is there, get a cleaning under anesthesia at least every 13 months from age three, or periodontal disease will not be covered.
• If the record already shows tartar or gingivitis, compare what happens. Nationwide, Figo and Trupanion exclude dental-illness treatment with no end date. Pets Best covers neither endodontic treatment (root canals) nor extractions. At Embrace the exclusion is temporary: after the recommended treatment, at your cost, it can expire. Healthy Paws has no separate dental clause on earlier signs, but excludes extractions due to disease for every pet. More in pre-existing conditions.
• Compare how much the policy pays for teeth in a year. At Embrace, no more than $1,000 for dental illness. What different policies include is in what is in a policy.
• If a claim is denied, ask the insurer to name the policy provision in writing. In Pennsylvania the insurer must prove a pre-existing condition exclusion applies; that includes Embrace’s dental clause.

Why you cannot move to another insurer once the teeth are a problem is covered in the pet insurance trap. Insurer pages: Trupanion, Figo, Embrace, Pets Best, Nationwide, Healthy Paws.

Sources

• Trupanion, sample policy “Medical Insurance for the Life of Your Pet”, TRU (D) 00001 (V10.201902), American Pet Insurance Company: PDF. Section 7: A and B, p. 11; C, p. 12. Checked against sample TRU (D) 00001.1 (V01.202309) and the Pennsylvania form TRU (D) 00001.1 PA (V01.202309).
• Figo, policy IAIC_FPI_POL_AI_TX_1025, Texas, Independence American Insurance Company: DOCX. Part II Conditions and Part III Coverage, p. 4; Part IV Exclusions, p. 5.
• Figo, policy IAIC FPI POL PA 0424, Pennsylvania: PDF. Part IV, exclusion 19, p. 9; Part III.1.l, p. 7.
• Figo, policy IAIC FPI POL IL 1025, Illinois: DOCX. Part I Definitions, Coverage, Part IV Exclusions. The same wording is in the forms for Arizona (IAIC_FPI_POL_AZ_1025), Indiana and Washington.
• Embrace, Pet Health Insurance V6 terms, American Modern: web page. Part III Coverage, Part IV Exclusions. State selector: embrace-terms. Wellness Rewards: program page.
• Embrace, Insurer Disclosure of Important Policy Provisions, INDPP (01/23): PDF, p. 1.
• Pets Best, Accident and Illness sample policy, IAIC-PB10001-ILL, Texas, with notice IAIC-NOTICE-TX-2023: PDF. Section 6.A, p. 8; 6.B, p. 9.
• Pets Best, sample IAIC-PB10001-ILL, Illinois: PDF. Section 6.A, p. 8; 6.B, p. 9.
• Pets Best, Accident & Illness sample, Washington, APIC-PBI0001-ILL (12/2015), with disclosure APIC-PBI0012-WA (11/2023) and endorsement APIC-PBI0004-AE-ILL-WA (06/2025): PDF. Section 8.A, p. 16; 8.E, p. 17 (booklet page numbers).
• Nationwide (National Casualty Co.), Modular Pet Insurance Coverage Form VS-G-15-PA (9-24): PDF. §9, pp. 5–6; §13.M, p. 8; §15, p. 10.
• Healthy Paws: Westchester Fire Insurance Co., Pet Health Insurance Policy LD-50812 (07/18): PDF, II.3.d, p. 2; V.10, p. 5; Illinois documents page with endorsement LD-50818 (09/19); dental health page.
• Pennsylvania: 40 Pa.C.S. ch. 47 (Act 2024-19), §§4703(c)(1), 4706(a)(2).
• Washington: RCW 48.205, §§48.205.020(6), 48.205.040(1)(b), 48.205.050(3).
• Texas: 28 TAC (pet insurance as non-regulated inland marine). Illinois: no pet insurance law (HB 3595 was enacted without its pet article, P.A. 104-0480).