One sign excludes a whole category: lumps, kidneys, skin, allergies

One sign before the waiting period ends, and the insurer excludes not one disease but a whole group: every lump including cancer, all kidney care, all skin conditions and ear infections for at least 12 months, all food and environmental allergies. We found clauses like this in Embrace and Figo policies.

How it works

The usual pre-existing condition rule excludes a specific disease: the one whose signs showed before the policy or during the waiting period. Most state laws that define the term require the signs to be “directly related” to the condition the claim is for; California’s law is broader (“consistent with” it). The details are in the guide to pre-existing conditions.

The clauses on this page work differently. A sign of one disease shuts off the whole group:

• a lump with no diagnosis → every mass, cancer included;
• signs of kidney disease → all kidney care and the conditions “related” to it;
• a sign of a skin condition → all skin conditions and ear infections until 12 months pass without any;
• a sign of an allergy → all food and environmental allergies, for good.

Three details make these clauses more dangerous than they look.

1. The window is the pet’s whole life before the policy plus the waiting period. At Embrace and Figo the illness waiting period is 14 days from the start date. At Embrace it can end later: if there was no vet exam in the 12 months before the start or in the first 14 days after, or if the records are missing, the end moves to the date of a later exam. For intervertebral disc disease the window runs from before the policy through the first 180 days. The mass clause has no lookback limit.
2. Anyone can notice the sign. Embrace and Figo define Clinical Signs as changes observed by “you, a Veterinarian, or other observer”. No diagnosis is needed.
3. The record is read at the first illness claim. Embrace tries to collect records from the clinics you name but reads them only when you file your first illness claim or ask for a review yourself (a Medical History Review). You may learn about the exclusion when the bill has already arrived.

Examples

Embrace: one undiagnosed lump excludes every mass, cancer included

If before the end of the 14-day illness waiting period the pet had a mass whose cause had not been identified (“Undiagnosed”), Embrace does not cover any mass. Nor any condition that shows up as a mass, cancer included. That applies to a different lump found years later. The clause sets no end date.

“If a Pet has had Undiagnosed masses prior to the end of the Illness Waiting Period, any mass, or condition where a mass is a Clinical Sign, is not covered, including those caused by cancer.”

The cytology way out is narrow. If the diagnosis of that mass “can be diagnostically confirmed via cytology, un-related conditions may be covered.” “May” is not a promise: the insurer decides. Masses related to the first one stay excluded. The text sets no deadline for the cytology, so a test after the policy starts is not clearly ruled out.

One more unclear opening. Temporary Conditions (those “likely to resolve”) stop counting as pre-existing after 12 consecutive months without signs or treatment. The policy does not say whether a lump that went away qualifies.

Source: Embrace Pet Health Insurance V6, sample policy (form PET00), Part IV Exclusions, item 2 “Pre-existing Conditions”. The same text is in Pet Health Insurance Policy PET00 (02/24), page 7 of 14, item 2.c, in California filing SERFF AMMH-134910014 (CDI 26-812), submitted 7 May 2026 and still pending.

Embrace: signs of kidney disease exclude all kidney care and “related” conditions

If before the end of the waiting period the pet was diagnosed with kidney disease, treated for it or showed signs of it, Embrace does not cover any kidney treatment or medication. Nor “related conditions that may develop”.

The policy lists them: “This includes but is not limited to vomiting, diarrhea, dehydration, constipation, blood pressure or pH issues, and cardiac complications.”

What is excluded is not every case of vomiting but vomiting linked to the kidney disease. But “not limited to” means the list is open. The clause sets no end date. Chronic kidney disease does not “resolve”, so the 12-month rule for temporary conditions is unlikely to help (our reading).

Source: Embrace V6, Part IV Exclusions, item 2; in form PET00 (02/24), item 2.d, page 7.

Embrace: one sign of a skin condition, and no cover for skin conditions or ear infections until 12 clear months

“If your Pet showed Clinical Signs of any Dermatological Condition prior to the end of the Illness Waiting Period, your Pet must be free of any Dermatological Conditions for twelve (12) consecutive months before any Dermatological Conditions may be covered again.”

The policy reads “skin condition” broadly: it is “deemed to include ear infections and skin lumps from skin irritation or infection, such as interdigital cysts from pododermatitis, but not conjunctivitis or parasitic infestations.”

What this means:

• One ear infection, rash or hot spot before the end of the waiting period, and no skin condition or ear infection is covered, even one unrelated to the first, until 12 clear months have passed.
• Any new skin condition or ear infection during those 12 months is not covered and restarts the count.
• A flea or mite infestation does not count: the definition leaves out parasitic infestations.
• The exclusion is not permanent. The 12 months count from the last skin problem, not from the start of the policy. If 12 clear months passed between the skin episode and the end of the waiting period, the episode does not count. It is mainly what happened in the last 12 months that bites. A chronic skin disease gets no such relief: it stays excluded as pre-existing.

Source: Embrace V6, Part IV Exclusions, the “Temporary Conditions” paragraph after item 2; the Dermatological Condition definition is in Part I.

Embrace: vomiting or diarrhea without a diagnosis, and 12 months with no cover for conditions with the same signs

Here the trigger is vet treatment where no cause was found. “If your Pet has been treated for Undiagnosed vomiting and/or diarrhea prior to the end of your Pet’s Illness Waiting Period, your Pet must be free of conditions with the same Clinical Signs for twelve (12) consecutive months before any conditions with the same Clinical Signs may be covered again.”

Source: Embrace V6, Part IV Exclusions, the “Temporary Conditions” paragraph.

Embrace: tartar blocks cover for dental illness until it is treated and the exclusion “expires”

If before the end of the waiting period there were signs such as “gingivitis, dental tartar, periodontal disease or plaque”, Embrace does not cover periodontal disease or any dental illness “until after the Clinical Signs have received the recommended Treatment and the exclusion has expired.” The policy does not say when the exclusion expires.

The recommended treatment is usually a cleaning. The policy does not pay for it: “Dental prophylaxis procedures are not covered by this policy, even when done as a Treatment for a Dental Illness.” Payouts for dental illness (not dental injury) are capped at $1,000 a year.

Source: Embrace V6, Part IV Exclusions (the dental Clinical Signs and Dental prophylaxis paragraphs); the cap is in Part III.

Embrace: one episode of disc disease excludes every disc, for good

If the pet was diagnosed with, treated for or showed signs of intervertebral disc disease (IVDD) before the policy or in the first 180 days, the policy expressly excludes “any future incidences of this condition in any area.” The mass and kidney clauses state no end date. The disc clause says outright “any future incidences”.

Source: Embrace V6, Part IV Exclusions, item 2; in form PET00 (02/24), item 2.b, page 7.

Figo: one allergy sign excludes all food and environmental allergies, for good

Figo’s Pennsylvania policy (insurer: Independence American Insurance Company), exclusion 5. It is triggered if, before the policy starts or before the end of the waiting period (14 days for illness), any one of three things happened:

• a vet gave advice about any environmental or food allergy;
• the pet was treated for one;
• the pet had “Clinical Signs or symptoms directly related to any Environmental Allergy or Food Allergy”.

Then Figo does not cover “any Environmental Allergy and any Food Allergy”. A sign of a food allergy also excludes a pollen allergy, and the reverse.

The general pre-existing clause has a way out: a condition Figo deems curable is covered again after 365 consecutive days without symptoms or treatment. The allergy clause has none. It lasts for the life of the policy.

What counts as an allergy. The clause names two defined kinds: environmental allergy (things inhaled or touching the skin: pollens, molds, dust mites) and food allergy. Reactions to drugs or insect stings are not clearly within these definitions.

An itch or rash has to be directly related to an allergy. Itching from fleas or an infection does not trigger the clause on its face. But Figo’s newer 1025 edition forms (Texas, Illinois, Indiana) are broader: signs “consistent with” an allergy. An unexplained itch or rash fits that much more easily. In Washington (form IAIC FPI POL WA 0724 AI2) the text is the same as in Pennsylvania, “directly related”.

Source: Figo Pet Insurance Policy, form IAIC FPI POL PA 0424, Part IV Exclusions, exclusion 5, page 8; definitions 9, 18 and 19 on page 3.

Where the Embrace clauses apply and what the law says

Embrace policies are underwritten by companies of American Modern Insurance Group. On Embrace’s terms page the state selector sends 47 states and DC to the V6 policy. Kansas, New Mexico and South Carolina get V5. V5 has the same mass, kidney, skin and vomiting/diarrhea clauses (on cytology it says “narrowed down”), has no tartar clause, and its disc clause lacks the words “in any area”. V6 is a sample policy for new customers, with no edition date on the page.

• Texas. No pet insurance law. The 28 TAC rules treat pet insurance as non-regulated inland marine: forms are not filed or approved. The policy wording governs.
• Illinois. No law. Bill HB 3595 passed the House, but the Senate replaced its text, and it became P.A. 104-0480 with no pet provisions.
• New Jersey. The law (P.L. 2025, c. 224, N.J.S.A. 17:46D-3–11) takes effect on 1 January 2027. It allows waiting periods for illness and orthopedic conditions of up to 30 days (17:46D-8b) and does not limit the types of exclusions (17:46D-6b). The 180-day window for discs may conflict with that cap (our reading; the same question arises in Pennsylvania). The insurer has to prove that the pre-existing condition exclusion applies (17:46D-8a). Under the law’s definition, signs count only if they are “directly related” to the condition claimed for. A new cancer years after a different lump is hard to call directly related. But as an ordinary exclusion the clause would probably survive (our inference).
• Pennsylvania. The law, 40 Pa.C.S. ch. 47 (Act 2024-19), also requires “directly related” (§4702) and puts the burden of proof on the insurer (§4706(a)(2)). But §4703(c)(1) does not limit the types of exclusions, so these clauses are probably lawful as exclusions. The law caps illness and orthopedic waiting periods at 30 days (§4706(b)(2)(i)), and the 180-day window for discs works like a longer waiting period. That is a possible conflict on our reading; we found no ruling. The V6 page promises a 15-day free look, while Pennsylvania requires 30 (§4704(c)). So the Pennsylvania policy may carry a state amendment we have not seen: Embrace’s Pennsylvania page returned a 403 error, and we could not open Pennsylvania filings through SERFF public access.
• California, Florida, Washington and other states with a law. Florida’s and Washington’s laws use the same “directly related” wording. California’s is broader: signs “consistent with” the stated condition (Cal. Ins. Code §12880(f)). In all these states the insurer has to prove that the pre-existing condition exclusion applies (in California since 2025), which makes the broad clauses harder to defend. But every law says it does not limit the types of exclusions, so no law we found voids these clauses. The policy’s “Conformity to State Statutes” clause changes its terms only where they conflict with a statute.
• Arizona. No pet insurance law, as in Texas and Illinois. The policy wording governs.

For Figo in Pennsylvania the picture is the same: the law does not limit the types of exclusions. The burden-of-proof rule is written for “the preexisting condition exclusion” and may not reach a separate allergy exclusion (our inference). Renewal protection (§4706(a)(3)) does not help either: the clause is triggered only before the policy starts and during the waiting period.

What it looks like for an owner

Say that at a routine checkup the vet feels a small lump under your dog’s skin. You decide to watch it; no needle sample is taken. The record keeps a note.

1. Six months later you buy Embrace. The lump still has no diagnosis.
2. Three years later a new tumor appears on the other side. It is malignant.
3. With the claim, Embrace reviews the record and finds the note about the first lump.
4. The clause: “any mass… is not covered, including those caused by cancer”. Treatment of the new tumor is not covered, even though it is unrelated to the first.
5. A chance remains if the first lump can be confirmed by cytology. Then conditions unrelated to it “may be covered”. The insurer decides.

With skin it goes like this. Three months before you buy the policy your dog has an ear infection, which clears up. Embrace covers no skin condition or ear infection until 12 months have passed since then, so for roughly the first nine months of the policy. If a rash appears eight months after you buy, its treatment is not covered, and the 12 months start over.

What to do

• Before you buy, read the whole Exclusions section. Look for “any”, “all”, “shall be considered Pre-existing Conditions”, “consecutive months”. The category exclusions sit in separate paragraphs after the general pre-existing clause.
• Pull your pet’s whole-life vet record and list: lumps with no diagnosis, abnormal kidney values, ear infections, itching, rashes, vomiting or diarrhea with no diagnosis, tartar, back pain, vet advice about allergies or diet. At Embrace or Figo each such entry can shut off a whole group of diseases.
• If there is an undiagnosed lump, get cytology (a needle sample) before you buy. Embrace’s clause is about masses whose cause has not been identified. On our reading of the text, a lump diagnosed before the waiting period ends does not fall under the broad clause. The diagnosed condition itself will still be excluded as pre-existing.
• See the vet on time. Embrace requires an exam in the 12 months before the policy starts or in the first 14 days after. Without one the policy becomes accident-only. If the record of a vet exam after the start date says outright that the pet has no pre-existing conditions, illnesses or clinical signs, new illnesses are covered even during the waiting period. That does not help a pet with a lump.
• Keep all records and give them to Embrace. Without them the end of the waiting period moves to the date of the first exam for the claimed condition, and the claim is not covered.
• After the 14 days, ask for a Medical History Review. That way you learn about exclusions before a big bill, not at your first claim.
• With Figo, check the edition of your policy: “directly related” (narrower) or “consistent with” (broader).
• Ask in writing before you buy: “Does the policy have exclusions where a sign of one condition excludes a whole group: masses, kidneys, skin and ears, digestive problems, teeth, spine, allergies? For how long?”
• If a claim is denied under such a clause in a state with a law, ask the insurer to show how the earlier sign is “directly related” to the claimed condition (in California, “consistent with” it): the burden of proof is on the insurer. In New Jersey this applies from 1 January 2027. If the answer does not satisfy you, complain to the state regulator.
• Other insurers. We checked these clauses at Embrace and Figo. We have not checked that other insurers lack them: read the Exclusions section yourself. Why it is hard to leave an insurer once such an entry is in the record is in the pet insurance trap. Insurer pages: Embrace, Figo.

Sources

• Embrace: Pet Health Insurance V6, sample policy (form PET00), Part I Definitions, Part II Conditions, Part III Coverage, Part IV Exclusions.
• Embrace: Pet Health Insurance V5 (Kansas, New Mexico, South Carolina).
• Embrace: Terms & Conditions, state selector (checked 17 October 2026).
• Embrace: Pet Health Insurance Policy PET00 (02/24), California Department of Insurance, SERFF AMMH-134910014 (CDI 26-812), submitted 7 May 2026, pending; Part IV, items 2.b–2.f (page 7) and the Temporary Conditions paragraph (page 8).
• Figo: IAIC FPI POL PA 0424 (Pennsylvania), exclusion 5, definitions 9, 18 and 19, Benefits 2.l.
• Figo: IAIC FPI POL WA 0724 AI2 (Washington).
• Figo, 1025 edition: Texas, Illinois, Indiana.
• Laws: 40 Pa.C.S. §§4701–4711 (Pennsylvania, Act 2024-19); N.J.S.A. 17:46D-3–11 (New Jersey, P.L. 2025, c. 224, in force from 1 January 2027); Cal. Ins. Code §12880(f), §12880.7(a); Fla. Stat. §627.71545 (Florida); RCW 48.205 (Washington); 28 TAC (Texas); Illinois P.A. 104-0480.