Pet insurance Frequently Asked Questions (FAQs)

Pet insurance works by helping to cover a portion of the cost of an eligible vet treatment for dogs and cats, by reimbursing that cost to you once you make a successful claim. Some brands offer accident-only cover for pets of all ages. However, with Choosi, you can apply for both specified accidental injury and illness cover for pets up to younger than 9 years old and up to younger than 16 years old for some policies. Depending on the policy you choose, you can claim up to 85% of eligible vet bills, up to $20,000 per year.¹

In addition to specified accidental injuries and illnesses, some policies also include a benefit for emergency boarding, essential euthanasia, pet overseas travel insurance, and paralysis ticks, at no extra cost. Some policies include cover for dental illness with a two-year waiting period. You’ll need to check the product details of the policy you wish to purchase to find out what’s covered under your preferred plan, by reading the relevant Policy Booklet.

A specified accidental injury means physical harm or an injury that results from an accident that’s a consequence of or results in:

• a motor vehicle incident;
• a burn or electrocution;
• an allergic reaction to insect and arachnid bites:
• a bone fracture;
• a snake bite toxicity;
• a traumatic ligament or tendon injury;
• a bite wound or fight wound abscesses; or
• lacerations or abrasion of tissue, skin or mucous membrane due to external violence.

Make sure you check the Policy Booklet for the full definition of what’s classed as a specified accidental injury, and to check what’s regarded as an ‘accident’.

Typically, an illness is a sickness or disease which isn’t included under specified accidental injury cover and is independent of any pre-existing condition.

Generally, the following won’t be covered by pet insurance:

• pre-existing conditions or conditions arising within the applicable waiting period;
• chronic or recurring conditions beyond pre-set annual benefit limit;
• widespread declared pandemic diseases;
• alternative therapies;
• voluntary euthanasia;
• prosthesis and organ transplants;
• treatment related to breeding and obstetrics;
• elective treatments;
• routine/preventative treatments (unless you add it to your cover for an extra fee)
• dental care; and
• a lack of protection for pet due to gross negligence.

The above exclusions aren’t the full list of what’s not covered, so it’s important to check the Policy Booklet of the product you want to purchase to ensure you know exactly what won’t be covered by your policy.

A condition is any specified accidental injury or any manifestation of an illness.

If a condition exists or occurs before the commencement date of the first policy period or within an applicable waiting period, it may be excluded from cover as a pre-existing condition depending on the insurer. Pre-existing conditions may be excluded from cover depending on the nature and experience of the condition. For example, if your pet has a temporary condition that hasn’t existed, occurred, or shown noticeable signs, symptoms, or an abnormality in the 18-month period immediately prior to your claim treatment date, it won’t be excluded from cover as a pre-existing condition. Chronic conditions and several other specified conditions can’t fall within this category. Refer to the Policy Booklet for more information.

Generally, a waiting period is a period of time which you must wait before you can make a claim on your policy. This period starts from 11:59 pm on the commencement date of your first policy period. There are different waiting periods that apply, depending on what you want to claim for.

• Specified accidental injuries: 0 days
• Illnesses: 30 days
• Cruciate ligament conditions: 6 months (may be waived on application)
• Dental illness: 2 years (only available on certain policies)

Conditions that exist or occur during the waiting period, or before your insurance policy commenced, will be considered a pre-existing condition and may be excluded from the coverage.

Choosi compares pet insurance plans with and without an applicable excess. For any plans with an excess, you’ll receive a reimbursement of up to 85% of your eligible vet bills less the applicable excess.¹

At some point, your pet may need to see a vet for treatment of either an injury from a specified accidental injury or an illness, and vet bills can be very expensive. Having pet insurance can help reduce the burden of these bills, so you can give your pet the treatment that they need.

Pet insurance will cover most breeds of cats and dogs.

If you don’t know how old your pet is, your vet may be able to give you an estimate.

Generally yes, as long as any symptoms and/or signs of these conditions weren’t present before your policy starts (first policy period date) or during any applicable waiting period.

Your policy will commence at one minute to midnight (11:59pm) on your first policy period date provided it’s accepted and approved by the insurer.

Yes, as long as your vet is registered to practice in Australia.

For pet insurance policies directly available from Choosi, yes.

You can check the Pet Portal for a summary of your coverage or refer to your Policy Booklet and Certificate of Insurance for all your coverage information.

Pre-approvals aren’t mandatory, but can provide you with additional reassurance, if you want to know if an upcoming or specific treatment for your pet will be covered, email us at claimreview@petsure.com.au with the following information:

• Policy number or policy holder and pet name
• Name of the condition being treated and the proposed procedure
• Name of your regular vet and the vet where the procedure will take place
• An itemised estimate of costs relating to the procedure (optional)

Once we receive this information, you can expect to hear back from us within two business days.

Note: A pre-approval will not be deemed to be valid unless we have agreed to it in writing. The reimbursed amount may vary from the pre-approval if the treatment provided by your vet differs from the treatment request in the pre-approval.

Yes. If your pet has had a temporary condition that was subject to the pre-existing condition exclusion, you can apply to have it reviewed by your insurer. Your vet will need to certify and provide records verifying that the condition remains a temporary condition and hasn’t existed, occurred, or shown noticeable signs, symptoms, or an abnormality for a period of 18 months. The pre-existing condition exclusion(s) won’t be lifted unless agreed to by your insurer in writing. Visit your pet insurance provider’s website for more information about pre-existing condition reviews and application forms.

If your pet has a chronic condition that existed or occurred before the commencement date of your first policy period or during any applicable waiting period, that condition will always be excluded from your policy. See your Policy Booklet for more information.

As a general guide, you can claim for specified accidental injuries immediately. For other claims, the following waiting periods usually apply:

• Illness: 30 days
• Cruciate ligament conditions: 6 months (may be waived on application)
• Dental illness: 2 years (if available on your policy)

You can apply to insure your pets from the age of 8 weeks up to younger than 9 years old for some policies, and up to younger than 16 years old for others.

New policies

Your premium is calculated using a combination of factors about you and your pet. These factors can affect the premium amount up or down depending upon whether we believe it increases or decreases the risk to us, such as the cover you’ve chosen, the benefit percentage applicable to the cover you’ve chosen, the species, breed, and age of your pet and other factors related to our cost of doing business.

Renewing policies

Factors that are taken into consideration for renewal premium calculation include your pet’s age and breed, as well as data relating to the health of pets that are of a similar age and breed. Each year, we review premiums based on these factors to ensure we can accommodate the costs of possible treatment up to your annual benefit limit, in the event that your pet becomes injured or ill. Your premium is calculated using a combination of factors about you and your pet. These factors can affect the premium amount up or down depending upon whether we believe it increases or decreases the risk to us, such as the cover you’ve chosen, the benefit percentage applicable to the cover you’ve chosen, the species, breed, and age of your pet and other factors related to our cost of doing business.

Yes, your premium will increase each year. This is for two main reasons:

Reason #1: Just like humans, the older our pets get, the more likely they are to have health hiccups. Cats and dogs age faster than we do, which means that their likely veterinary treatment costs go up rapidly each year too. As a result, the cost of insuring your pet will also increase as they get older.

Reason #2: Advancements in veterinary treatments

The overall cost of medical treatment for pets has increased in recent years due to the increased availability of medical treatments and technology-enabled services and ongoing demand for these services. The treatment options and advancements in technology are providing us with great opportunities to give our pets a great quality of life for longer.

While this is great news for the care of our pets, these treatments come at a significant cost. Year on year, treatment costs increase and this is factored into the cost of pet insurance.

Please see ‘How do you calculate my premium?’ for more information about calculation of premiums.

Every year, we review the cost of everyone’s insurance with regards to a combination of factors. This includes increases in our claims costs due to increases in the range of available veterinary procedures, or due to an increased take-up of those services.

Your premium takes into account the average cost of care for pets like yours. To provide an example of this, a pet parent with a three-year-old French Bulldog will be affected by the trends we see in our data from hundreds of three-year-old French Bulldogs that we insure.

No. Pet insurance doesn’t work like health insurance. Health insurance is ‘community rated’, which means that everyone pays the same premium for their health insurance regardless of their individual health status, age, or claims history. This isn’t the case for pet insurance.

Health insurance providers are able to community rate health insurance because there are many other factors at play in the human health care system, such as Medicare and government rebates and subsidies, which isn’t the case with veterinary care and pet insurance. Pet insurance claim reimbursements are paid for purely by the premiums received by those who insure their pets. In order for each person to pay a fair price for their pet insurance, premiums vary depending on your and your pet’s risk factors.

GapOnly® allows your vet to lodge your claim during your visit at participating vets, which is assessed in approximately 10 minutes. If your claim is approved and once a benefit outcome is calculated, you simply pay the gap². That’s the difference between the vet’s invoice and your insurance benefit amount, so you don’t need to worry about being out of pocket for the entire vet bill while your claim is being processed.

Firstly, check that your vet has GapOnly^® enabled by visiting gaponly.com.au. If they do, simply let your vet know that you’d like to submit a GapOnly^® claim the next time you’re there. To minimise delays, it’s best to let your vet know that you intend to make a GapOnly^® claim as early as possible so they can prepare your claim ahead of time.

You can request a pre-approval (from any participating vet practice) prior to your pet’s treatment, or have your claim processed ahead of picking up your pet from the vet. Pre-approvals can be lodged Monday - Friday 8:00am – 8:00pm, and Saturday 8:00am – 5:00pm AEST (excluding NSW public holidays).

You can contact your current vet and ask if they offer GapOnly®, or simply visit gaponly.com.au

When GapOnly® isn’t available, a pet insurance claim can either be made online by your treating vet or you can submit the claim yourself via your online pet portal. Just go to the website of the brand your policy is with, and there should be an online portal that you can log into to submit a claim. Claims would then be assessed and paid in the form of reimbursement of any eligible vet bill.

If the claims assessment concludes a $0 benefit, you’ll need to pay your vet for the full invoice amount. If you’re not totally happy with the outcome of a claim decision, then you’ll need to contact the dispute resolution team for your policy. For pet policies you can purchase through Choosi, the contact details and the dispute resolution process are contained within your applicable Policy Booklet (under the If you have a complaint’ section).

GapOnly® claims are available at participating vets Monday – Friday 8:00am – 8:00pm, and Saturday 8:00am – 5:00pm AEST (excluding NSW public holidays). When GapOnly® isn’t available, your vet may be able to submit an online pet insurance claim instead.

A GapOnly® claim made in a vet clinic will usually take around 10 minutes to process. If the claim is likely to take a little longer, the vet clinic staff will let you know so you can decide whether you’d like to wait or not. If you’re not able to wait, you’ll be required to pay your vet the full invoice amount so your vet clinic can adjust your GapOnly® claim to a standard electronic claim, and your insurance provider will consider the claim and reimburse you the calculated benefit of an eligible vet bill.

GapOnly® works in partnership with participating vets, and as long as your vet is GapOnly® enabled, you can use it for all eligible vet fees covered in your policy.

Yes, you can ask your vet to submit a GapOnly® claim so you don’t have to wait for your claim to be processed when you pick up your pet. Simply let your vet know when you drop off your pet that you’d like them to submit a GapOnly® claim for your pet’s treatment and, if available, they can arrange this for you.