How Claim Payments are Calculated
We know that understanding pet insurance claim payments can sometimes be confusing. This page explains how your deductible and reimbursement percentage work together to determine the amount paid on eligible claims.
Understanding Your Coverage
Before reviewing the examples, here are the key parts of your policy that affect how claim payments are calculated.
Annual Limit
Your Annual Limit is the maximum amount your policy can pay for covered claims during a policy year.
Reimbursement Percentage
Your reimbursement percentage determines the portion of eligible veterinary expenses covered by your policy. For example, if you selected an 80% reimbursement rate, your policy covers 80% of eligible expenses and you are responsible for the remaining 20%.
Annual Deductible
Your deductible is the annual amount you are responsible for paying toward eligible veterinary expenses. Once your deductible has been satisfied during the policy year, it does not apply again until your policy renews.
Claim Payment Examples
First Claim of the Policy Year
Your deductible has not been met yet.
Your Policy
- Annual Deductible: $250
- Reimbursement Percentage: 80%
- Annual Limit: $20,000
Veterinary Invoice
- Eligible veterinary expenses: $1,000
Calculation
- Eligible expenses: $1,000
- Policy share (80%): $800
- Your co-insurance share (20%): $200
- Policy share before deductible: $800
- Remaining deductible: $250
- Policy payment: $550
Outcome
| Description | Amount |
|---|---|
| Eligible expenses | $1,000 |
| Policy payment | $550 |
| Your responsibility | $450 |
Deductible Already Met
Your deductible has already been satisfied for the policy year.
Your Policy
- Annual Deductible: Met
- Reimbursement Percentage: 80%
Veterinary Invoice
- Eligible veterinary expenses: $1,000
Calculation
- Eligible expenses: $1,000
- Policy payment (80%): $800
- Your responsibility (20%): $200
Outcome
| Description | Amount |
|---|---|
| Eligible expenses | $1,000 |
| Policy payment | $800 |
| Your responsibility | $200 |
Multiple Claims During the Policy Year
This example shows how the deductible applies across more than one claim in the same policy year.
Claim #1
- Eligible veterinary expenses: $600
- Policy share (80%): $480
- Deductible applied: $250
- Policy payment: $230
Claim #2
- Eligible veterinary expenses: $1,000
- Policy payment (80%): $800
- Your responsibility (20%): $200
Total for the Year
| Description | Amount |
|---|---|
| Total eligible expenses | $1,600 |
| Total policy payments | $1,030 |
| Total member responsibility | $570 |
Frequently Asked Questions
Does my deductible reset?
Yes. Your deductible resets at the beginning of each new policy year.
Will every veterinary invoice be covered?
No. Coverage is subject to the terms, conditions, exclusions, waiting periods, and limitations outlined in your policy.
Why is my reimbursement amount different than expected?
Claim payments are based on eligible expenses under your policy. Factors such as deductibles, reimbursement percentages, exclusions, benefit limits, and non-covered services can affect the final payment amount.
Where can I find my specific coverage details?
You can find your deductible, reimbursement percentage, annual limit, and complete policy terms in your policy documents and member portal.
Important Note
These examples are intended to help explain how claim payments are calculated and are not a guarantee of coverage or payment. Actual claim payments will vary based on your policy selections, eligible expenses, and the specific facts of each claim.