Frequently Asked Questions
Can I apply to have a pre-existing condition reviewed?
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. Your vet will need to certify and provide veterinary 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 us in writing. You can download a copy of the Pre-existing Condition Review Form here:
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.
Can I get pre-approval of my pet’s upcoming treatment?
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 email@example.com 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.
What’s a pre-existing condition?
A pre-existing condition is:
- a condition that existed or occurred prior to the commencement date of your first policy period or within any applicable waiting period; and
- a condition that you or your vet were aware of, or a reasonable person in your circumstances would have been aware of.
This is irrespective of whether the underlying or causative condition was diagnosed at the time. Whether it’s a pre-existing condition will depend on its nature and experience. Outside of any applicable waiting period, if your Pet has a Temporary Condition that is considered to be a Pre-existing Condition (because it occurred or existed prior to the Commencement Date of the First Policy Period, or during any applicable Waiting Period, but that Condition has not existed, occurred or shown noticeable signs, symptoms or an abnormality in the 18-month period immediately prior to your claim Treatment date), it will no longer be excluded from Cover as a Pre-existing Condition. Chronic conditions and several other specified conditions can’t fall within this category. See your Policy Booklet for more information.
I already have a wonderful vet. Can my pet still visit them?
Absolutely! We help to cover eligible bills for your pet from any vet registered to practice in Australia.
How much of my vet’s bill is covered?
It depends on the plan you choose. We cover up to 65% of your pet’s eligible treatment costs up to your annual benefit limit for the Regal plan, up to 80% for the Imperial plan, or up to 85% for the Sovereign plan. Sub-limits may apply or if you choose the Regal plan, then a $2,000 annual per condition limit also applies. There’s no excess to pay but there are exclusions for all these insurance plans, which you can read all about in the relevant Policy Booklet.
What about everyday care — does my policy help pay for that?
With our Sovereign Plan, you can choose to add the routine care option, which covers up to $80 a year spent on a whole range of everyday treatments, from teeth cleaning and microchipping, to prescription diets and alternative therapies. See the relevant Policy Booklet for details.
My pet has a hereditary problem. Is that covered?
Hereditary and congenital conditions will be eligible for cover if they haven’t shown noticeable signs, symptoms, or an abnormality at any time before the first policy period or during any applicable waiting period. General exclusions apply which are detailed in the relevant Policy Booklet.
Are ongoing conditions covered for the life of my pet?
Yes. As long as you continue to renew your policy with us each year with no break in cover, we continue to offer the product and subject to the terms and conditions of your renewal policy, we’ll continue to provide cover for chronic, recurring, or lifelong conditions such as cancer or arthritis. Benefits for these conditions, like any other, are subject to the annual policy limits and exclude some pre-existing conditions. You can find out more in the relevant Policy Booklet.
What does pet insurance not cover?
We’ve tried to make Prime Pet Insurance as comprehensive as we possibly can, but like most insurance policies, there are a number of things that aren’t covered which helps to make costs more manageable and keep premiums affordable. These include (but aren’t limited to):
- pre-existing conditions, or conditions arising within the applicable waiting period;1
- routine care (unless you purchased it with your policy);
- dental care;
- certain treatments and conditions;
- certain services and procedures;
- elective treatments and procedures; and
- lack of protection for your pet due to gross negligence.
You can find the details in the relevant Policy Booklet.
1If 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. Some conditions are eligible for review after an 18-month period. Please refer to your Policy Booklet for more information regarding pre-existing conditions.
There’s more than one special pet in my family. Can I insure them all?
Of course! You can insure all your special dogs and cats under the same policy (although naturally, you’ll need to pay a separate premium for each pet). All additional pets insured will qualify for a 10% discount.
How old does my pet have to be?
Under the Sovereign and Imperial Accident & Illness plans, you can insure your special dog or cat as long as they’re at least 8 weeks old and under 9 years old when your policy starts. For the Regal Accident & Illness plan, they must be at least 8 weeks old and under 16 years old when your policy starts.
Can I keep my insurance when my pet gets older?
Absolutely! Once your pet is insured with us, we offer lifetime cover subject to the terms and conditions of your renewal policy, as long there are no breaks in your cover and as long as we continue to offer the product.
When will my policy start?
Your policy starts at one minute to midnight (11:59pm) on the commencement date of your policy. Once it starts, you can claim immediately for any specified accidental injuries (refer to your Policy Booklet for details) that happen after that date. There are waiting periods though, which apply from the date your policy starts:
- Illness: 30 days
- Tick paralysis: 30 days
- Cruciate ligament conditions: 6 months
- Dental illness: 2 years (available on the Sovereign and Imperial plans only)
For cruciate ligament conditions, you can apply to waive the waiting period if we receive a cruciate ligament waiver form from your vet within 14 days of the date of examination, certifying that your pet has no history of or latent cruciate ligament conditions.
How do you calculate my premium?
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.
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.
Will my premium increase every year?
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 they’re likely 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 the calculation of premiums.
Will my premium increase even if I don’t submit claims?
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.
Is my premium calculated the same way as my private health insurance?
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, 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.
My pet’s been unwell! How do I make a claim?
We’re sorry to hear that. Be sure to get your claim to us as soon as possible after your pet’s treatment. Please visit our claims section for detailed information on how to make a claim.
Why should I get pet insurance?
Breakthroughs in veterinary medicine over the last few decades mean that your pet can now enjoy a longer and healthier life than ever before, but that higher standard of care comes at a cost. Just as you take measures to ensure your family have access to the best medical care, it also makes sense to insure your pet as they’re often regarded as members of your family. That way, you don’t need to think twice about helping them get the care they deserve, and you won’t need to worry about the cost.
What is GapOnly?
GapOnly allows your vet to lodge your claim during your visit, which is assessed in approximately 10 minutes. Once the claim for your insured pet has been processed and a benefit outcome is calculated, you simply pay the gap. 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 while your claim is being processed.
I’d like to use GapOnly — what do I need to do?
Firstly, check that your vet has GapOnly enabled by visiting gaponly.com.au. If they are, 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.
Can I get a pre-approval for a GapOnly claim?
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).
How do I know if my vet uses GapOnly?
You can contact your current vet and ask if they offer GapOnly, or simply visit gaponly.com.au.
What if my vet doesn’t have GapOnly?
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 (https://petportal-prime.petsure.com.au/SignIn). Claims would then be assessed and paid in the form of reimbursement of any eligible vet bill.
What if my GapOnly claim doesn’t cover any of my treatment costs?
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, we'll do our best to work with you to resolve it. You can get in touch with us by calling one of our trained consultants on 1300 070 753. Alternatively, you can put your concerns in writing, care of Prime Pet Insurance, Locked Bag No. 9021, Castle Hill NSW 1765, Fax Number: 1300 738 979 or email: firstname.lastname@example.org. Remember to provide us with your name, policy number and full details relating to your concerns. Further detailed information about our complaints process can also be found in your Policy Booklet.
When are GapOnly claims available?
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 electronic pet insurance claim instead.
How long does a GapOnly claim take to process?
A GapOnly claim made in a vet clinic will 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.
Can I use GapOnly for all vet treatment costs?
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.
Can my GapOnly claims be processed before I pick up my pet?
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.