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Please read your Pet Assist Insurance Policy carefully to determine the parties’ rights and duties and what is and is not covered. Some provisions in the policy limit or restrict coverage. Throughout this policy, the words you, and your, refer to the policyholder (Pet Parent) shown in the Declarations Page. The words we, us and our, refer to the company providing this insurance, Middle East Assurance & Reinsurance Co. (MEARCO) S.A.L.. Words and phrases that appear in bold type have special meaning found in Section V. Definitions.
I. INSURING AGREEMENT
Upon your payment of the premium, we will provide coverage as specifically described in this policy for your pet as shown on the declarations page. Benefits are subject to terms, conditions, limitations and exclusions of this policy and to the insured’s responsibility. Coverage is in effect at the time and date shown on the declarations page subject to the waiting periods described in II. EXCLUSIONS & LIMITATIONS 1) b.
1) WE COVER: Reimbursement of the cost incurred by you for reasonable medical emergency expenses recommended by your veterinarian for conditions of your pet covered by this policy. These costs will be covered when your pet:
a. develops a sudden, non-preexisting illness, or
b. has an injury as a result of an accident, or
c. is subject to poisoning; during the coverage term.
This policy shall not cover amounts charged by the treating veterinary clinic greater than the veterinary standards agreed upon with our company and according to our company pricing list.
2) YEARLY AGGREGATE LIMIT: The maximum amount you may claim while coverage is in force with respect to any one pet for veterinary
treatment over one year. The Yearly Aggregate Limit is USD 1,500 per year.
3) WE ALSO COVER : Bodily injury sustained by a human third party and caused by your pet, excluding you and any of your Immediate Relatives or members your household, up to a yearly aggregate limit of USD 300.
1) GENERAL EXCLUSIONS
We do not cover:
a. Veterinary examination fees, also known as consultations, when those are not related to emergency medical cases covered by these general conditions of coverage. Follow-up consultations and medical post-treatment are also not covered;
b. Illness or Injury or any Medical Situation that occurs in the first fifteen (15) days following the payment of the premium, before the pet policy effective date;
c. Pets with less than 4 months of age; Cats should have a maximum age of 12 years inclusive, large dogs 9 years inclusive and small dogs 11 years inclusive.
d. Illness related to hip dysplasia, patella luxation, cruciate ligament rupture and herniated discs except when related to a sudden traumatic incident and not in cases related to race, congenital origin or pre-existing cases.
e. Medical cases related to race and/or congenital cause;
f. In case the veterinary or the pet owner decides to proceed with an innovative technique to treat any covered case, the treatment of the case will only be covered up to the amount mentioned in the price list.
g. More than four days of hospitalization related per medical case.
h. Only one case per pet per year of rat-killer poison ingestion is covered, including the consultation and the first coagulation test if required.
i. Ehrlichiosis and babesiosis are only covered if the test is positive.
j. MRI and CT scans are not covered except at the discretion of the company.
k. Pets with no FDA-approved microchip installed are not covered by this policy.
2) PRE-EXISTING CONDITIONS
We do not cover pre-existing conditions.
Pre-existing conditions means:
a. illness or the recurrence of any illness or condition which first occurred or displayed any signs and/or symptoms consistent with the stated illness or condition that is previously known to have occurred, to be recurrent or create a state of recurrence;
b. an injury or recurrence of an injury that occurred prior to the pet policy effective date; or
c. any condition or complication resulting from an illness or injury that occurred prior to the pet policy effective date.
3) PREVENTIVE CARE EXCLUSIONS
We do not cover:
a. Spaying and neutering, preventive healthcare including vaccinations or titer test, flea control, heartworm medication, deworming, nail trim,
and grooming. Parasite control including but not limited to internal and external parasites for which readily available prophylactic treatments are available. Dental health care, however if injury to teeth is caused by an accident, we do cover the cost of extraction of damaged teeth. Anal gland expression.
4) OTHER EXCLUSIONS
We do not reimburse the costs, fees or expenses associated with:
a. Injury or illness due to any intentional, neglectful or preventable act, including organized dog fighting, by you or a member of your household;
b. Elective procedures, cosmetic procedures, preventive procedures including but not limited to: tail docking, ear cropping, de-clawing, dew claw removal, ear cleaning, etc…
c. Boarding or transport expenses;
d. Conditions arising from a specific activity if the same or a similar activity occurred prior to the pet policy effective date and displayed the propensity for the activity to recur and cause injury or illness to your pet;
e. Diseases preventable by vaccines and prophylactic medications (such as heartworm, lice, internal parasites and fleas);
f. Complications related to conditions excluded or limited by this policy;
g. Abnormalities where clinical symptoms were apparent prior to the pet policy effective date. This includes conditions that are detectable by a routine physical exam by your veterinarian;
h. Claims in any way arising from the lack of use and/or implementation of preventive healthcare products and/or methods when such products and/or methods would be in accordance with generally accepted veterinary standards. Routine healthcare includes: vaccinations, flea
control, heartworm medication, de-worming, dental care, ear plucking, grooming, and prudent regular care;
i. Special diets, pet foods, vitamins, supplements, grooming, nail trims, shampoo and bathing (including medicated baths);
j. Conditions arising from any specific activity if the same or similar activity occurs after you have received written notice from us regarding
the specific activity;
k. Experimental or investigational treatment or medicine (diagnostic treatment);
l. Breeding or conditions relating to breeding, whelping, and queening;
m. Diagnostic tests for conditions excluded by this policy;
n. Diagnostic tests due to complications of conditions excluded or limited by this policy;
o. Conditions caused by war or war activities whether war be declared or not. War activities include civil war, insurrection, rebellion, or sabotage actions, terrorism or vandalism strikes, street barricades erected at the time of public demonstrations, and general troubles of all kinds and measures taken for restoring order;
q. Behavioral modification, training, therapy or medications for behavioral modification;
r. Expenses related to depression, anxiety, stress, mental or nervous condition;
s. All events and accidents associated with or resulting from pregnancy and/or breast feeding, including diagnosis, follow-up treatments,
abortion, or delivery;
t. Prosthesis and anatomical and orthopedic devices (fixed or removable) unless after explicit approval from the company; u. Medicines, prescribed outside the emergency coverage or the hospitalization that follows;
v. Pets covered under this policy must have undergone all standard vaccinations required, namely for the parvovirus, canine distemper virus, canine hepatitis virus, leptospirosis, parainfluenza virus, rhinotracheitis, panleukopenia, calicivirus, rabies and similar known viral and infectious diseases with available vaccination. The vaccination protocols should correspond to the WSAVA vaccination recommendations, especially for young pets before they reach 4 months of age;
w. Endemic and epidemic diseases;
x. Injury due to high-rise syndrome is only covered the first time and at the discretion of the company;
y. Injury due to shooting or intentional harm is not covered except on case by case basis and at the discretion of the company’s decision;
z. Medical conditions related to pregnancy;
aa. Euthanasia is only covered in extreme medical cases, due to clear medical necessity and when all other medical options are not available. This decision is also at the discretion of the company;
ab. For working pets, no coverage shall apply for any condition resulting from activities related to racing, breeding, law enforcement, guarding or for any commercial use;
ac. We will not make any payments for any claims for which you are entitled to be paid under any other insurance except for any additional sum which is payable over and above such other insurance;
ad. Telluric movements, floods, volcanic eruptions, or other kinds of natural phenomenon considered as natural calamity.
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