A Vet's Review of Pumpkin Pet Insurance
2024

• According to the sample policy: If you make certain changes to your policy after purchasing a plan, this may require canceling the old plan and starting a new plan. This will also make any conditions covered under the old plan, pre-existing in the new plan.
• They will not cover a "ligament and knee condition" if ANY "ligament and knee condition" occurred before your policy effective date or during the waiting period. For example if a dog has been diagnosed with a cruciate tear in their left knee before the effective date or during the waiting period, a cruciate tear in the right leg will not be covered. Even if it happens after the waiting period.
  
  Based on their sample policy, their definition of 'ligament and knee conditions' is: "Conditions involving a ligament, patella, meniscus or soft tissue disorder of the knee."
• Dental coverage for accidents and illness is limited

• Strong underwriter
• Coverage when travel out of state including the US territories Guam, Puerto Rico, and the U.S. Virgin Islands and to Canada.
• Reimbursements are calculated by subtracting the deductible before applying the reimbursement percentage.
• Some pre-existing conditions may be deemed curable (and therefore will be covered) if there has been no symptoms or treatments for 180 days. This does not apply to knee conditions.
• Provides coverage in the 5 important areas as part of the base plan:
  1. Chronic disease
  2. Continual coverage for chronic disease
  3. Hereditary/congenital conditions
  4. Cancer
  5. Breed specific conditions

• Pumpkin is a newer company. Based on what I've seen since 2008, it can take time for a company to settle in on consistent premium pricing and policy terms.
• In its sample terms and conditions policy, Pumpkin states they can cancel your policy if "There is a material change that substantially increases the probability or severity of a covered loss". This is very open ended. Contact the company for clarity on the reasons they can cancel a policy. Given that Nationwide unexpectedly announced the cancellation of over 100,000+ policies in the spring of 2024, it's important to have clarity in this area.
• Pumpkin was acquired by JAB Holding's Independence Pet Group (IPG) at the end of 2022. IPG owns the underwriter Independence American Insurance Company (IAIC). When JAB/IPG acquired other Pet Insurance companies in the past (e.g. FIGO), their underwriters changed to IAIC. I have concerns there may be an underwriter change in this situation as well. Underwriter changes can lead to coverage changes and premium increases. Hopefully this transition will leave customers well taken care of.
• Based on their pre-existing conditions policy, symptoms can be used to denote something as pre-existing. As with all pet insurance companies that use this wording, I have concerns that this can be used to deny claims even when these previous symptoms are not directly related to the disease or condition currently in question.
• I would like to see more clarity on when and by how much premiums can increase.

• Make sure you research what customers are saying about the company. A company may have the 5 components that should be part of a pet insurance plan, but the company may not be a hit with customers. Sites to check include but are not limited to BBB.org, Yelp.com and PetInsuranceReview.com Things to look for include but are not limited to: How fast are payments paid?, What are customers saying about the pre-existing conditions policy?, How often are claims denied and for what reason?, What is the customer service experience like?, Are there issues with premium increases?
• Check with your state's Department of Insurance to see if any complaints have been filed for the company you are interested in.
• Make sure you understand what the waiting periods are.
• Make sure you understand their bilateral conditions policy.
• Make sure you understand any requirements that you must adhere to to maintain coverage.
• Make sure you read the terms and conditions to get a thorough understanding of all exclusions.
• Make sure you understand when and by how much your premium can increase.
• If you change plan levels, there is a possibility that all medical conditions present under the old plan will be considered pre-existing in the new plan. Make sure you ask the company if this is the case.
• For some companies, pre-existing conditions can be based on signs and symptoms alone, a diagnosis is not needed. For example, if your pet had a cough before you applied for pet insurance and this cough was discussed and written in the pet's medical record, there is the possibility that all future cough conditions, no matter what the cause, would be considered pre-existing - even if there was no treatment given. Make sure you ask the company if this is the case.
• Pet insurance companies are businesses. The top priority of any business is to make a profit for their stakeholders. Pet insurance companies can and may change your rates and terms to meet that top priority. A change of business ownership or underwriters can also be a catalyst for changes in your rates and terms.
  
  When you purchase pet insurance make sure you have a realistic understanding of this and how it can affect you.

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