Short answer: most pet insurers calculate a claim as (eligible bill × your reimbursement percentage) − whatever is left of your deductible. So on a $3,000 emergency with an 80% plan and a $500 deductible you haven’t met yet, you’d typically get $1,900 back and pay $1,100 yourself — not the $2,000 many people expect. The percentage is applied first; the deductible comes off afterward. That order is confirmed by the insurers’ own published examples, including Trupanion’s policy disclosure and Lemonade’s claims guide.
Four settings decide what you’re actually paid: the reimbursement percentage, the deductible type, the annual limit, and what counts as eligible. Here’s how each one works.
Step 1: What Counts as “Eligible”
Before any math, the insurer removes charges your policy doesn’t cover. The common ones:
- Pre-existing conditions — excluded by every major insurer. Definitions differ: Trupanion looks back 18 months for signs or symptoms; Healthy Paws and Embrace may cover a curable condition again once it’s been symptom- and treatment-free for a year; ASPCA uses 180 days, except for knee and ligament conditions. See how insurers verify pre-existing conditions.
- Exam fees on some plans (Trupanion and Healthy Paws exclude them).
- Routine and preventive care — vaccines, flea and heartworm prevention, spay/neuter — unless you’ve added a wellness plan.
- Cosmetic procedures and, on some plans, behavioral therapy.
- Taxes, on some plans.
Step 2: Apply the Reimbursement Percentage
This is the share of the eligible bill the insurer pays — usually 70%, 80% or 90%. From the insurers’ own sites:
| Insurer | Reimbursement options | Deductible type | Annual limit |
|---|---|---|---|
| Trupanion | 90% (flagship) | Per-condition, lifetime | No limit |
| Nationwide | 50%–80%, by plan | Annual | $2,500–$10,000, by plan |
| Fetch (formerly Petplan) | Up to 90% | Annual | $5,000 / $10,000 / $15,000 |
| Healthy Paws | Up to 90% | Annual | Up to unlimited |
| Embrace | 70%–90% | Annual | You choose (e.g., $10,000) |
| Lemonade | 70%, 80% or 90% | Annual | $5,000–$100,000 |
| ASPCA | Customizable | Annual | Customizable |
Plan details from each insurer’s website, checked September 21, 2026. Options vary by state and change over time — confirm on your own policy.
Step 3: Subtract the Deductible
Here’s where the deductible type matters.
Annual deductible (Nationwide, Fetch, Healthy Paws, Embrace, Lemonade, ASPCA): paid once per policy year. After that, every covered claim that year just gets the percentage applied.
Per-condition (lifetime) deductible (Trupanion): paid once per condition for the life of your pet. Trupanion describes it as a deductible that lets “future medical costs associated with that condition” be covered without paying it again.
A Worked Example: The Same Bills Under Two Plans
Illustrative numbers, not a quote from any insurer: a $500 deductible, 80% reimbursement and $10,000 annual limit. In March your dog has a $3,000 emergency; in July, an unrelated $1,000 illness.
Annual-deductible plan
| Claim | Math | You’re reimbursed | You pay |
|---|---|---|---|
| March, $3,000 | $3,000 × 80% − $500 | $1,900 | $1,100 |
| July, $1,000 (deductible already met) | $1,000 × 80% − $0 | $800 | $200 |
| Year total | $2,700 | $1,300 |
Per-condition-deductible plan
| Claim | Math | You’re reimbursed | You pay |
|---|---|---|---|
| March, $3,000 (condition A) | $3,000 × 80% − $500 | $1,900 | $1,100 |
| July, $1,000 (new condition B) | $1,000 × 80% − $500 | $300 | $700 |
| Year total | $2,200 | $1,800 |
The per-condition plan cost more this year because two unrelated problems each triggered a deductible. But if condition A were chronic — allergies, arthritis, diabetes — the annual plan would charge the $500 again every year, while the per-condition plan would never charge it again for that condition. Per-condition deductibles favor pets with one long-running problem; annual deductibles favor pets with several small, unrelated ones.
What about 90% instead of 80%? On the $3,000 bill: $3,000 × 90% − $500 = $2,200, so you’d pay $800 instead of $1,100 — $300 less on one claim, in exchange for a higher premium.
Step 4: The Annual Limit
Once the insurer has paid your annual limit, you cover everything else that year. Embrace has described a real case where covered charges of about $12,160 resulted in a $10,000 payout because that was the plan’s cap. For the difference between annual, per-incident and unlimited caps, see annual limit vs. per-incident pet insurance and high-limit vs. standard plans.
Actual Bill vs. Benefit Schedule
Most modern plans reimburse a percentage of what your vet actually charged. Some plans instead pay from a benefit schedule — a fixed dollar amount per condition or procedure, whatever your vet charges. Nationwide’s Major Medical plan uses defined benefits per condition, and wellness add-ons are typically schedule-based. If your vet’s prices are above the schedule, you pay the difference. The NAIC Pet Insurance Model Act requires insurers to disclose which method they use.
How and When You Get Paid
With most insurers you pay the vet, upload the itemized invoice in their app or website, and receive the money by direct deposit or check. Published timelines vary: Healthy Paws says most claims are processed within two business days; Fetch says typically under 10 days. Trupanion’s VetDirect Pay can settle its share at checkout, but only at hospitals using its software. Healthy Paws requires claims within 90 days of the invoice — check your insurer’s deadline.
How to Use This When Choosing a Plan
- Pick one realistic emergency cost for your pet and run the math above for each plan you’re considering.
- Check the deductible type against your pet: young and healthy, or already showing a chronic condition?
- Check exam-fee and dental coverage — they’re the most common surprises.
- Compare the yearly premium difference with the out-of-pocket difference you calculated.
For typical premiums, see how much pet insurance costs per month, and for why prices rise at renewal, why pet insurance keeps going up.
The Bottom Line
Your reimbursement is the percentage applied to eligible charges, minus the deductible, capped by the annual limit. Knowing that order — and whether your deductible resets each year or each condition — tells you more about a plan’s real value than the headline “up to 90%” does.
This article is general information, not insurance advice. Terms vary by insurer, plan and state; your policy documents govern.
Sources
- Trupanion — How pet insurance works; Insurer Disclosure of Important Policy Provisions; What isn’t covered; Pre-existing conditions
- Lemonade — What is co-insurance?, updated October 2025
- Nationwide — All products; What’s covered
- Fetch — annual coverage limit; Is Petplan now Fetch?; exam fees
- Healthy Paws — Coverage & Benefits
- Embrace — How Does Pet Insurance Work?; Coverage
- ASPCA Pet Health Insurance — Compare plans; What’s covered
- NAIC — Pet Insurance Model Act (Model 633)
