• ASPCA, the nonprofit, allows the insurance company, Crum & Forster, to license the ASPCA name for a fee. ASPCA, the nonprofit, has no administrative role or oversight in ASPCA Pet Insurance. In 2018, according to ASPCA’s financial filings, the non-profit earned $9.4 million “in royalties, licenses, and other.” Much of that came from a partnership in which Crum & Forster, a global multi-product insurer — pays licensing fees to sell pet insurance under the ASPCA name.
• There is a “cancel” clause in this policy and all pet insurance policies underwritten by United States Fire Insurance which states that the carrier “may also cancel your coverage by giving  you at least 30 days notice for any of the following reasons….” c. “There is a material change that substantially increases the probability or severity of a covered loss.”

When asked about this clause by TCR reporters who did not reveal their identity, insurance customer suppport agents were adamant that they were certain that no person had ever had a policy cancelled due to the cost of claims.

• Consumers should be aware that whereas all policies available for enrollment on the provider’s website are tethered to annual reimbursement limits, the maximum annual reimbursement limit being $10,000, in fact, unlimited reimbursement plans are available if the customer calls and speaks with a live agent — an action that, statistically, less people take as opposed to enrolling online. Thus, it appears that one risk management strategy this company has adopted is simply to steer customers towards plans less likely to pay sufficiently for medical coverage for their pets.
• This insurance product pays claims by making a determination of the “usual and customary costs.”  In other words, your costs are calculated by the insurance company, and not based on the amount that you actually paid your veterinarian for your dog’s medical care. Healthcare.gov provides the following definition of UCR (usual, customary, and reasonable costs): “The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service. The UCR amount sometimes is used to determine the allowed amount.” This is perhaps the most significant pitfall consumers should be aware of.
• This insurance product’s base policy excludes [“unless covered by an applicable endorsement] “any Hereditary, Genetic or Congenital Condition including those Conditions that are related, secondary, or resultant from any Hereditary.” Any number of medical events in an animal’s life could be characterized as “hereditary.” It’s a highly subjective exclusion, leaving much discretion to the provider.