This is a topic that confuses a lot of people and for good reason. It's kind of confusing! And it has a bearing on Pet Health Insurance, too, because some providers cover hereditary conditions under some circumstances and others exclude hereditary conditions. PurinaCare, for instance, does not exclude hereditary conditions that are not pre-existing. That statement alone can be a little confusing and this post will help explain what that means so there is as little confusion as possible. You should look at the definition of pre-existing at the bottom of page one of the sample policy.
Confused already? OK, here we go.
By definition, congenital conditions are present at birth...
and are the result of some developmental abnormality that takes place as the puppy or kitten grows in the mother's uterus. Congenital conditions can result from environmental or maternal influences. If the mother develops a disease during a critical phase of the puppy or kitten's development that can result in a congenital defect. Some drugs may have the same influence. We all remember the
thalidomide tragedy from the late 1950's and early 1960's. One dose of this drug in the early part of pregnancy was capable of creating severe birth defects in children.
Congenital conditions may also be due to genetic abnormalities and this is where things get a little confusing. In most cases these genetic defects are hereditary.
A classic example is the
portosystemic shunt or liver shunt that is fairly common in some
small breed dogs. In the early stages of fetal development the fetus relies on the mother's liver to filter blood and process nutrients. At later stages prior to birth this circulatory pattern changes and the normal fetus develops the blood supply system to use it's own liver to perform these critical functions. Puppies born with liver shunts never develop this ability and are born with a liver that has an abnormal blood supply. Consequently the liver never works properly and many of these puppies show clinical signs shortly after birth. In other cases they may not show signs until they are one or two years of age even though the condition itself was present at birth.
Hereditary conditions are the result of inherited chromosomal defects from one or both parents. The
interesting thing about hereditary conditions is that even though an animal may have a genetic predisposition, meaning he has inherited the gene or genes responsible for the disease or condition, the condition may never show up. Some hereditary diseases may not express themselves due to lifestyle or other general health related issues.
For instance, in the post we did earlier this week we discussed
hip dysplasia in dogs. This debilitating disease of the hip joint has a definite genetic component yet not all dogs with the genes implicated develop hip dysplasia. The way you
feed large breed puppies can have a significant influence on the expression of the hip dysplasia genetic factor. Feeding them properly can result in fewer signs of hip dysplasia. You could say that this is a positive lifestyle influence on genetics.
So how does this relate to Pet Health Insurance? Virtually all pet health insurance policies exclude pre-existing conditions as we've discussed
previously on the blog. Therefore, congenital conditions present at birth, are by definition, pre-existing. This is obvious with something like a cleft palate, umbilical hernia or congenital heart defect that is obvious on auscultation with a stethoscope, and these things would clearly be excluded from coverage.
But here's where it gets interesting with PurinaCare and the previous example of the Portosystemic Shunt illustrates the point. We typically exclude congenital conditions because they are by definition pre-existing. But what about the case of a liver shunt where the dog shows no signs until they are 18 months old? The condition was congenital but there were no clinical signs associated with it. Should coverage be denied?
We think not. We have inserted the word "known" congenital condition in our policy wording for just this reason. In the case above our claims adjusters would cover the dog with the liver shunt if it had been insured as a puppy prior to the diagnosis or appearance of clinical signs and the policy was current.
Our coverage of hereditary conditions is similar and the hip dysplasia example is a good one. If the hereditary condition is not subject to the pre-existing definition it would not be excluded. Therefore a puppy insured before there is any evidence of hip dysplasia that subsequently comes down with hip dysplasia would not be denied coverage under a PurinaCare policy.
These are important considerations when you consider purchasing Pet Health Insurance. Most providers will exclude hereditary conditions or place strict limits on coverage. For instance they might only cover a certain dollar amount; say $100- $300 and then you are on your own. For this reason they may advertise that they cover hereditary conditions. Technically they do. Read the fine print. I know of only one other provider besides PurinaCare that does not routinely exclude hereditary conditions or place special dollar limits on the coverage.
And keep this little tidbit in mind when you are shopping. There is a school of thought that says all diseases or conditions other than infectious diseases have a genetic component. A Pet Health Insurance provider could use this reasoning to deny claims. I'd make sure that I had a good understanding of the policy before I bought it to make sure this was not the case. It is certainly not the case with us.