Pet insurance limits, excesses and exclusions

What are limits, excesses and exclusions on a pet policy?

A limit is a ceiling on what a policy pays. An excess is the part of a claim you pay yourself. An exclusion is something the policy does not cover at all. Together they decide how much of a vet bill is paid, so they matter more than the headline description of the cover.

Olvian is not an insurer, broker or financial services provider. It passes a person's request to licensed providers, who pay Olvian a fee and contact the person. This guide explains the terms and what the rules say you must be told. It does not say which cover level to choose.

What levels of pet cover are there?

On our pet insurance page we describe three common levels. Accident-only cover is the basic level. Accident and illness cover adds conditions such as infections. Comprehensive cover adds routine care, such as vaccinations and sterilisation. A policy might not use those words, so go by the benefits table, not the name.

Which level a household takes, and whether any level is right for them, is for the licensed provider to discuss with you. What this guide can do is show what to look at on the schedule.

How do limits work?

Limits come in several shapes, and the schedule shows which apply:

• a limit per claim or per condition;
• a limit per policy year;
• a limit over the life of the policy;
• a limit on how long benefits are paid for one condition; and
• sub-limits for particular items, such as dental care, specialist referral or medicine.

Rule 11.1 treats "any limit on the amount or amounts of cover" and "any limit on the period for which benefits will be paid" as significant limitations. Where an insurer sends you a quotation with detailed information about a specific policy, or sells to you by direct marketing, Rule 11.4.2(g) requires "concise details of any significant exclusions or limitations" before you enter into the policy. Rule 11.5.1(d) then requires comprehensive details of all exclusions and limitations in writing no later than 31 days after the policy starts.

Ask the provider to explain how each limit renews. A limit that resets every year behaves differently from one that runs for the pet's life, and a limit per condition can be used up by a single illness.

How does an excess work?

The policy schedule shows how the excess is set. Some policies state a rand amount per claim. Others set the excess as a share of the bill. Some use both. The wording also says whether the excess is deducted from the payment or you pay it to the vet first.

The Rules put this up front. Rule 11.4.2 requires the insurer to disclose "any excesses that may become payable by the policyholder, the circumstances under which it will be payable and the consequences of not paying". Rule 11.5.1(c) repeats it in the written information you get after inception, and Rule 17.8.3(d) requires the insurer to tell a claimant of any excess when they claim.

Rule 6.1 also says the way risk of loss is borne by policyholders through excesses "must reasonably balance the interests of the insurer and the reasonable benefit expectations of a policyholder". That is an obligation on the insurer when it designs the product, and it is not something you have to prove.

Can there be other fees?

Rule 6.2 says an insurer "may not charge a policyholder or member of a group scheme any fee or charge in addition to the premium payable under the policy". Rule 6.3 sets two exceptions: a fee deducted from the benefits where the policy explicitly provides for it, and a fee permitted in terms of legislation. Rule 6.4 requires any such fee to be clearly and prominently disclosed before the policy is entered into. Rule 17.8.3(e) also requires the insurer to tell a claimant about any administrative fee payable in relation to managing the claim.

If a fee appears that you were not told about, ask the insurer which of these exceptions it relies on.

What is usually excluded?

Exclusions are listed in the policy, and they are different from policy to policy. Typical subjects you will see addressed are conditions that existed before the policy began, waiting periods, breeding and pregnancy, cosmetic procedures, and conditions linked to age. Do not assume any of these. Read the exclusions section and ask the provider to confirm each one that matters to you.

Rule 11.1 specifically includes "any exclusion relating to certain diseases or medical conditions" and "any restrictions on eligibility to claim such as age, residence or employment" in its list of significant exclusions and limitations. Our guide on waiting periods and existing conditions covers the first of those in detail.

How is a claim paid?

Rule 11.5.1(b) requires the insurer to tell you, in writing after the policy starts, "the timing and manner in which the policy benefits will or may be made available". For a pet policy that might mean paying you after you have settled the vet, or paying the vet. Which applies to your policy is in the wording, so ask before an emergency, not during one.

When you claim, Rule 17.8.3 requires the insurer to tell you the type of information it needs, where and how to submit it and any time limit. Keep the vet's invoices and clinical notes, and send them within the time the insurer sets.

What are my rights if a claim is declined?

Rule 17.6.3 applies to pet policies written as short-term insurance. If an insurer repudiates or disputes a claim, it must give you a plain-language notice with reasons in sufficient detail for you to dispute them, your right to make representations within a period of not less than 90 days, its internal review process, and your right to complain to an ombud with contact details. If you make representations, Rule 17.6.5 requires it to reply in writing within 45 days of receiving them.

The National Financial Ombud Scheme says it is free and that it can only look at a complaint once you have lodged it with the insurer. Its telephone number is 0860 800 900.

How can I check that the insurer is licensed?

The Financial Sector Conduct Authority says that on its consumer page you can "confirm if a company or individual is licensed by the FSCA". You can do that before paying a first premium. Keep the insurer's name and contact details with your schedule, because Rule 11.4.2(a) requires the insurer's name and contact details to be given to you before you enter into the policy where it quotes or sells by direct marketing.

What should I check on the schedule?

1. The limit per claim, per year and over the life of the policy.
2. How the excess is worked out and when it is paid.
3. What is excluded, and the definition of any condition that is excluded.
4. Whether the insurer pays you or the vet.
5. Any fee deducted from benefits.
6. How the premium can change, and how often. Rule 11.4.2(e) requires the insurer to disclose details of premium increases, including frequency and basis.

Sources

Checked on 31 October 2026. Olvian is not a financial services provider and this guide is information, not advice.

• Policyholder Protection Rules (Short-term Insurance), 2017, Rule 11: disclosure, Government Notice 1433, Government Gazette 41329, 15 December 2017, as amended by Notice 996, Government Gazette 41928, 28 September 2018.
• Rule 17: claims management
• Rule 6: determining premiums and excesses
• National Financial Ombud Scheme
• Financial Sector Conduct Authority: consumer page