We have been with Petplan almost 10 years.
Recently our eldest cat diagnosed with large cell lymphoma in her stomach, been doing chemo for ever since.
The plan we chose for our cat is the petplan cover for life Classic 1
https://www.petplan.com.au/cat-and-kitten-insurance
and here is the PDS
https://www.petplan.com.au/FileReference/ServeFileType/5348/…
“Maximum Benefits” - P.11
means the most We will pay for the relevant level of cover You have chosen during the Period of
Insurance as set out in the Certificate of Insurance, subject to exclusions of the Policy and subject to
the Policy Aggregate less the applicable Excess.
"Policy Aggregate" - P.12
means the total amount payable for all Veterinary Fees and Alternative or
Complementary Treatment for Injuries and/or Illnesses occurring during any one Policy
Year as specified in the Certificate of Insurance.
What happened is after 2 claims for the lymphoma
Petplan advised we have reached maximum benefits this period ( April 2019- April 2020).
Our Maximum is $9,000
Fixed excess is $125
Age excess is 35%
and our total current bill from vet is $9,036.85 (Already paid to vet)
which bring us the excess of $3,288 of age excess (35%) + $125
So Petplan will paid us $5,748.95
and the balance of the maximum = $3,251.05
Here is problem, Petplan said our total bill which is $9,036.8 has already reach the limit and they refused to pay anymore which we certainly cannot agree.
We are getting our dispute/complaint escalated to their Internal Dispute Resolution on the 17th Dec 2019 and advised a response will be given before the 6th Jan 2020.
When we called today asked for updates, they started arguing with us on phone and insisted we are wrong.
We have been stress out for the last few two months and we still have another 10 chemo sessions ahead of us, we would be appreciated we can get some ideas/suggestions/advices from all OZbarginer see if we actually right on this one or not.
Feel free to ask any question if i missed any info from above. Cheers.
Your limit is $9000
But you have a reduced claimable amount due to the pet age excess.
The example below is given in the PDS
Claimable Veterinary Fees
$10,000
Less the Fixed Excess
$150
Revised claimable amount
$9,850
Less Optional Pet % Share Excess 25% (on revised claimable amount
$2,462.50
Total claimable amount
$7387.50
So in the example above, a person with $10,000 cover with a 25% age excess after their fixed excess would only be able to claim a total of $7387.50
They spent $10,000 in the example
Got $7387.50 back
They have effectively claimed their entire $10,000 for the year.
Age excess is the same method of calculation as above.
Claimable Veterinary Fees
$10,000
Less the Fixed Excess
$150
Revised claimable amount
$9,850
Less Age Excess loading 20% (on revised claimable amount)
$1,970
Total claimable amount
$7,880
In this case $10,000 cover would mean they would pay $7,880 but the entire $10,000 would be considered claimed.
So based on that pet plan has paid you the max you are entitled too.
Your total claimable amount is $5748
But the $9000 is considered to have been fully claimed.
saying that I can still see how the wording in the PDS might give another impression. The pet insurance industry is fraught with dodgy wording and exclusions left right and centre, this is why we save our premiums ourselves and have PI the flick a long time ago