Policy Details

INSURING AGREEMENT

We will provide the insurance described in this policy in return for the premium and compliance with all applicable provisions of this policy.

The Declarations and Schedule Page show the policy period, coverages, limits of liability and

premiums.  This policy is not complete without the Declarations and Schedule Pages.

PART 1 – DEFINITIONS

In this policy, “you” and “your” refer to the Named Insured shown in the Declarations and the

spouse, if a resident of the resident premises.  “We”, “us”, and “our” refer to the Company providing this insurance.  In addition, certain words and phrases are defined as follows:

1. Accident(s) means an unexpected or unintended event, which is specific as to place and time causing injury to your Pet.
2. Allowable Charge(s) means the costs of the actual Treatment(s) provided by your Veterinary Provider.
3. *Alternative and Complementary Therapies include but are not limited to acupuncture, chiropractic Treatment, hydrotherapy, and physiotherapy performed by a Veterinarian or a veterinary staff member under direct supervision of a Veterinarian.
4. Lifetime Maximum is the maximum amount we will reimburse you per Pet in a period of insurance. The Lifetime Maximum does not include the Co-payment amounts you pay.
5. Bilateral Condition is a condition or disease that affects both sides of the body.
6. Chronic Condition is a detectible condition that, once developed, is deemed incurable or likely to continue for the remainder of a Pet’s life.
7. Claim means your request for reimbursement of an amount under the terms of your policy for Treatment by a Veterinary Provider of your Pet.
8. Clinical Signs means changes in a Pet’s normal healthy state, bodily function or behaviour observed by you, a Veterinarian, or other observer.
9. Co-payment is the percentage of the covered Allowable Charge for which you are responsible per Pet and which is not reimbursable under this policy.
10. Coverage is the insurance described in this policy.
11. Dental Illness is an illness affecting the teeth and/or gums including but not limited to gingivitis, stomatitis, epulides, and gingival hyperplasia. This does not include FORLs or illnesses manifesting as oral diseases such as FELV gingivitis, feline bartonella infection, or auto-immune (eosinophilic) stomatitis or any disease related to FIV.
12. Dermatological Condition means an Illness related to your Pet’s skin and is deemed to include ear infections and skin lumps from skin irritation or infection, such as interdigital cysts from pododermatitis, but not conjunctivitis or parasitic infestations.
13. Genetic Condition means an Illness whose presence is determined by hereditary factors.
14. Illness means sickness, disease, or any change in a Pet’s normal, healthy state, which is not caused by Injury to the Pet.
15. Injury means physical harm or damage to your Pet.
16. Medical Director means a Veterinarian who may be assigned by us to monitor and review the appropriateness of the services provided to the Pet, the reasonableness of the fees, and the relationship between conditions.
17. Medically Necessary means directly and materially related to a covered Illness or Injury, in our reasonable judgment.
18. Medication means any veterinary recommended medications prescribed by your Veterinarian and approved by the Food and Drug Administration (FDA) of the United States or accepted for inclusion in the Homeopathic Pharmacopoeia of the United States for veterinary use. FDA-approved or Homeopathic Pharmacopoeia – included drugs available over the counter must be dispensed directly by your Veterinarian or compounded by a pharmacist under the guidance of your Veterinarian.  Items purchased from an outside store or other pharmacy are not covered.  Medication includes medical supplies required to administer those Medications.
19. Orthopaedic means the musculoskeletal system, which is made up of the body’s bones (the skeleton), muscles, cartilage, tendons, ligaments, and joints.
20. Original Start Date means the effective date when you were first continuously covered by a policy administered by CG United Insurance Ltd., unless otherwise stated on the Schedule Page.
21. Pet is a cat or dog named and described in the Schedule Page(s) and both owned by you and residing with you.
22. Pet Original Start Date means the effective date when that Pet was first covered by a policy administered by CG United Insurance Ltd., unless otherwise stated on the Schedule Page.
23. Preventative Care means any Treatment, service or procedure, including but not limited to physical examinations, Medications, surgery, inoculations or laboratory procedures, for the purpose of prevention of Injury or Illness or for the promotion of general health, where there has been no Injury or Illness.
24. Professional Services are diagnosing, treating, operating, or prescribing for any cat or dog Illness or Injury.
25. Pre-existing Condition(s) means:
26. A Chronic Condition observed by you or your Veterinary Provider prior to the end of the Waiting Period for your Pet(s) and any related conditions; or
27. an Illness or Injury that first occurred or showed Clinical Signs prior to the end of the Waiting Period for your Pet and any related conditions.

Undiagnosed conditions with the same Clinical Signs as those in (a) or (b) above are also considered pre-existing.

26. Reimbursement Percentage is the percentage of the covered Allowable Charge for which we are responsible per Pet. It is equal to the calculation (100% minus Co – payment).
27. Treatment means any examination, consultation, hospitalization, anaesthesia, surgery, X-rays, MRI or CT scans, alternative or complementary therapies, laboratory tests, nursing or other care provided and administered by a Veterinary Provider.
28. Undiagnosed means not having been identified.
29. Veterinarian means a currently licensed Doctor of Veterinary Medicine.
30. Veterinary Provider means a Veterinarian, veterinary technician or veterinary nurse currently licensed in the country of Barbados in which Treatment is performed.
31. Waiting Period means the time period where the policy’s Coverage is restricted. For this policy, the time period 30 days except for Orthopaedic conditions for dogs where the Waiting Period is six (6) months.

The Waiting Period starts from the Pet Original Start Date.  Conditions that occur during the Waiting Period will be excluded from your policy’s Coverage as Pre-existing Conditions.  The Waiting Period also applies to Coverage increases but is waived for policy renewals and Optional Coverage renewals.

PART 2 – CONDITIONS

1. Your pet must be examined and a Complete blood work and Chemistry panel (Chem 15 or chem 17) performed prior to your pet’s insurance start date or within 7 days after the Start Date.
2. The examining Veterinarian for the purposes of medical information or for an Orthopedic examination cannot be you or be related to you. No Coverage is available until a qualifying Veterinarian has examined your Pet, and Pre–existing Conditions, if any, may be determined upon the date of the qualifying Veterinarian’s examination.
3. All Treatment must be performed by a CENVET Group Veterinary Provider. This includes Central Veterinary Clinic and Central Veterinary Clinic South. The insurance is not via any other veterinary provider.
4. You must arrange for an approved Veterinarian to examine and treat your Pet within 72 hours after it shows Clinical Signs of Injury or Illness.
5. You are financially responsible to your Veterinary Provider for payment of all Treatment in full at the time of service. Any arrears on your account must be paid in full before your insurance coverage is approved and/or before any claims are honored.
6. Your Pet(s) must reside with you and be under your regular care and supervision at the physical address listed on the Declaration Page.
7. You must give us permission to gather all medical information for your Pet(s) from all your Veterinary Providers as we deem necessary.
8. The standard Orthopaedic condition Waiting Period for dogs is six (6) months from the Pet Original Start Date shown on the Schedule Page for that dog.

You may apply to reduce the Orthopaedic Waiting Period by having a Veterinarian perform, at your own expense, an Orthopaedic examination on your dog and submitting the results to us for review. This includes X-rays of all relevant anatomy and any further diagnostic deemed necessary by the Veterinary Surgeon.

The Orthopaedic examination must occur on or within 14 days of the Pet Original Start Date for that dog and the Veterinarian must complete, sign and date the “Canine Orthopaedic Examination Report” form based on that Orthopaedic examination, which we shall supply upon request.  Upon review of the results of the Orthopaedic examination, we may reduce the Orthopaedic Waiting Period for some or all Orthopaedic conditions to two (2) months for Injuries or Illnesses.  Our review of the Canine Orthopaedic Examination Report only addresses the length of the Orthopaedic Waiting Period.  A comprehensive review of your dog’s medical information to determine Pre-Existing Conditions   is not performed as part of this review and must be requested separately.  Regardless of when the medical history is reviewed, any condition noted in the medical history prior to the end of the Orthopaedic Waiting Period is a Pre – Existing Condition even if the condition is not noted on the Canine Orthopaedic Examination Report form.

PART 3 – COVERAGE

If shown in the Schedule Page(s), the following coverages apply separately to each Pet.

1. Coverage

We will reimburse you for Allowable Charges up to 70% of the total invoice, subject to Co – Payment requirements, for Treatment(s) performed for conditions that started after the Waiting Period and during the policy period, which result from:

1. Accidents, including but not limited to an automobile Accident, ingestion of a foreign body, poisoning, animal bites, gastric torsion, and cruciate ligament rupture, as well as Accidents resulting in dental trauma, burns and fractures; (if shown as applicable on the Schedule Page(s)); or
2. Illnesses, including but not limited to Genetic Conditions, cancer, and Chronic Conditions (if shown as applicable on the Schedule Page(s)).

We will reimburse you for the cost of Treatment your Pet receives in the current period of insurance for an Illness or Injury that first showed Clinical Signs after the end of the Waiting Period.

Coverage is up to the Lifetime Maximum as shown on the Schedule Page(s), subject to the Co – payment requirements.

1. Coverage will not extend outside of the country of Barbados. Should your pet be insured and travel outside of Barbados, on return to Barbados, your pet will be required to undergo a waiting period of 14 days before coverage will resume.

 

2. Benefits

We will reimburse you for Medically Necessary Treatment, including tax, for:

1. Physical examination;
2. Surgery;
3. X-rays, ultrasounds, and other diagnostic tests;
4. Professional Services rendered by your Veterinary Provider;
5. Medical supplies required to perform covered procedures performed in the Veterinarian’s office and other medical supplies, where deemed Medically Necessary by the Veterinarian, such as but not limited to an Elizabethan collar; bandages, penrose drains, splints, casts.
6. *Laboratory tests required by your Veterinary Provider;
7. Hospitalization required in order for your Veterinary Provider to deliver Professional Services to your Pet; Once your Veterinary provider discharges your pet, any additional hospitalisation requested by you or otherwise will not be covered.
8. **Medication that is prescribed and directly administered by a Veterinary Provider for the problem the pet was seen for.
9. Medication administered during a hospital stay;
10. Endodontic Treatment for dental Injuries, such as root canals and crowns or extractions, where deemed Medically Necessary by our Medical Director;
11. Euthanasia where necessary for humane reasons;
12. Cremation of your pet.

*Shipping costs for laboratory tests sent overseas will not be covered in any plan

**Medication coverage will be deducted from the maximum allowable coverage of the pet based on the plan

3. Co-Payment

Your Co-Payment is necessary for each submitted claim.  We will reduce your Claim reimbursement by your Co-payment which is 30%.  Hence a maximum of 70% will be re-imbursed for all allowable veterinary medical expenses for your pet.

PART 4 – EXCLUSIONS

Please read the following exclusions carefully.  If an exclusion applies, we will not provide Coverage under this policy and you will not be reimbursed for any cost of Treatment you have paid for.  We do not cover:

1. Pre-existing Conditions;

In addition, the following Illness or Injury shall be considered Pre–existing Conditions:

1. If your Pet has had Clinical Signs, prior to being insured, of a Bilateral Condition on one side of the body, she/he runs a higher risk of the same condition on the other side of the body and future occurrences of the same condition will not be covered. For example, but not limited to, if a dog has been diagnosed with a cruciate tear in his left leg before the end of the Waiting Period, a subsequent cruciate tear in his right leg shall be considered Pre–existing;
2. Any Pet diagnosed or treated for intervertebral disk disease (IVDD), any spinal vertebral problem or hip dysplasia prior to the end of the Waiting Period runs a higher risk of further episodes of IVDD and will not be covered for any future incidences of this condition.
3. If a Pet has been diagnosed or treated for any form of cancer prior to the end of the Waiting Period, further incidences of any form of cancer in any location in the body are not covered. This exclusion includes any conditions that are a direct result of the cancer.
4. If a Pet has been diagnosed or treated for but not limited to hyperthyroidism, cardiac disease, Hyperadrenocorticism, hypothyroidism, Diabetes and epileptic seizures prior to the end of the Waiting Period, any Treatments and Medications are not covered, as well as any kidney, heart, and high blood pressure conditions that may develop as a result of the above.
5. If a Pet has been treated for Undiagnosed tumors or masses prior to the end of the Waiting Period, any tumor or mass, or condition where a tumor or mass is a Clinical Sign, is not covered, including those caused by cancer. If the cause of the mass that occurred prior to the end of the Waiting Period can be diagnostically narrowed down via cytology or biopsy, un-related conditions may be covered.
6. Any injury to a person, animal or damage to property by your pet is not covered. In the case whereby your pet has accidentally suffered injuries from another animal, only your pet’s treatment will be covered.

However, for the purposes of this exclusion, those conditions that started prior to the end of the Waiting Period that have not shown any Clinical Signs for a period of twelve (12) consecutive months shall not be considered Pre-existing Conditions:

Specific situations include but are not limited to:

1. If your Pet showed Clinical Signs of any Dermatological Condition prior to the end of the Waiting Period, your Pet must be free of any Dermatological Conditions for six(6) consecutive months before any Dermatological Conditions may be covered again.
2. If your Pet has been treated for Undiagnosed vomiting and/or diarrhoea prior to the end of your Pet’s Waiting Period, your Pet must be free of conditions with the same Clinical Signs for six (6) consecutive months before any conditions with the same Clinical Signs may be covered again.
3. Preventative Care including, but not limited to, wellness exams or tests; preventative Treatment, tests or diagnostic procedures; vaccinations; flea and other parasite prevention; spaying or castration (including preventative sterilization surgery, such as for Treatment for cryptorchidism, chimerism, or chromosomal abnormalities); grooming and de-matting; nail trims; routine ear cleaning or plucking of fur from the ears; baths.
4. If your pet is treated with medication used to treat pruritus (itching) associated with allergic dermatitis (inflammation of the skin) or atopic dermatitis in dogs without performing an allergy test panel. Such medications include but are not limited to Apoquel or Cytopoint.
5. Treatments for Accidents or Illnesses arising from any Pre – existing behavioural problems. For example, a dog that has persistently eaten foreign objects prior to the Pet Original Start Date shall not be covered for Treatment during the policy period for similar episodes;
6. Parvovirus- If your pet was not vaccinated by a registered Veterinarian in Barbados and proof of vaccination is not provided, no coverage will be allowed. If your puppy missed any of the 3 vaccines needed for Parvo by more than 1 week and then is diagnosed with Parvo up to the age of 10 months, no coverage will be allowed.
7. More than one (1) removal of an ingested foreign body in one (1) period of insurance;
8. More than one(1) orthopedic procedure in one (1) period of insurance
9. More than one (1) bladder surgery in one (1) period of insurance
10. Any Illness as a result of a covered Accident that is not part of the initial course of Treatment for that Injury. For example, future Treatment(s) for liver damage from an accidental poisoning incident.  This exclusion does not apply to policies with Illness Coverage;
11. Ambulance transportation; This exclusion does not apply to policies on the Healthy Paws Premium pet insurance plan.
12. The cost of burial or cremation of your Pet’s remains unless on the Healthy Paws Premium pet insurance;
13. The cost of boarding your Pet;
14. Treatment for Dental Illness from lack of regular care;
15. Orthodontic Treatment other than treated required as a result of an accident;
16. Costs of Treatments arising from your decision to pursue a course of Treatment other than that which was recommended to you by your Veterinarian, unless specifically authorized by us prior to Treatment. Examples include:
17. Cost of Treatments continued after a Veterinarian has recommended a Pet be euthanized for humane reasons;
18. Ignoring a Veterinarian’s recommendation to amputate a leg, resulting in extra costs associated with Treatment of gangrene;
19. Ignoring a Veterinarian’s recommendation to remove an eye, resulting in extra costs associated with chronic eye issues;
20. Treatment for any Injury or Illness deliberately caused by you, your family members, anyone living with you, or any other persons who have care, custody, or control of your Pet;
21. Treatment for Injury or Illness caused by deliberate endangerment of your Pet, such as organized fighting;
22. Treatment for Injury or Illness caused by persistent neglect of your Pet;
23. Treatment for any Injury or Illness resulting from activities related to racing, personal protection, law enforcement or guarding, unless specifically authorized by us prior to the Pet Original Start Date as shown on the Schedule Page;
24. Cosmetic, aesthetic, or elective surgery including tail docking, ear cropping, de–clawing or any other surgical procedure not related to Injury or Illness or any secondary complications to the above or related procedures.
25. Prescription Medication that is not directly prescribed or administered by a Veterinary Provider
26. Natural supplements, vitamins, and all foods, whether prescribed or not, including but not limited to Denamarin, glucosamine, probiotics, shampoo, conditioner, or non medicated ear cleaner;
27. Treatments for any Illness for which a vaccine is available for your Pet to prevent such Illness and for which vaccination is both recommended by your Veterinary Provider and rejected by you. For the purposes of this exclusion, such Illness shall include but not be limited to “core vaccinations” as recommended and performed by the Barbados Veterinary Association for your dog or “highly recommended vaccinations” as recommended and performed by the Barbados Veterinary Association.
28. Any administration fees charged by a Veterinary Provider or others, including chart set-up fee or for providing information which may be required by us;
29. Services performed by Veterinary Provider for his/her own cat or dog;
30. Costs for any Treatment for:
31. Organ transplants;
32. Genetic/chromosome testing;
33. Semen analysis
34. Vaginal cytology to stage the period of the estrus cycle
35. Procedures to determine the suitability or categorization of your Pet for breeding or genealogical purposes, including PennHIP and OFA evaluations;
36. Costs related to breeding, pregnancy, whelping or queening unless deemed medically necessary by our Medical director. This includes Progesterone testing.
37. Costs arising from cell-replacement therapies, except where deemed Medically Necessary by our Medical Director;
38. Costs for any Treatment arising from:
39. avian, swine, or any other type of influenza or any mutant variation;
40. intentional slaughter by, or under, the order of any government or public or local authority;
41. epidemics or pandemics
42. Costs for any Treatment arising from a nuclear reaction, radiation, radioactive contamination or the discharge of a nuclear device, whether controlled or uncontrolled, accidentally or otherwise;
43. Costs for any Treatment arising from a chemical, biological, bio-chemical or electromagnetic weapon, device, agent or material whether controlled or uncontrolled, accidentally or otherwise;
44. Costs for any Treatment arising from war, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection, military or usurped, strikes, riots, or civil commotion.

PART 5 – LIMITS OF INSURANCE

Regardless of the number of Claims made or covered Injuries or Illnesses that occur during the period of insurance, our total liability of insurance for all covered benefits shall not exceed the amounts allocated to each category of policy. For the Healthy Paws Basic Pet Insurance plan, the total allowed coverage for a pet is BBD 7,500.00 over the life of the pet and for the Healthy Paws Premium Pet Insurance, the total allowable coverage for a pet is BBD 10,500 over the life of the pet.

PART 6 – ADDITIONAL COVER FOR POLICYHOLDERS

If shown as applicable in the Schedule Page(s), the following optional coverages apply separately to each Pet.

1. Prescription Drug Coverage:

We will reimburse you for the costs of Medications your Veterinarian prescribes as part of your Pet’s Accident or Illness Treatment that started after the Waiting Period and during the policy period.

This Prescription Drug Coverage will not increase the Annual Maximum limits of insurance. total allowable Lifetime coverage for the basic plan is BBD $1,000.00

The total allowable Lifetime coverage for the premium plan is BBD $1,500.00.

 

The Co-Payment requirements apply to this Optional Coverage.

2. Ambulance Care Coverage:

We will reimburse you for Pet ambulance transport costs in the case of a medical emergency.

This Ambulance Care Coverage is ONLY applicable to the Premium plan and will not increase the Maximum Limits of Insurance.  The Co-Payment requirements apply to this Optional Coverage.

3. Final Respects Coverage:

We will reimburse you for the cost of final expenses for cremation upon the death of each Pet covered for such costs incurred after the Waiting Period and during the policy period.

This Final Respects Coverage is ONLY applicable to the Premium plan and will not increase the Annual Maximum limits of insurance.  The Co-Payment requirements apply to this Optional Coverage.

PART 7 – OTHER TERMS AND CONDITIONS

1. Paying Your Premiums

Your policy does not become legally binding until you have paid your premium.  The premium is payable when you take out a new policy and when you renew an existing policy.  Your policy is an annual contract of insurance.  You must pay your premiums in full and on time to remain covered.

2. Cancellation

Notwithstanding anything contained in this Insurance to the contrary you may cancel this insurance at any time by written notice.  This Insurance may also be cancelled by us or on our behalf by delivering to you or by mailing to you, at your address as shown in this Insurance, written notice stating when, not less than 30 days thereafter, the cancellation shall be effective.  The mailing of notice as aforesaid shall be sufficient proof of notice and this Insurance shall terminate at the date and hour specified in such notice.  If you cancel this Insurance we will retain the customary short rate proportion of the premium hereon subject to our standard Minimum Premium.  If we cancel this Insurance we shall retain the pro rata proportion of the premium hereon.

3. Nonrenewal

If we decide not to renew or continue this policy, we will mail notice of non-renewal to the named insured shown on the Declaration at the last known address appearing in our records.

4. Misrepresentation, Concealment, or Fraud

This policy is void in any case of fraud, intentional concealment, or misrepresentation of a material fact, by you or any other insured, at any time, concerning:

1. This policy;
2. Your Pet;
3. Your interest in your Pet; or
4. A Claim under this policy.

 

5. Rights

In the event we reimburse a Claim contrary to the policy terms and conditions, this payment will not constitute a waiver of our rights to apply the terms and conditions retrospectively as they stand to any paid Claims or to any future Claims for that or any related condition.  We reserve our right to recover from you any Claim reimbursement paid in error.

6. Splitting of Charges

In the event an Allowable Charge is for both covered and non-covered conditions, the Allowable Charge may be split into a covered and a non-covered Allowable Charge to calculate your Claim reimbursement.

7. Increasing Coverage

In the event you choose to increase your Pet ’s coverage after the Original Pet Start Date, the Waiting Period and the determination of Pre-Existing Conditions reset as of the date of the coverage change.  There is no reset for a decrease in coverage.

8. Allowable Charges Disputes

In the event that your Veterinary Provider charges an amount for Treatments in excess of those typically charged in your geographic area for identical Treatments or Professional Services or Treatments that are not Medically Necessary, we reserve the right to dispute the amount of the Allowable Charges to be reimbursed.

9. Other Insurance

You may have other insurance subject to the same plan, terms, conditions and provisions as the insurance under this policy.  If you do, we will pay our share of the Allowable Charges.  Our share is the proportion that the applicable Limits of Insurance under this policy bears to the Limits of Insurance of all insurance covering on the same basis.

If there is other insurance covering the same Allowable Charges, other than that described above, we will pay only for the amount of Allowable Charges in excess of the amount due from that other insurance, whether you can collect on it or not.  But we will not pay more than the applicable Limits of Insurance.

It is your responsibility to notify us in the event that other insurance is in force.  Failure to do so may be considered concealment and may render Coverage provided under this policy null and void and all outstanding Claims shall be forfeited and not paid.

10. Transfer of Rights of Recovery Against Others to Us

If the insured has rights to recover all or part of any payment we have made under this policy, those rights are transferred to us.  The insured must do nothing after loss to impair them.  At our request, the insured will bring “suit” or transfer those rights to us and help us enforce them.

11. Joint and Individual Interests

If there is more than one Named Insured on this policy, any Named Insured may cancel or change this policy.  The action of one Named Insured shall be binding on all persons afforded Coverage under this policy.

12. Transfer

This policy may not be transferred to another person without our written consent.

13. Period of Insurance and Territory

This policy applies only to Injuries and/or Illnesses occurring during the policy period shown on the Declaration and which occur in Barbados.

14. Electronic Delivery

By accepting the terms of this insurance as evidenced by the payment of premiums, you agree that this policy, any endorsements and any notices shall be delivered to you by electronic mail via the Internet.

 

PART 8 – HOW TO FILE A CLAIM

Contact Information

Central Veterinary Clinic and/or Central Vet South

Lower Estate Complex, St. Michael

1. Claim Procedure

Any Claim you make will be assessed fairly, reasonably and promptly by Central Veterinary Clinic against the information you provide and the terms of the policy

1. All Claims will then be submitted to CG United by Central Veterinary clinic
2. CG United will review the claim submission and will send the reimbursement back to Central Vet who will then contact the insured for payment.
3. The reimbursement will be within 60 days of CG United receiving the claim information.
4. You must provide all itemised invoices from your Veterinary Provider along with your completed Claim form before we will reimburse you. Save the originals in case we require them from you.
5. You must cooperate with us in the investigation or settlement of the Claim.