Research reviewed August 6, 2026. A pet-insurance plan that advertises 90% reimbursement does not necessarily pay 90% of the veterinarian’s entire invoice. The percentage is normally applied only to expenses the policy considers eligible, and the final payment can also be reduced by the deductible, exclusions, benefit limits, and the owner’s coinsurance share.
This guide explains the arithmetic in plain language. It is educational information, not an insurance quote or personalized recommendation. Policy forms and claim calculations vary by insurer and state, so the issued policy and explanation of benefits control.
The basic claim calculation
A useful starting formula is:
Eligible expenses − remaining deductible = reimbursable amount
Reimbursable amount × reimbursement percentage = estimated insurer payment
That formula is common, but it is not universal. Some older or specialized policies may apply a different order, use a benefit schedule, or limit reimbursement to a stated usual-and-customary amount. Always confirm the exact method in the sample policy.
Quick comparison
| Plan choice | Insurer share of eligible expenses after deductible | Owner coinsurance share |
|---|---|---|
| 70% | 70% | 30%, plus the deductible and noncovered charges |
| 80% | 80% | 20%, plus the deductible and noncovered charges |
| 90% | 90% | 10%, plus the deductible and noncovered charges |
Example: one invoice, three reimbursement levels
Suppose a veterinary invoice totals $4,000. The insurer determines that $3,600 is eligible because $400 consists of excluded examination fees or other noncovered items. The policy has $500 of deductible remaining.
- Eligible amount: $3,600
- After the deductible: $3,100
- At 70%: estimated payment $2,170; owner pays $1,830 of the original bill
- At 80%: estimated payment $2,480; owner pays $1,520
- At 90%: estimated payment $2,790; owner pays $1,210
The owner’s total is not merely the 10%, 20%, or 30% coinsurance. It also includes the deductible and every charge the policy excludes. If the annual or per-condition limit has been reached, the payment can be lower still.
Five amounts that should never be confused
1. Total invoice
This is everything the veterinary practice charged. It may include examination fees, taxes, preventive care, food, supplements, boarding, grooming, or other items the accident-and-illness policy does not cover.
2. Eligible expenses
These are the charges left after the insurer applies the policy’s coverage rules and exclusions. The reimbursement percentage is usually calculated from this smaller amount, not automatically from the full invoice.
3. Deductible
The deductible is the eligible amount the owner must absorb before reimbursement. Whether it is annual, per incident, or lifetime per condition determines when it must be met again. See our guide to annual and per-condition deductibles.
4. Coinsurance
Coinsurance is the percentage of eligible expenses the owner retains after the deductible is satisfied. With 90% reimbursement, the owner’s coinsurance is normally 10%—but only within the claim amount that remains eligible.
5. Benefit limit
An annual, per-incident, per-condition, or lifetime maximum can cap payment even when the underlying treatment is covered. “Unlimited” benefits remove that particular ceiling; they do not remove deductibles, coinsurance, waiting periods, or exclusions.
Why two 90% plans can pay different amounts
Plans displaying the same percentage may define eligible expenses differently. One may include examination fees while another excludes them. One may reimburse the actual eligible veterinary bill while another policy uses a fee schedule or another allowed-amount method. Rehabilitation, alternative therapy, prescription food, dental illness, behavioral treatment, and take-home medications may also be handled differently.
The deductible structure matters too. An annual deductible may already have been satisfied by an earlier unrelated claim. A lifetime per-condition deductible may still be outstanding for a newly diagnosed condition. The advertised reimbursement percentage alone cannot reveal those differences.
Giant-breed considerations
For a giant dog, a single orthopedic surgery, emergency admission, or chronic course of rehabilitation can create a large invoice. A higher reimbursement percentage reduces the owner’s share of eligible costs, but it often comes with a higher premium. The useful comparison is therefore not “Which percentage is biggest?” It is whether the household can manage the premium, deductible, coinsurance, excluded charges, and the possibility of paying the veterinarian before reimbursement arrives.
Direct veterinary payment can reduce the amount an owner must advance, but it may depend on the insurer, hospital participation, claim approval, and the services involved. Confirm the process with both the insurer and veterinary hospital before an emergency.
Questions to ask before choosing a percentage
- Is reimbursement calculated from the actual eligible veterinary invoice or from another allowed amount?
- Is the deductible subtracted before or after the reimbursement percentage is applied?
- Which invoice items are commonly excluded?
- Are examination fees covered in the base plan or only through an optional benefit?
- Does the plan use an annual, per-incident, or per-condition deductible?
- What annual, per-condition, or lifetime payment limits apply?
- Must I pay the veterinarian first, or can the insurer pay participating hospitals directly?
- How are multi-condition invoices divided?
- Will the explanation of benefits show each excluded charge and calculation?
- How would the same sample claim be paid at each reimbursement option offered?
A fair way to compare quotes
Request quotes using the same annual limit, deductible, reimbursement percentage, and optional benefits wherever possible. Then test each policy with the same hypothetical invoice. Separate the total bill into eligible and excluded charges, apply the stated deductible method, calculate coinsurance, and check the benefit limit.
Finally, compare annual premiums alongside the largest out-of-pocket amount your household could reasonably face. A lower reimbursement percentage may lower premiums but retain more claim risk. A higher percentage may reduce eligible claim costs but does not protect against exclusions or noncovered care.
Sources and evidence limits
- National Association of Insurance Commissioners: Pet Insurance Consumer Insight
- NAIC pet-insurance overview
- Trupanion: How Pet Insurance Works
- Embrace: How Claim Reimbursement Is Calculated
- Pets Best frequently asked questions
Provider examples explain current company practices but are not substitutes for a state-specific policy. CompareDecisions.com is not an insurance producer, broker, veterinarian, or legal adviser. We do not sell insurance, provide individualized insurance advice, or guarantee claim eligibility or payment.
Affiliate disclosure: CompareDecisions.com may seek or maintain referral relationships with providers discussed in its pet-insurance coverage. Commercial relationships do not determine inclusion, calculations, or editorial conclusions.