Accident Only Pet Health Insurance

This policy has been written in readable language to help you understand its terms.

PLEASE READ YOUR POLICY CAREFULLY

Your policy is underwritten by American Modern Home Insurance Company, rated A+ by A.M. Best.

A stock insurance company Main Office Mailing Address: P.O. Box 5323 Cincinnati, Ohio 45201-5323

Embrace Pet Insurance Agency LLC

4530 Richmond Rd Cleveland, Ohio 44128

Your policy is fully administered by Embrace Pet Insurance Agency.

READ YOUR POLICY CAREFULLY.

This cover sheet provides only a brief outline of some of the important features of your policy. This is not the insurance contract and only the actual policy provisions will control. The policy itself sets forth, in detail, the rights and obligations of both you and your insurance company.

IT IS THEREFORE IMPORTANT THAT YOU READ YOUR POLICY.

You have 15 days from the day you receive this policy to review it and return it to the company if you decide not to keep it. You do not have to tell the company why you are returning it. If you decide not to keep it, simply return it to the company at its administrative office or you may return it to the agent/insurance producer that you bought it from as long as you have not filed a claim. You must return it within 15 days of the day you first received it. The company will refund the full amount of any premium paid within 30 days after it receives the returned policy. The premium refund will be sent directly to the person who paid it. The policy will be void as if it had never been issued.

Insuring Agreement for Accident Only Policy:

We will provide the insurance described in this Accident Only policy in return for the premium and compliance with all applicable provisions and conditions of this policy. The Declarations and Schedule of Insurance show the policy period, coverages, limits of liability, and premiums. This policy is not complete without the Declarations and Schedule of Insurance. Please note: This policy is for Accidents Only. It does not provide Coverage for any Illness at

PART I – Definitions

n this policy, "you" and "your" refer to the Named Insured shown on the Declarations Page. "We", "us" and "our" refer to the Company providing this insurance. In addition, certain words and phrases are defined as follows:

Accident(s) means an unexpected or unintended event, which is specific as to place and time causing Injury to your Pet.
Aggression means an abnormal hostile response to an otherwise normal situation.
Alternative Treatment means a group of practices that may diverge from veterinary medicine routinely taught in North American veterinary medical schools and/or differ from current scientific knowledge. If a Treatment is not a generally accepted practice for the condition and type of Pet insured, it is also considered Alternative Treatment.
Ambulance means a specialized land vehicle used for the sole purpose of transporting sick or injured Pets.
Annual Maximum is the maximum amount we will reimburse you per Pet in a period of insurance.
Bilateral Condition is a condition or disease that affects both sides of the body.
Chronic Condition means a condition that can be treated or managed, but not cured.
Congenital Anomaly or Disorder means a condition that is present from birth, whether inherited or caused by the environment, which may cause or contribute to Illness or disease
Claim means your request for reimbursement of an amount under the terms of your policy for Treatment by a Veterinary Provider of your Pet.
Clinical Signs means changes in a Pet’s normal healthy state, bodily function or behavior observed by you, a Veterinarian, or other observer.
Complementary Therapies covered by this policy are acupuncture, chiropractic Treatment, laser Treatment, hydrotherapy and physiotherapy performed by a Veterinarian or a veterinary staff member under Direct Supervision of a Veterinarian.
Coverage is the insurance described in this policy
Deductible is the annual amount you pay per Pet for Treatments covered by this policy before we begin to reimburse you.
Direct Supervision means the supervisor is physically present at the location where Treatment is performed and is quickly and easily available.
Enrollment Exam means a Physical Examination having taken place within the applicable periods outlined in paragraph 1. of PART II – CONDITIONS.
Illness means sickness, disease, or any change in a Pet’s normal, healthy state.
Injury means physical harm or damage to your Pet.
Medical Boarding is a hospital stay for the Pet parent's convenience, or an abnormally prolonged stay that is not Medically Necessary hospitalization, where the therapy or Treatments provided could be completed at home by the Pet parent.
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.
Medical History Review means a comprehensive review of your Pet(s) full medical history for the twelve (12) months before your Pet was insured or the date of acquisition of your Pet, whichever is later.
Medically Necessary means directly and materially related to a covered Injury, in our reasonable judgment. Our reasonable judgment shall be based on consultation with and the advice of a Veterinarian.
Medication means any veterinary recommended items 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. FDAapproved 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. Medication includes medical supplies required to administer those Medications.
Orthopedic refers to conditions affecting the bones, skeletal muscle, cartilage, tendons, ligaments and joints. It includes, but is not limited to, elbow dysplasia, hip dysplasia, intervertebral disc degeneration, patellar luxation and ruptured cranial cruciate ligaments. It does not include cancers or metabolic, hemopoietic or autoimmune diseases.
Pet is a cat or dog named and described in the Schedule of Insurance and both owned by you and residing with you.
Pet Original Start Date means the effective date when that Pet was first covered by this policy, unless otherwise stated on the Schedule of Insurance.
Physical Examination means an exam, check-up, physical consultation, health inspection, office visit, office call, after-hour fee, referral, telemedicine consultation, telemedicine service fee, or recheck for otherwise covered conditions, that is performed by a licensed and registered Veterinarian and is documented in a written Veterinarian record.
Preventative Care means any Treatment, service or procedure, routine exam, Physical Examination, Medication, surgery, inoculations or laboratory procedures, for the purpose of prevention or for the promotion of general health.
Professional Services are diagnosing, treating, operating, or prescribing for any cat or dog.
Pre-existing Condition(s) means any condition for which any of the following are true prior to the effective date of a pet insurance policy
1. A Veterinarian provided medical advice;
2. The Pet received previous Treatment; or
3. Based on information from verifiable sources, the Pet had signs or symptoms directly related to the condition for which a Claim is being made. A condition for which Coverage is afforded on a policy cannot be considered a Pre-existing Condition on any Renewal of the policy.
Reimbursement Percentage is the amount of the covered Veterinary Expense for which you may be reimbursed.
Renewal means to issue and deliver at the end of an insurance policy period a policy which supersedes a policy previously issued and delivered by the same pet insurer or affiliated pet insurer and which provides types and limits of Coverage substantially similar to those contained in the policy being superseded.
Temporary Condition means an abnormal Clinical Sign or diagnosis, which is likely to resolve. A Temporary Condition may become a Chronic Condition.
Treatment means any examination, consultation, hospitalization, anesthesia, surgery, X-rays, MRI or CT scans, Complementary Therapies, laboratory tests, nursing or other care provided and administered by a Veterinary Provider.
Undiagnosed means the underlying or causative condition has not yet been identified.
Veterinarian means an individual who holds a valid license to practice veterinary medicine from the appropriate licensing entity in the jurisdiction in which the individual practices.
Veterinary Expenses means the costs associated with medical advice, diagnosis, care or Treatment provided by a Veterinarian, including, but not limited to, the cost of drugs prescribed by a Veterinarian.
Veterinary Provider means a Veterinarian, veterinary technician or veterinary nurse currently licensed in the state in which Treatment is performed. Technicians or nurse providers must be under the Direct Supervision of a Veterinarian to qualify as a Veterinary Provider

PART II – Conditions

We will pay covered veterinary expenses that you incur during the policy term for the diagnosis or Treatment of your Pet’s condition, up to the limits of this policy.

All Treatment must be performed by a Veterinary Provider that you may freely choose.
You must arrange for a Veterinarian to examine and treat your Pet as soon as possible after it shows Clinical Signs of Injury.
You are financially responsible to your Veterinary Provider for payment of all Treatment.
Your Pet(s) must reside with you and be under your regular care and supervision at the physical address and zip code listed on the Declarations Page
You must disclose all Veterinary Providers your Pet has seen in the twelve (12) months prior to the Pet Original Start Date. Failure to disclose all Veterinary Providers is considered concealment. (see 5. Misrepresentation, Concealment or Fraud under PART VI – OTHER TERMS AND CONDITIONS)
By purchasing a policy, you give us permission to gather all medical history for your Pet(s) from all your Veterinary Providers, as we deem necessary. The medical information must contain detailed Veterinarian examination findings and must be made available to us for review.
We will attempt to collect your Pet(s) medical history from all Veterinary Providers you inform us of at the start of your policy. However, we will not review the medical history until your Pet’s first Injury Claim is submitted, or you request a Medical History Review. If we cannot obtain your Pet(s) medical history, it is your responsibility to provide the information. If we do not have your Pet(s) medical history by the date of your Claim, it may delay the processing of your Claim and/or your Claim may be denied for a Pre-existing Condition.
When you submit a Claim, we may ask you to provide any medical records from the prior twelve (12) months and all written medical records of the Enrollment Exam that you, when you applied for this insurance, represented as having taken place. If you provide such record, we will process your Claim, subject to the terms and conditions of this policy provided there are no Pre-existing Conditions related to that Claim. If there are Pre-existing Conditions related to the Claim, your Claim will not be covered because this policy does not cover Pre-existing Conditions.

PART III – Coverage

THE FOLLOWING COVERAGES APPLY SEPARATELY TO EACH PET.

Coverage. We will reimburse you for Veterinary Expenses in excess of the Deductible amount, subject to Reimbursement Percentage amounts. This applies for Treatment(s) performed for conditions that occurred during the policy period.
1. To qualify for reimbursement under this policy, the diagnosis must be an Accident per defined by this policy in PART I definition 1.
2. Accidents
3. We will reimburse you for Pet Ambulance transport costs in the case of a medical emergency related to an Accident.
4. We will reimburse you for the costs of Medications your Veterinarian prescribes as part of your Pet's Accident Treatment that started during the policy period. Coverage is up to the Annual Maximum as shown on the Schedule of Insurance, subject to the Deductible and Reimbursement Percentage requirements.
Benefits. We will reimburse you for Medically Necessary Treatment, including tax, for:
1. Physical Examination, if Coverage is shown on your Pet’s Schedule of Insurance;
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 an Elizabethan collar;
6. Laboratory tests required by your Veterinary Provider;
7. Hospitalization required in order for your Veterinary Provider to deliver Professional Services to your Pet and post procedure in-hospital care as is medically standard by our best estimation;
8. Medication that is prescribed by a Veterinary Provider
9. Endodontic Treatment for dental Injuries, such as root canals and crowns, for all adult canine teeth, upper 4th premolar teeth, and 1st molar teeth;
10. Euthanasia where necessary for humane reasons resulting from an Accident.
11. Medical waste disposal
12. Complementary Therapy related to a covered surgical procedure or Injury which is not performed for maintenance or prevention

PART IV – 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:

Any Illness;
Pre-existing Conditions;
Treatments arising from any pre-existing behavioral problems. For example, Treatments for a dog that has persistently eaten rocks or foreign objects prior to the Pet Original Start Date shall not be covered during the policy period for similar episodes;
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, and dew claw removal;
Intervertebral disc disease and cruciate ligament injury are not covered by this policy, as it is a degenerative process, not an Accident. Though it can show signs suddenly and seem like an Accident, it is not covered as an Accident by this policy;
More than the first submitted anesthetic removal of an ingested foreign body in one (1) policy term of insurance;
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 or follow up joint rehabilitation for a cruciate ligament Injury are not covered by this policy;
The cost of boarding your Pet including Medical Boarding;
Costs of Treatment(s) 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:
1. Cost of Treatment(s) continued after a Veterinarian has recommended a Pet be euthanized for humane reasons;
2. Ignoring a Veterinarian’s recommendation to amputate a leg, resulting in extra costs associated with Treatment of gangrene;
3. gnoring a Veterinarian’s recommendation to remove an eye, resulting in extra costs associated with chronic eye issues;
Treatment for any Injury deliberately caused by you, your family members, anyone living with you, or any other persons who have care, custody, or control of your Pet;
Treatment for Injury caused by deliberate endangerment of your Pet, such as leaving your Pet in a hot vehicle with the windows closed;
Treatment for Injury caused by persistent neglect of your Pet;
Cost for Treatment of Injury that arise out of racing, commercial guarding, organized fighting or any other occupational, professional or business use of your Pet unless specifically authorized by us prior to the Pet Original Start Date as shown on the Schedule of Insurance;
Cosmetic, aesthetic, or elective surgery including tail docking, ear cropping, dew claw removal, de-clawing or any other surgical procedure not related to an Injury;
Natural supplements, vitamins, and all foods, whether prescribed or not, including but not limited to Denamarin, glucosamine, probiotics, shampoo, conditioner, or ear cleaner;
A dog who has shown any signs of Aggression prior to the Pet Original Start Date shall not be covered for Treatment for dog fights;
Professional fees and services performed by a Veterinary Provider for their own cat or dog;
Dental cleanings, even in the case of a dental Accident;
Alternative Treatments, including Reiki; Magnet Therapy; Prolotherapy; Ozone Therapy; Hyperbaric Oxygen; Electroacupuncture; Veterinary Orthopedic Manipulation; Massage; Bicom; TENS; Extracorporeal Shock Wave Therapy; or Nutritional Counseling;
Complementary Therapies performed as maintenance, prevention or not as the initial course of Treatment.

PART V – Limits of Insurance

Regardless of the number of Claims made or covered Injuries that occur during the period of insurance, our total liability for each period of insurance for all covered benefits shall not exceed the amounts shown on the Schedule of Insurance under Annual Maximum.

PART VI – Other Terms and Conditions

Paying Your Premiums. Your policy does not become legally binding until you have paid your premium. Your policy is an annual contract of insurance with the option to pay annually or monthly. You must pay your premiums in full or billed installments and on time to remain covered. Your policy will automatically renew at the end of your policy term unless you tell us otherwise or we non-renew under rare circumstances.
Cancellation.
1. You may cancel this policy at any time by calling customer service and stating the future date that you wish the cancellation to be effective
2. We may cancel this policy at any time within the first sixty (60) days of the policy period. To cancel this policy, we will mail a notice of cancellation to the Named Insured shown on the Declarations Page at the last known address shown in our records. If we cancel this policy within the first sixty (60) days after the effective date, notice of cancellation will be mailed at least ten (10) days before the effective date of the cancellation.
3. If we cancel this policy at any time due to nonpayment of premium, notice of cancellation will be mailed at least ten (10) days before the effective date of the cancellation. If this policy is cancelled for nonpayment of premium, we may, at our option reinstate the policy. However, policies cancelled for nonpayment of premium are subject to underwriting review prior to reinstatement being offered or approved. A reinstatement fee may be charged.
4. After this policy has been in effect for more than sixty (60) days, notice of cancellation due to any reason other than nonpayment of premium will be mailed at least thirty (30) days before the effective date of the cancellation.
5. After this policy is in effect for more than sixty (60) days, or if this is a Renewal or continuation policy, we may only cancel for one or more of the following reasons:
  1. You fail to pay your premium by the due date in accordance with the policy terms.
  2. The policy was obtained through fraud, misrepresentation or concealment in your application, the content of which is specifically incorporated into and as a material term of this policy
  3. We have agreed to issue a new policy with the same or an affiliated company.
  4. The Department of Insurance of the state governing the policy determines that a continuation of the policy could place us in violation of that state's insurance laws.
  5. You fail to comply with the policy terms and conditions in a manner that prejudices or negatively impacts our ability to properly assess or evaluate the Claim or other material rights we have under the policy.
  6. Failure to provide us with information we have requested that is directly relevant to the Coverage provided under this policy or any Claim.
  7. A Claim was made based on false information with the purpose of defrauding us, including but not limited to submitting invoices that have been altered or concealing past medical records.
6. With respect to cancellation, this policy is neither severable nor divisible. Any cancellation will be effective for all Coverage for all persons and all Pets. If this policy is cancelled, Coverage will not be provided as of the effective date of the cancellation shown on the notice of cancellation.
Cancellation Refund. Upon cancellation, you may be entitled to a premium refund. If you provide us notice of cancellation within thirty (30) days of the first policy term effective date and you have made no Claim, we will refund the premium you paid us and the policy will be cancelled. If you have made a Claim within thirty (30) days of the effective date, the premiums paid for or allocable to the first month of Coverage become fully earned upon the submittal of the Claim, and you will only receive a refund for any premiums paid for periods beyond the first month. After the first thirty (30) days of the policy period, we will compute any refund due on a daily pro-rata basis based on the termination date of the policy.
Nonrenewal. If we decide not to renew or continue this policy, we will mail notice of nonrenewal to the Named Insured shown on the Declarations Page at the last known address appearing in our records. Notice, including the reason for nonrenewal, will be mailed at least thirty (30) days before the end of the policy period.
Misrepresentation, Concealment or Fraud. This policy will be cancelled if, whether before, during or after a Claim, you or any other insured has;
1. Misrepresented or failed to disclose any material fact or circumstance or made any false statement related to this insurance or your Pet; or
2. Engaged in fraudulent conduct. Moreover, if a person knowingly makes a Claim based on false information with the purposes of defrauding us, that person may be guilty of insurance fraud, which is a crime. We have a duty to seek out insurance fraud and report it to the appropriate authorities. We will then cooperate fully with the authorities as required by law.
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.
Splitting of Charges. In the event a Veterinary Expense is for both covered and non-covered conditions, the Veterinary Expense may be split into a covered and a non-covered Veterinary Expense to calculate your Claim reimbursement
Increasing Coverage. In the event you choose to increase your Pet’s Coverage after the Pet Original Start Date, including lowering your Deductible, increasing the Annual Maximum, adding Physical Examination Coverage and/or Medication Coverage, or increasing the Reimbursement Percentage, the determination of Pre-existing Conditions reset as of the date of the Coverage change. There is no reset for a decrease in Coverage.
Adding a Pet Mid-term. All Pets in the same household are on the same policy. If you add a Pet to your policy midterm, the new Pet will have the same policy term Renewal as your existing Pet. The Deductible you choose for the new Pet will apply to the remainder of the policy term, even though it is not twelve (12) full months. The premium can change at Renewal regardless of how soon it occurs.
Veterinary Expenses 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, we reserve the right to dispute the amount of the Veterinary Expenses to be reimbursed. Should we fail to resolve such disputes to your satisfaction, such disputes shall be resolved by means of the procedures listed in the CLAIMS, APPEALS AND COMPLAINTS ENDORSEMENT.
Promotional Offers Insurance. Each Named Insured may occasionally receive promotional offers, which include but are not limited to gift cards, coupons, gift certificates, and items of merchandise. The maximum value of any promotional item will not exceed $50.
Other Insurance. This insurance is excess over any other insurance covering your Pet that is provided by a policy issued by any other insurance company, whether collectable or not. 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.
Transfer of Rights of Recovery Against Others to Us. If the Named Insured has rights to recover all or part of any payment we have made under this policy, those rights are transferred to us. The Named Insured must do nothing after loss to impair them. At our request, the Named Insured will bring suit or transfer those rights to us and help us enforce them
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 or Additional Insured shall be binding on all persons afforded Coverage under this policy.
Transfer. This policy may not be transferred to another person without our written consent. This Coverage is not transferable to other Pets.
Period of Insurance and Territory. This policy applies only to Injuries occurring:
1. During the policy period as shown in the Declarations; and
2. Within the policy territory. The policy territory is The United States of America, its territories or possessions. Exceptions may be made for military deployments and vacations as long as the Named Insured’s primary residence is located in the policy territory.
Electronic Delivery. By accepting the terms of this insurance as evidenced by the payment of premiums, it is agreed that, unless otherwise notified by you, all documents, notices and communications regarding this policy, other than documents required to be delivered by another method, may be delivered to you by electronic mail using the email associated with your account. It is your responsibility to keep your contact details including email address current and correct.
Conformity to State Statutes. When this policy’s provisions conflict with the statutes of the state in which this policy is issued, the terms and conditions are amended to conform to such statutes.
Our Right to Recover Payment. If we make a payment under this policy and the person to or for whom the payment was made has a right to recover damages from another, we shall be subrogated to that right. That person shall:
1. Sign and deliver to us any legal papers relating to that recovery;
2. Do whatever is necessary to enable us to exercise our rights; and
3. Do nothing after loss to prejudice them. If we make a payment under this policy and the person to or for whom payment is made recovers damages from another, that person shall:
  1. Hold in trust for us the proceeds of the recovery; and
  2. Reimburse us to the extent of our payment.
Policy Renewal. We will automatically renew your policy at expiration unless you are otherwise notified of nonrenewal. If we offer to renew or continue and you or your representative does not accept, this Policy will automatically terminate at the end of the current policy period. Failure to pay the required Renewal or continuation premium when due shall mean that you have not accepted our offer. We may change the premium, Reimbursement Percentage amounts, Deductible, policy terms and conditions at Renewal. You will be notified of changes in writing.
Deductible and Reimbursement Percentage. Your Deductible is an annual amount. We will apply the Deductible to your Veterinary Expenses and then apply your Reimbursement Percentage to the remainder to determine your Claim reimbursement.
Your Duties in the Event of a Claim.
1. You must provide us with notice of loss within 60 days of your policy end date or Renewal
2. You must submit complete and legible itemized receipts for Veterinary Expenses that identify your Pet by name.
3. You must provide us with all medical records or requested documentation from your Veterinarian(s) relating to your Pet's health upon our request.
4. You must submit to an examination under oath at our request and give us a signed statement of your answers.
5. You must cooperate with us in the investigation or settlement of the Claim.
Suit Against Us. No action can be brought against us unless there has been full compliance with all of the terms of this policy and the action is started within three (3) years after the date of loss.

Signiture of secretary and president for
Accident only Terms and Conditions Document