The reimbursement rate is the number buyers understand fastest and compare worst. It looks like a simple quality score, where 90 beats 80 and 80 beats 70. What it actually describes is how you and the insurer split the bill after two other numbers have already done their work. This page shows the calculation order and what each tier returns on identical bills. It also covers the specific mistake of pricing a 90 percent policy against an 80 percent one as though the rest of the policy matched.
What is a pet insurance reimbursement rate?
A reimbursement rate is the percentage of your remaining covered bill the insurer pays you back, applied after the deductible and capped by the annual limit. On a hypothetical $1,000 covered bill with a $250 deductible, an 80 percent rate returns $600 and a 90 percent rate returns $675.
The share you keep is called coinsurance in the rest of the insurance world, and it exists to keep your incentives pointed the same direction as the insurer's. At 90 percent you still pay a tenth of every treatment decision. At 70 percent you pay nearly a third. That is a policy design choice, not a defect of the cheaper tier.
In what order is a pet insurance claim calculated?
Every US insurer runs the same three steps in the same order: excluded items come off the invoice, the deductible comes out next, and the percentage applies to what remains, up to the annual limit. Get the order wrong and every estimate you make will be too high.
- Strip the invoice to covered charges. Vaccinations, spay and neuter surgery, and pre-existing conditions are removed before anything else happens. What survives is the covered bill.
- Subtract the deductible. This is either your remaining annual deductible or a fresh per-condition deductible, depending on the structure explained in how pet insurance deductibles work.
- Apply the percentage, then test the cap. The insurer pays your rate on the balance, unless the annual limit has already been reached.
Reversing steps two and three is the most common claim-day surprise. On that $1,000 bill, taking 90 percent first and then subtracting the deductible reads as $650, which is $25 short of the real answer. The gap widens as bills grow.
What does each reimbursement rate pay back on the same bill?
On identical bills the tiers differ by a fixed amount per step, because each ten points of reimbursement returns ten cents more on every post-deductible dollar. Here is a hypothetical $2,000 covered bill against a $250 annual deductible, which leaves $1,750 to split.
| Reimbursement rate | Insurer pays | You pay in total |
|---|---|---|
| 70 percent | $1,225 | $775 |
| 80 percent | $1,400 | $600 |
| 90 percent | $1,575 | $425 |
| 100 percent | $1,750 | $250 |
Each ten-point step is worth $175 on this bill, because $175 is ten percent of the $1,750 balance. That is the entire mechanism. Nothing else about the tier changes when you move a step up or down.
Scale it to a real procedure and the same rule holds. CareCredit's veterinary cost guide puts a TPLO cruciate ligament repair at about $3,525 per knee, and billed costs vary widely by region and clinic. After a $250 deductible, the balance is $3,275, so the gap between 80 and 90 percent on that single claim is about $328.
How much does a higher reimbursement rate add to your premium?
A higher reimbursement rate raises your monthly premium at every insurer, because it transfers expected claim cost from you to the carrier. The direction is certain; the size is specific to your pet, your zip code and the insurer, and we will not publish a figure we have not collected.
Our own dated premium samples across the reimbursement tiers are pending first quote run. The collection rules we hold ourselves to are set out in our ratings and pricing methodology, and the five-step process for pulling comparable numbers yourself is in how to get pet insurance quotes. Price the identical pet at 80 and at 90 percent with everything else held constant, and the difference on your screen is the real answer for your pet.
Is a 90 percent policy better than an 80 percent policy?
A 90 percent policy is better only if the extra premium costs less than the extra payout you actually collect, which is a claim-volume question rather than a quality question. The break-even is easy to compute from your own two quotes.
Take the annual premium difference between the 90 percent and 80 percent versions of the same policy, then multiply it by 10. That product is roughly the amount of post-deductible covered billing you need in a year before the upgrade pays for itself. Bill less than that and the 80 percent policy wins; bill more and the 90 percent policy wins. The multiplier is 10 because each ten points is worth ten cents on the dollar.
Two traps sit inside the comparison, and both cost more than the tier choice itself.
- Mismatched quotes. Comparison tables routinely set a competitor at 70 percent with a $5,000 cap against a 90 percent plan with a $20,000 cap, then present the price gap as a verdict. A quote is only comparable when species, breed, age, zip code, deductible, limit and rate all match.
- The cap outranks the percentage. On a hypothetical $12,000 claim year with a $250 deductible, a 90 percent policy capped at $5,000 pays $5,000. A 70 percent policy with no annual cap pays $8,225 on that same year. The lower percentage returns more money because the higher one ran into its ceiling.
Does 100 percent reimbursement mean you pay nothing?
No. A 100 percent tier means the insurer covers the whole balance after the deductible, so you still pay the deductible, every excluded charge, and everything above the annual limit. Figo is the verified US insurer offering a 100 percent option, and the tier carries the highest premium in any menu that sells it.
On the $2,000 example above, the 100 percent tier still left you $250 out of pocket. On an invoice that mixes covered treatment with wellness items, it leaves more than that, because the excluded lines never entered the calculation. Compare the tier against the Figo pet insurance review rather than against the headline number.
Why does the payout come in below the headline percentage?
Payouts land below the headline rate because the percentage applies to covered charges only, and real invoices carry lines your policy does not cover. An owner holding a 90 percent policy who gets back 62 percent of what the clinic charged has usually met the rules exactly, not been shortchanged.
Three things shrink the base before the percentage touches it: items excluded by the policy class you bought, the remaining deductible, and any charge tied to a pre-existing condition. The full exclusion matrix by insurer is in what pet insurance covers. Reading it before you file is the difference between a fair payout and a fight.
The honest limitation of this whole page: none of the arithmetic predicts your year. The tier choice is worth ten cents on the dollar of claims you cannot forecast. Owners who claim rarely tend to conclude the lower tier was right, and owners who claim heavily conclude the opposite. Both are describing the same policy from different ends of a distribution.
Which reimbursement rate should you choose?
Choose 80 percent as the default, because it splits the cost of an unpredictable year without buying the most expensive tier for claims you may never file. Move up or down for a stated reason rather than for the look of the number.
- Take 90 or 100 percent when you would approve any treatment regardless of price, or when the breed carries a known orthopedic or chronic risk that makes heavy claiming likely.
- Take 70 percent when the monthly cost is the binding constraint, and spend the savings on a higher annual limit instead. Catastrophe protection beats percentage points.
- Take any tier only after checking the cap, because the annual limit decides the worst year and the percentage only decides the ordinary one.