> _Markdown transcription of Cove Pet Insurance Cove Pet Insurance policy wording, effective 2026-05-18. Source: https://www.coveinsurance.co.nz/wp-content/uploads/2022/05/Pet-Insurance-Policy-CovePet012022.pdf_ --- # Pet Insurance Policy Wording Version: CovePet01 2022 Questions? 0800 268 347 support@coveinsurance.co.nz Made with 💖 in New Zealand --- # My Cove All Cove customers get access to My Cove, where you can see all your policies and manage them 24/7. From My Cove, you can: - Amend your personal details - Make changes to your policy - Lodge a claim - Buy additional policies - Cancel a policy - Refer a friend - Update your payment details My Cove is the quickest way to get anything done with Cove. If you do need additional assistance however, our friendly staff are available to help. If this is your first policy, your login details will be delivered shortly via email. ## Queries If you have any queries about your policy or ever need to make contact, you can do so by either: - Visiting or chatting with us at coveinsurance.co.nz - Emailing us at support@coveinsurance.co.nz - Calling us on 0800 26 83 47 ## Claims To make a claim or to enquire about a claim already made: - Head online to coveinsurance.co.nz, or - Call us on 0800 268 347 option 1 --- # 1. Certificate of insurance The Certificate of insurance is our understanding of you and your pet being insured. This is the information you have provided when you took out the policy, or sometime since, and on which we have based our pricing and terms of cover. It is critical that this is reviewed on a regular basis to ensure all the information is correct at all times. Failure to notify us of changes to any of this information may result in claims being declined and your cover being affected. Please note this is provided as a separate PDF document when you purchase your policy. You can find it in My Cove whenever you need it. --- # 2. Key features of Cove pet insurance ## A. Primary Cover Cove pet insurance provides financial help if your pet unexpectedly becomes ill or suffers an accident and requires expensive vet treatment by reimbursing vet expenses up to the benefit limits, as explained in section 4. ## B. Additional Cover In addition, we provide you with the following complementary benefit if needed, as explained in section 4: - Emergency boarding costs for your pet ## C. Optional Covers The following optional covers are offered for the Major + Minor plan only, as explained in section 4: - Dental illness - Everyday stuff ## D. What we pay We will pay you our share of the eligible vet expenses and other costs, as summarised by the covers in A, B, & C above and provided in section 4, less your excess and co-payment. ## E. Pay your premium You must pay the premium when you apply for a new policy and when you renew your policy. This is the amount stated on the certificate of insurance. ## F. What we will not pay Some things are not covered and some benefits have limits. Refer to section 5 Policy exclusions and as further set out in each benefit or condition. ## G. How to make a claim Is explained in section 7 Claims. ## H. Insurer When you purchase this policy it is a contract of insurance with Aioi Nissay Dowa Insurance Co., Ltd. ## I. Cancellation You may cancel your policy at any time. You may be eligible for a refund of all or part of your premium paid dependent on the circumstances – refer section 6e for detail. We may cancel your policy in certain circumstances - refer to section 6e for detail. ## J. More than one policy We have a refer-a-friend program which rewards customers when they introduce new customers or when you buy an additional policy. When this happens your "friend" receives a free month (up to $100 including GST) and so do you. Additional terms and conditions apply to this and can be reviewed here. --- # 3. Your responsibilities ## A. Read the policy This is your policy document which describes what is covered, how it works and your responsibilities. Your Cove pet insurance policy consists of this policy document, your certificate of insurance, any other documents we tell you form part of your policy, the information you provided to us when you applied for cover, and any subsequent information you provide. Please take the time to read this policy document so you understand it and can be sure it meets your needs. We have used headings to help you interpret this policy document. These headings are purely descriptive in nature. You should not rely on headings to interpret the policy. Words with special meaning specific to this policy are indicated in the text in italics and defined in section 10. The singular includes reference to the plural and vice versa. ## B. Free-look (14 days) If you decide this insurance isn't what you intended and you haven't made a claim, you may cancel your policy within 14 days of buying the policy and you will receive a full refund of the premium paid. ## C. Pay your premium Your premium is stated on the certificate of insurance. You must pay the premium when you apply for a new policy and when you renew your policy. If you do not pay your premium we may be entitled to: - reject payment of a claim; - reduce a claim payment; or - cancel your policy or treat it as though it never existed. ## D. Look after your pet and maintain your pet's health care You must take reasonable care of your pet and undertake treatment prescribed by a vet to prevent illness or sickness. You should immediately take your pet to a vet as soon as it shows symptoms of being unwell to be examined and treated without delay. Your pet must always be in your care or a trusted friend or in the care of a registered and recognised animal care institution like a registered cattery or boarding kennel. ## E. Assist us when making a claim We'll need your help providing information about your pet and its accident or illness to support your claim including access to your vet and records about your pet. Any difficulty with this may slow down or render your claim invalid. ## F. Keep us up to date With your email, address and phone contact details. --- # 4. Explanation of covers provided This section describes details of the benefits and limits available for the cover you have chosen, as shown on your certificate of insurance, subject to the terms, conditions, limits and exclusions which apply as described in the policy documents. ## Eligibility for applicable benefits ### Entry age of new pets From 8 weeks up to 5 years of age. ### Lifelong cover Provided there is no break in cover, we will offer renewal of your policy at each renewal for so long as we continue to provide this product. We may also change the terms and conditions of the policy upon renewal based on the risk associated with insuring pets like yours. At the time of renewal, we will send you a renewal notice confirming changes (if any) to the terms and conditions of the policy and premiums. ### Dog breeds excluded Your pet may not be one of the following dog breeds (or a cross including this): - Pit Bull Terrier - Dogo Argenino - Perro De Presa Canario - Dogo Canario - Dingo - Japanese Tose - Fila - Brasileiro - Czechoslovakian Wolfdog - Saarloos Wolfhound/Wolfdog - Any wolf hybrid ### Waiting period - 21 days for illness conditions - 0 days for accidental injury - 6 months for cruciate ligament conditions and intervertebral disc disease (IVDD) ### Annual benefit limit for Accidental injuries and illness conditions is combined as stated in the certificate of insurance. ### Exclusions Refer to section 5 Policy exclusions and as further set out in each condition or benefit. --- ## Accidental injuries ### What we will pay We will pay you our share of the vet expenses incurred and paid by you up to the annual benefit limit for treatment of your pet during the policy period as a result of your pet suffering an accidental injury, less any applicable co-payments and excesses. You will be responsible for any excess and co-payment as shown on the certificate of insurance. ### To qualify for cover The accident must have occurred during the policy period and: - Be a direct consequence of one of the following: - a motor vehicle incident - a burn or electrocution - a sting or bites of ants, bees, flies, mosquitoes, spiders and wasps - Or result in: - a bone fracture - a ligament or tendon injury - a bite wound or fight wound abscesses - lacerations or abrasion of tissue, skin or mucous membrane. ### What we will not pay for Vet expenses attributable to: - a pre-existing condition, a related condition or a condition arising within the waiting period - conditions included in the Illness conditions section (whether covered or not) including: - patella luxations (dislocating kneecap), elbow or hip dysplasia; - toxicity; - ingestion of a foreign object; - intervertebral disc disease (IVDD) or desexing procedure complications under accidental injury cover no matter how the condition arises (these conditions will only be covered under illness cover and will be subject to the relevant waiting period). - conditions resulting from external parasites such as ticks, fleas or skin/ear mites; - excluded matters listed in section 5 Policy exclusions. --- ## Illness conditions The following benefit will not apply if you have selected Accident Only cover as shown on your certificate of insurance. ### What we will pay We will pay you our share of the vet expenses incurred and paid by you up to the annual benefit limit for treatment of your pet during the policy period as a result of your pet suffering an illness, less any applicable co-payments and excesses. You will be responsible for any excess and co-payment as shown on the certificate of insurance. ### What we will not pay for - Treatment of the following if your pet has not been vaccinated: - For dogs: infectious canine hepatitis (canine adenovirus), parvovirus, canine distemper, parainfluenza, canine influenza and all forms of kennel cough; or - For cats: parvovirus infections (including feline panleukopenia), chlamydia, feline leukaemia virus (FeLV), feline immuno deficiency virus (FIV), viral rhinotracheitis, calicivirus, herpes virus and all forms of cat flu; - Dental illness - Any declared widespread epidemic or pandemic disease that affects dogs or cats; - Any flea/tick/worm preventative treatments or measures (e.g. tick baths, sprays, intestinal worming products etc.) whether recommended by your vet or not, unless you have selected the Everyday stuff option; or - Excluded matters listed in section 5 Policy exclusions. --- ## Emergency boarding ### What we will pay We will pay you our share of the cost of boarding your pet at a licensed kennel or cattery up to the sub-limit shown below in the following scenarios and subject to any applicable co-payment: - if you are hospitalised (other than in the circumstances specified below) for five or more consecutive days during the policy period; - if you require emergency accommodation due to family violence. You will be responsible for any excess and co-payment as shown on the certificate of insurance. ### Benefit limit Sublimit of $1,500 per year ### What we will not pay for If you are hospitalised for: - cosmetic surgery or other forms of elective surgery; - pregnancy (unless you were hospitalised due to an unexpected complication); - any sickness known or foreseeable prior to the commencement date of the first policy period you are insured with us; or - if someone else living with you can reasonably be expected to look after your pet whilst you are in hospital. ### Waiting period There is no waiting period for emergency boarding. --- ## Optional benefits for Major + Minor plan The following benefits may be added to your policy at your choice and will show on your certificate of insurance if selected. Cove pet insurance encourages responsible pet ownership by providing benefits towards listed preventative health care treatments for your pet. ### Dental illness #### Benefit limit Sublimit of $500 per policy period #### Benefit percentage 100% (no customer co-payment) #### Benefit excess $100 #### What we will pay our share for Gingivitis, abscesses, removal of teeth where medically necessary due to dental disease arising from infection, retained deciduous teeth, cavities, tooth fracture. #### What you are not covered for The benefit excess Any dental illness treatment unless your pet has been insured under this policy for at least 6 months and in this period your pet has not shown signs of or been treated for any dental illness; - any dental illness treatment unless there is a history of annual routine dental check-ups by a vet; - orthodontic treatment, crowns, root canal, cosmetic dental surgery or corrective treatment, odontoclastic resorptive lesions; - elective dental treatment, checks or cleaning; - excluded matters listed in section 5 Policy exclusions. ### Everyday stuff #### Benefit limit A total amount of $300 per policy period comprising up to $100 per item #### Benefit percentage 100% (no customer co-payment) #### Benefit excess There is no excess applied for Everyday stuff claims #### Waiting period 6 months #### What we will pay We will pay the cost incurred by you for the Everyday stuff benefits listed below your pet has received during the policy period up to the benefit limit shown on your certificate of insurance. #### Everyday benefits covered You can claim a maximum of $100 per item with a total amount of $300 per policy period for the following items: - desexing - health checks - registration costs - flea/ tick/ worm control - microchipping - heartworm control - heartworm test - vaccinations - dewclaw removal - urinalysis - bloods tests & screening - FIV/FeLV tests --- # 5. Policy exclusions ## A. Pets not kept as companion or assistance animals Cover only applies for pets kept primarily as a companion or assistance animal and not for animals kept primarily for work, breeding, hunting or sport. ## B. Pre-existing conditions We exclude pre-existing conditions. Please read this section carefully to fully understand what your pet is or isn't covered for. If a condition exists or occurs before the commencement date of the first policy period your pet is insured with us or within an applicable waiting period, and you or your vet were aware of the condition, or a reasonable person in your circumstances would have been aware of the condition, it will be excluded from cover as a pre-existing condition. If your pet has a temporary condition that occurred or existed prior to the commencement date of the first policy period you are insured with us or during any applicable waiting period, but that condition has not existed, occurred or shown noticeable signs, symptoms or an abnormality in the 18-month period immediately prior to your claim treatment date, it will no longer be excluded from cover as a pre-existing condition. Chronic conditions that occur prior to the commencement date of the first policy period you are insured with us or during any applicable waiting period cannot fall within this category of temporary condition and will always be excluded from cover. Hereditary conditions and congenital conditions will not be considered a pre-existing condition if they have not shown noticeable signs, symptoms or an abnormality at any time before the commencement date of the first policy period or within an applicable waiting period. ### Pre-existing condition review If you would like us to review whether a temporary condition(s) which has been subject to the pre-existing condition exclusion in your policy remains excluded, you may apply to us to review the condition. To do so, your vet will need to certify and provide vet records verifying that the condition remains a temporary condition and has not existed, occurred or shown noticeable signs, symptoms or an abnormality for a period of 18 months. The pre-existing condition exclusion(s) shall not be deemed to have been lifted unless agreed to by us in writing. ## C. General exclusions Cove pet insurance has been designed to help you cover unforeseen and unexpected vet expenses. However not all expenses are covered. The following vet expenses and/or costs are not covered, unless stated on your certificate of insurance. ### Pre-existing conditions Pre-existing conditions, a related condition or a condition arising before the first policy period you are insured with us or within the applicable waiting period. Refer to Section 5b Pre-existing conditions above. ### Bilateral conditions When applying a benefit limit or exclusion, a bilateral condition will be considered a single condition. ### Brachycephalic Obstructive Airway Syndrome (BOAS) A group of conditions resulting from the body conformation of dogs with short noses (brachycephalic dogs) including nasal folds, stenotic nares, soft palate resection, everted laryngeal saccules or collapse and tracheal hypoplasia. ### Preventive and routine items Food (regular or prescription), vitamins / nutraceuticals / supplements, vaccinations, microchipping, flea / tick / worm control, grooming and bathing of your pet, and non-medicated grooming products, unless you have selected the Everyday stuff option. ### Certain treatments and conditions - Accessories including (but not limited to) pill poppers, cage hire, crates, bedding and collars. - Behavioural conditions including (but not limited to) anxiety disorders, phobias or chemical imbalances. - Breeding activities or obstetrics treatment. - Cell-replacement therapies including (but not limited to) stem cell therapy and platelet-rich plasma. Blood transfusions are covered when medically necessary. - Chemical castration, suprelorin implants or other desexing procedures, unless required to treat your pet's reproductive organs due to inflammation, infection or cancer. - Medicated baths and shampoos, unless your vet deems them medically necessary to treat a condition covered by your policy. - Medication not approved or registered for animal consumption in New Zealand by the Ministry of Primary Industries or the Veterinary Council of New Zealand. - Training, socialisation, therapy and alternative therapies including (but not limited to) homeopathic remedies, acupuncture, laser therapy, hydrotherapy, chiropractic treatments and/or physiotherapy. - The provision of any prolonged course of veterinary medicines, alternative or complementary treatments for more than three (3) months if there is a veterinary operation that would have improved or cured the condition unless agreed by us. The maximum payment will be limited to the equivalent cost of the operation. We will not cover medications which cover a period of more than 30 days beyond the policy end date. ### Certain services and procedures - Ambulance fees and non-essential hospitalisation. - Genetic/chromosome testing. - Pre-anaesthetic blood tests. - The following items and any associated expenses: - any trial or experimental procedures and treatments; - organ transplant surgery, open heart surgery, artificial limbs, mitral valve and chordae tendineae replacement surgery and pacemakers; - external fixtures (such as wheelchairs); or - prosthetics (including but not limited to hip replacements and elbow replacements); or - 3D printing. - Transport or boarding expenses other than those listed in the Emergency boarding benefit, section 4, if applicable. ### Elective treatments and procedures - Cosmetic procedures, hip/elbow scoring, nail clipping, declawing, dew-claw removal and ear cropping. - Tail docking and debarking. - Voluntary euthanasia. ### Duty of care Treatment if due to gross negligence by you or your failure to take all reasonable precautions to protect your pet from situations which may result in injury or illness. Situations include your pet participating in organised fighting and hunting activities. ### Overweight pets Treatment due to your pet being overweight or obese. ### Consequential loss Any consequential loss including (but not limited to) economic loss, loss of enjoyment, costs or expenses you may incur to prove or assist us with your claim, your time or anyone else's time or materials used, or other such loss not specifically covered in the policy document. ### Legal liability Your legal liability for payment of compensation in respect of death, bodily injury or Illness, and/or physical loss or damage to property. ### Policy exclusion expenses Expenses in relation to policy exclusions or related complications/adverse reactions of an exclusion. This includes when the diagnosis is inconclusive, but the treatment protocol is consistent with an excluded condition (e.g. treatment for coughing where kennel cough is suspected but not diagnosed or excluded as a diagnosis). Exceptions to this include: - vaccination reactions; - desexing procedure complications; and - reactions to flea/tick/worm control products. ### Fees for assistance with your claim or policy Fees charged by your vet for provision of any information or other assistance in relation to a claim made under this policy or administration of your policy. ### Operation of law You will not be covered under this policy if you or your pet do not comply with New Zealand laws and regulations including (but not limited to): - Dangerous dogs - dogs declared as dangerous or the Dangerous Dogs Act - Laws and regulations related to animal health or importation Your pet being confiscated, destroyed or having restrictions imposed by any Government, local or public authority. ### Fines, penalties and legal costs Your policy does not cover: - legal costs and expenses relating to any charge or offence; or - any fine or penalty; or any punitive or exemplary damages. ### Civil commotion/riot Your policy does not cover loss or liability and defence costs connected in any way with civil commotion assuming the proportions of or amounting to an uprising, insurrection, rebellion, military or usurped power. ### Electronic data Your policy does not cover loss, liability, costs or expenses from any cause whatsoever, regardless of any other contributing cause or event whenever it may occur for: - the total or partial destruction, distortion, erasure, corruption, alteration, misinterpretation or misappropriation of electronic data; - any error in creating, amending, entering, deleting, or using electronic data; or - the total or partial inability or failure to receive, send, access or use electronic data for any time or at all. ### Terrorism Your policy does not cover loss, liability, costs or expenses of whatsoever nature directly or indirectly caused by, resulting from or in connection with: - any act of terrorism regardless of any other cause or event contributing concurrently or in any other sequence to the loss; - any action taken in controlling, preventing, suppressing or in any way relating to any act of terrorism. ### Nuclear materials and events Your policy does not cover loss, liability or expense directly or indirectly caused by or contributed to or arising from: - nuclear weapons material; - ionising radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel; - the radioactive, toxic, explosive or other hazardous properties of any nuclear assembly or nuclear component thereof; - any weapon or device employing atomic or nuclear fission and/or fusion or other like reaction or radioactive force or matter; - the radioactive, toxic, explosive, or other hazardous or contaminating properties of any radioactive matter. ### War Your policy does not cover loss or liability directly or indirectly occasioned by happening through or in consequence of: - war, invasion, acts of foreign enemies, hostilities or war-like operations (whether war be declared or not), civil war; - mutiny, civil commotion assuming the proportions of or amounting to a popular rising, military rising, insurrection, rebellion, revolution, military or usurped power. ### Sanctions Your policy does not provide cover for loss, liability, claim or benefit to the extent that the provision of such cover, payment of such claim or provision of such benefit would expose us to any sanction, prohibition or restriction in any applicable jurisdiction. --- # 6. General terms and conditions ## A. Your contract of insurance This insurance policy is your insurance contract with us. It tells you what we will and will not do, what you must and must not do, and explains the terms and conditions of the cover that we offer. This contract also includes the information you gave us when you applied for this policy. We recommend you review this cover periodically to ensure it remains adequate for your needs; be sure to notify us of any changes that may impact our decision to offer insurance cover and on what terms. You will always have access to this document via the My Cove portal. ## B. Policy term and renewal If the policy is an Annual billing policy, shown in the certificate of insurance as 'Your period of cover' then your policy has a one year term. Unless we decide not to offer you renewal, we will remind you that your policy is due to renew no less than 14 days prior to the end date shown in the certificate of insurance. To renew your policy, you will be required to pay the premium owing prior to the end of the current term. If the policy is a Monthly billing policy, shown in the certificate of insurance as 'Your period of cover' then your policy has a one month term. Unless we decide not to offer you renewal, we will continue to renew your policy each month until you tell us to cancel your policy or we cancel your policy. You can request a new certificate of insurance showing the current term of insurance at any time online via your My Cove portal or by contacting us. ## C. Variations and communication We may change the terms and conditions of the policy upon renewal based on the risk associated with insuring pets like yours. At the time of renewal, we will send you a renewal notice advising any changes to the terms and conditions of the policy and premiums. Unless we notify you otherwise, your policy will be automatically renewed on the same terms or the terms contained in the renewal offer that we send you prior to the policy end date and we will charge the renewal premium to your nominated credit card. We require you to notify us via your My Cove account, by phone or in writing prior to the policy end date should you decide not to renew your policy. Other than any changes to the policy that we advise you of in our renewal offer, your cover is treated as if it were continuous, meaning: - no waiting periods are applicable; and - pre-existing conditions apply as set out in section 5b, based on the commencement date of the first policy period you are insured with us, provided there is no lapse in cover from your first policy. ### Changing your level of cover If you would like to transfer your pet to a level of cover with higher or additional benefits (including but not limited to a lower excess or higher annual benefit limit) then a new policy will be issued to you and your previous policy will be cancelled. You will only be able to do this with our prior consent. If you would like to transfer your pet to a level of cover with lower coverage (including but not limited to a higher excess) then a new policy will be issued to you and your previous policy will be cancelled. You can make this change at any time. If your policy has a monthly term, and the premium has decreased following a reduction to the level of your cover, there is no premium refund (including any remaining days of a current instalment period) and you will pay the reduced premium from the next month. If your policy has an annual term, and the premium has decreased following a reduction to the level of your cover, we will refund you, from the date you notified us you wish to transfer your pet to a lower level of cover, the difference between the premium that would have been payable for the remainder of the term of the policy and the new premium that will be payable for the downgraded cover you have selected subject to a minimum of $25. As a change in cover means a new policy is issued, the free-look period applies from the date the new policy is issued. However, in all other respects (beside the change to level of cover and the premium) your cover is treated as if it were continuous, meaning: - no waiting periods are applicable; and - pre-existing conditions apply as set out in section 5b, based on the commencement date of the first policy period you are insured with us, provided there is no lapse in cover from your first policy. ### Communication We will only send your policy documents and policy related communications electronically. This includes email and/or other methods of electronic communication. You will need to provide us with your current email address and your mobile phone number. Each electronic communication will be deemed to be received by you on the transmission date recorded in our systems. ## D. Important Information ### Limitation of cover Notwithstanding anything contained in this policy document we will not provide cover nor will we make any payment or provide any service or benefit to any person or party where providing such cover, payment, service or benefit would contravene or violate any applicable trade or economic sanction or any law or regulation. ### Jurisdiction and choice of law Your policy is governed by and construed in accordance with the laws of New Zealand and you agree to submit to the exclusive jurisdiction of the courts of New Zealand. ### Correctness of statements and fraud If any claim under this policy is in any respect fraudulent, or if any false declaration is made, or false or incorrect information is provided in support of any claim, then we can, at our sole discretion, not pay your claim and/or cancel your cover under this policy (and any other pet insurance policies you hold which are issued by Aioi Nissay Dowa Insurance Co., Ltd) retrospectively from the date that the incorrect statement or fraudulent claim was made to us. ### Duty of disclosure You have a duty to disclose all material facts to us when you apply for insurance and when this policy is renewed, reinstated or varied. Where we agree to provide (or vary) cover under the policy we rely on the representations made by you during your application for insurance and on an ongoing basis (for example, when your circumstances change). If you fail to comply with your duty of disclosure, we may reduce our liability for any claim and/or cancel your policy. If the misrepresentation is material and substantially incorrect, we may, at our discretion, void the policy retrospectively with the effect that the policy never existed. ### Currency referred to in your policy All amounts referred to in your policy are expressed in New Zealand Dollars (NZD) and include Goods and Services Tax (GST). We will pay all claims in New Zealand Dollars (NZD). ## E. Cancellation ### Free-look period-14 days You have free-look rights after you purchase or change your level of cover under the policy. The free-look rights allow you to cancel your policy by notifying us within 14 days after you first start cover. If you cancel your policy during the 14-day free-look period, provided that no claim has been made, we will refund any premiums paid since the commencement of the relevant policy period. You cannot cancel your policy during the free-look period if a claim has been made. ### Cancellation by you You may also cancel your policy for any reason after the free-look period. If you want to cancel your policy, you must tell us by phone or email, and we will keep a record of the conversation and/or communication. The cancellation will be effective from the date that we receive cancellation notification from you. If you cancel your policy for whatever reason (other than your pet passing away, which is dealt with below) we will refund any annual premium payment less a pro-rata amount covering the period your pet was insured for and an administration fee (currently $25). If you have been paying your premium monthly, there is no premium refund (including for any remaining days of a current period). However, no further monthly premiums will be deducted. Any outstanding premium may be deducted from any claim payment owed, or alternatively, charged to your nominated bank/credit card account. This clause survives termination of this contract. ### Cancellation by you where your pet has passed away If you cancel your policy because your pet has passed away, we will refund annual premium payments less a pro-rata amount covering the period your pet was insured for and an administration fee (currently $25). If your policy is a monthly billing policy, you will receive a pro-rata refund of any unused premium for the remaining days of a current instalment period. No further premium instalments will be deducted. Any outstanding premium may be deducted from any claim payment owed, or alternatively, charged to your nominated bank/credit card account. This clause survives termination of this contract. ### Cancellation by us We may cancel your policy with immediate effect where the law permits us to do so, and no refund of premium will be paid, including if you have: - failed to comply with your duty of disclosure; - failed to comply with the relevant provisions of the policy; - provided us with any information that was not truthful or correct when you took out your policy or when you made a claim; - made a fraudulent claim under the policy; or - allowed your premium to be in arrears. If we cancel your policy, we will do so by giving you notice by email. ### Assignment You must not assign or attempt to assign: - this policy or your interest in this policy to anybody else; or - any claim or claim proceeds under this policy; without our prior written consent. ## F. Premium Your premium is shown on your certificate of insurance. ### Payment of premium Your payment of the premium advised confirms that you agree to the terms of the policy or renewal of the policy. If you do not pay your premium when we attempt to collect it, your policy will lapse, in which case you will be without cover. We recognise non-payment is sometimes accidental and so we may try, but are not obliged, to attempt further collection from you for up to fourteen days after the end of the term to ensure you are not without cover. If you have not contacted us to pay the premium due within these 14 days, your policy will be treated as if it had lapsed on the date the missed premium first became due. If your policy lapses, cover under this policy, or a new policy with us, cannot recommence without our agreement. If you pay the premium within this fourteen-day period, your policy will be treated as if it renewed on the date the missed premium first became due provided that in this period you have not become aware of any loss or circumstance occurring which might result in a claim being made under this insurance. Where you become aware of such loss or circumstance, you must contact us before we can confirm cover: failure to do may result in claims relating to the undisclosed loss or circumstance being declined or, possibly, the policy being treated as if it had never existed. ### Payment method You can pay by direct debit from your debit/credit card. All transactions are made in accordance with the terms and conditions we disclose to you when you provide your authority, or as confirmed to you in writing. --- # 7. Claims You can make a claim by either: - Going to My Cove and completing the claim form online; - Visiting us online at www.coveinsurance.co.nz; or - Calling us on 0800 268 347. ## Important claim information All claims must include itemised tax invoices, payment receipts and applicable consultation notes. You must provide sufficient evidence to substantiate your claim to our reasonable satisfaction. We may also require you to provide us with additional supporting information in our reasonable opinion to substantiate your claim. Please note: - There may be scenarios where we request additional vet history from current or previous vets (such as if there is a large history gap) to ensure we have all relevant clinical information for your pet. - For adopted pets, if you can provide us with proof of adoption or transfer of ownership papers, we will only request vet history from the date you took ownership onwards. - You agree that your vet is authorised to release information and/or records to us about your pet. You agree that we are authorised to discuss with the vet, details relating to your claim or treatment provided to your pet in relation to a claim made under the policy. If your vet makes a charge for this you must pay the charge. You agree we have the right to decline to process a claim where you or your vet refuse or are unable to provide information reasonably requested by us in order to process your claim. We reserve the right to request a second opinion from an independent vet at our cost. If your claim is accepted we will pay you and not the vet, unless we otherwise agree. ## Other insurance cover If any part of any valid claim is covered by any other insurance or a third party, or refunds, credits, rebates or discounts then you must provide us with those details at the time you submit your claim and the maximum amount we can pay will be the difference. If you can claim against someone, you must claim against them first before we will consider covering the difference. ## Your responsibilities - you must: - complete all claims accurately and truthfully. - allow your personal information in connection with your claim to be disclosed to us and for us to disclose it to our agents assisting with your claim. - allow us at our expense and in the name of a policy holder, to take action to recover from another person or entity anything covered by this policy and you must assist us in providing information and/or any legal proceedings. - pay your excess and co-payment as and when requested. - tell the Police as soon as possible if you or we suspect the loss has been caused by any criminal act. If you make a claim, we may record details of the claim on relevant insurance industry databases. ## Example of how claims will be settled where cover is provided: A claim with a $1,000 excess and co-pay 10% | Item | Amount | |------|--------| | Total amount of eligible vet expenses | $5,000 | | Less excess | $1,000 | | Vet expenses less excess | $4,000 | | Less customer co-payment (10% x $4,000) | $400 | | Total amount payable as reimbursement by us | $3,600 | | You pay | $1,400 | --- # 8. Compliance ## We protect your privacy We collect and keep the personal information you give us, as this is necessary for us to: - Confirm your identity; - Assess your application for insurance; - Manage your policy; - Process any claim you make. Should you choose not to provide us with your personal information, this may affect your eligibility for insurance cover and/or approval of any claim. Your personal information may be shared with Government agencies (where we are required to do so by law), and our insurance partners, including reinsurers, reinsurance intermediaries, contractors and contracted service providers engaged to deliver our services or carry out certain business activities on our behalf, to enable us to provide and manage your policy and any claim you make. Some of our insurance partners may be located outside New Zealand. The countries in which these insurance partners may be located will vary from time to time, but may include Japan, Bermuda, the United States, the United Kingdom, Singapore, Hong Kong, Australia and other countries where we operate. If you make a claim, we may record details of the claim on relevant insurance industry databases. In entering into this policy, you agree that we may use your personal information from time to time to send you offers or information relating solely to your policy and our products that may be of interest to you. If you do not wish to receive such information, please contact us via support@coveinsurance.co.nz to 'opt out'. You are entitled to a copy of the personal information held by us about you and to correct or update your personal information. If you would like to see this information, please contact us via support@coveinsurance.co.nz. --- # 9. Complaints If you make a complaint to us, we will acknowledge receipt within two business days of receiving your complaint. ## Step 1: Contact us If you are unhappy about a policy, our service or a decision made, please contact us and we will try to resolve your issue as soon as possible. The easiest way to contact us is either: - via the My Cove portal, - by talking to us on live chat, - emailing us support@coveinsurance.co.nz, - or even by calling us 0800 268 347 8am to 5pm weekdays. To assist with your enquiry, please provide your claim or policy number (if applicable) and as much information as you can about the reason for your complaint. If we are unable to resolve your issue to your satisfaction immediately, your complaint will be referred to our internal dispute resolution service. At this time, we will record details of your complaint and, depending on the nature, will as appropriate, escalate the matter to your insurer for resolution. ## Step 2: Our internal review panel If our Customer Services team have been unable to resolve your problem, you can make a formal complaint in writing to Cove Internal Complaints Review Panel by email to: complaints@coveinsurance.co.nz Within 5 working days of us receiving your complaint you can expect: - To receive an acknowledgement of your complaint. - To receive the contact details of who is responsible for handling your complaint. Upon receiving all relevant information, your complaint handler will do their best to issue a first response and resolve your complaint within 10 working days of the complaint being received. If further information, assessment or investigation is required, your complaints handler will discuss this with you and provide you with a reasonable timeframe for a response. We will keep you updated. ## Step 3: If our internal process has not worked for you If after two months, you are still unsatisfied, or we have confirmed to you that we have reached the end of the complaints process via a letter, you may refer your complaint to the Insurance & Financial Services Ombudsman (IFSO), which offers a free, independent complaint resolution service, through the following contact details: Insurance & Financial Services Ombudsman Scheme - PO Box 10-845 - Wellington 6143 - NEW ZEALAND - Level 8, Shamrock House - 79-81 Molesworth Street - Wellington - Telephone: 0800 888 202 - Internet: IFSO.co.nz - Email: info@ifso.nz - Fax: 04 499 7614 --- # 10. Definitions Words with special meaning specific to this contract are indicated in the text in italics and defined in this section. ## Accident - A single event which is unexpected and unintended; and - Is independent of any illness or any pre-existing condition. ## Accidental injury Physical harm or injury arising from an accident that is a consequence of or results in one of the following: - a motor vehicle incident; - a burn or electrocution; - an allergic reaction to the following insect and arachnid bites: - ants; - bees; - flies; - mosquitoes; - spiders; and - wasps. - a bone fracture; - a snake bite toxicity; - a traumatic ligament or tendon injury; - a bite wound or fight wound abscesses; or - lacerations or abrasion of tissue, skin or mucous membrane. ## Alternative therapy Means acupuncture, behavioural therapy, Bowen therapy, herbal therapy, homeopathy, hydrotherapy, laser therapy, massage therapy, osteopathy, physiotherapy, TENS (transcutaneous electrical nerve stimulation) or similar therapies where they are administered by, prescribed by or supervised by a vet to treat, or to complement treatment for your pet's injury. ## Benefit limits - annual and sub-limits There are two types of benefit limits - annual and sub-limits. The benefit limits set out the total amount payable under your policy in relation to the relevant cover determined as follows: - if a specified limit or sub-limit for a particular cover, item, condition or treatment on an individual or per claim basis is specified to apply in the certificate of insurance or this policy document, we will not pay more than that amount; and - we will not pay more than the overall annual benefit limit specified in your certificate of insurance. ## Bilateral condition Any condition affecting body parts of which the pet has at least two, one each side of the body (e.g. ears, eyes, knees and elbows). When applying a benefit limit or exclusion, a bilateral condition will be considered a single condition. Example 1: If your pet has had cruciate ligament problems in the left knee prior to the commencement date of the first policy period you are insured with us or during the applicable waiting period, which falls within the definition of pre-existing condition, subsequent cruciate ligament issues in the right knee will still be considered a pre-existing condition. Example 2: If your pet suffers from a patella luxation in its left hind leg and arthritis in its right hind leg, this is not a bilateral condition, as patella luxation and arthritis are not the same condition. ## Brachycephalic Obstructive Airway Syndrome (BOAS) A group of conditions resulting from the body conformation of dogs with short noses (brachycephalic dogs) including nasal folds, stenotic nares, soft palate resection, everted laryngeal saccules or collapse and tracheal hypoplasia. Breeds of dogs commonly affected include but are not limited to English and French bulldogs, Pugs, Shih-Tzus and Pekingese. ## Certificate of insurance The most recent certificate we provide outlining the key details of the contract of insurance between you and us, and identifying the policy number, excess, co-pay, commencement date, end date, insured pet and a schedule of benefits including benefit limits. ## Chronic condition A condition that is long-lasting or recurring in its effects and affects (or is present in) your pet over a period that is greater than three months in total (the three-month period need not be consecutive). Chronic conditions may also be intermittent or managed with medication and/or prescription diets with intervals of remission. This includes (but is not limited to) chronic or seasonal allergies, inflammatory bowel disease, diabetes, osteoarthritis, cancer and some autoimmune diseases. This definition is relevant to determining whether a condition is a pre-existing condition (please refer to the definitions of pre-existing condition and temporary condition). Example: Before commencement of the first policy your pet suffered atopic dermatitis for more than three months in total. The condition would be a chronic condition given it is recurring in its effects. If the condition otherwise falls within the definition of pre-existing condition it will be excluded from coverage. ## Commencement date 12:01am on the date shown on your certificate of insurance unless otherwise stated. ## Condition(s) Any accidental injury or any manifestation of an illness. ## Congenital condition A congenital anomaly or developmental defect which is present at birth but may not manifest until later in your pet's life. ## Co-payment Means the portion of each eligible claim after deduction of any applicable excess which you are responsible to pay and will not be reimbursed by us as set out in your certificate of insurance. This may change in future policy renewals (notified in advance) as your pet gets older. ## Consultation An examination performed by or under the supervision of a vet, including a physical consultation, inpatient examination, in-hospital examination, health certificate, consultation or recheck consultation/visit, referral/specialist consultation/visits, emergency and after-hours consultations/visits. ## Cover - The annual benefit limit, excess, co-payment and any options applicable to the policy you have selected; and - Where relevant, the cover applicable under any previous policies you have held with us where the same or a substantially similar or a higher level of cover was provided in the current policy period. - Information about the cover can be found in section 4 Explanation of covers provided and section 5 Policy exclusions. - The cover applying to your pet for the relevant policy period is shown on your certificate of insurance. ## Cruciate ligament condition Partial or complete rupture of the cruciate ligament(s). This includes meniscal tears, any looseness of the cruciate ligaments along with any complications following treatment for this cruciate ligament condition. A cruciate ligament condition is considered a single condition irrespective of whether one or both legs are affected (refer definition of bilateral condition). ## Dental illness A dental illness as specified under the Optional benefits - Dental illness section 4. If selected, this benefit is payable up to the sub-limit shown. ## Elective treatment A treatment or surgery that is beneficial to your pet but is not essential for your pet's survival or does not form part of the treatment for a condition. Refer to section 5 Policy exclusions. ## End date 12:01am on the date upon which your policy terminates and benefits cease. The end date is shown on your certificate of insurance. If the policy is cancelled, then the date of cancellation will be deemed to be the end date. ## Everyday stuff Certain preventive healthcare treatments for your pet. If you have this cover, the list of allowable treatments and the benefit limits applicable to these, are shown on your certificate of insurance. ## Excess The first amount of a claim we do not pay and which you are required to pay yourself as shown on your certificate of insurance. The excess is deducted from your benefit for each condition treated during the policy period that is not related to any other condition treated during the same policy period. ## Illness A sickness or disease which: - is not included under accidental injury cover; and - is independent of any pre-existing condition. ## Pet A domestic breed of dog or cat ordinarily residing with you in New Zealand, which is primarily a companion animal or assistance animal, and which is named on your certificate of insurance. ## Policy The contract of insurance between you and us which includes the documents set out in section 3 under the heading Read the policy. ## Policy period The time during which we provide cover as specified on your certificate of insurance. ## Pre-existing condition As defined in section 5b. ## Related condition A condition that results from the same disease process, arises as a consequence of or has the same diagnostic classification as another condition, regardless of the number of areas of your pet's body that are affected. Example 1: If your dog suffers from itchy skin, future occurrences of eczema will be a related condition. Example 2: If your cat suffers an intestinal infection and then later suffers from eye cataracts, these are not related conditions, as the cataracts are not a consequence of the intestinal infection, nor do they follow the same disease process or diagnostic classification. ## Routine care Means treatment intended to prevent future conditions from occurring rather than treating existing conditions, and includes but is not limited to micro-chipping, de-sexing, nail clipping, vaccinations, dental check-ups or dental scale and polish, and dew-claw removal. ## Temporary condition A condition which normally resolves with treatment, other than: - cruciate ligament conditions; - intervertebral disc disease; - hip dysplasia; - elbow dysplasia; - patella luxation; - endocrine diseases; or - any other chronic condition This definition is relevant to determining whether a condition is a pre-existing condition (please refer to the definition of pre-existing condition). For example: your cat has a urinary infection prior to the start of the first policy your cat is insured with us which is resolved with medication. Your cat does not suffer any further instances of urinary infections until three years later, when your pet suffers another episode. This condition would be a temporary condition which has not existed, occurred or shown noticeable signs, symptoms or an abnormality in the 18-month period immediately prior to the second urinary infection episode, so would not be a pre-existing condition and would be coverable subject to your policy terms and conditions. ## Treatment Reasonable and customary examinations, consultations, hospitalisation, surgery, x-rays, medication, diagnostic tests, nursing and other care and procedures provided by a vet to relieve or cure a disease, illness or accidental injury during the policy period. ## Vet Any veterinarian, veterinary specialist, animal hospital, animal clinic, or animal surgery, other than yourself, who is licensed in and currently registered in New Zealand. ## Vet expenses The reasonable, customary and essential expenses incurred and paid in respect of treatment provided by a vet in New Zealand during the policy period. ## Waiting period A period starting from the commencement date of the first policy period you are insured with us during which a condition that exists or occurs, of which you or your vet are aware or a reasonable person in your circumstances would be aware will be considered a pre-existing condition, subject to the terms of the definition of pre-existing condition and unless otherwise stated on your certificate of insurance. See section 4 Explanation of covers provided for details of waiting periods that apply. ## We, us or our Cove Limited for and on behalf of Aioi Nissay Dowa Insurance Co., Ltd. ## You and your The person(s) named as the policy holder on the certificate of insurance. --- # 11. Information about Cove ## Cove This insurance is arranged and administered by Cove Limited for and on behalf of and in accordance with the authorisation granted to it by the underwriter Aioi Nissay Dowa Insurance Co., Ltd (Aioi). Cove Limited is authorised to deal with and settle any claims as an agent of Aioi. ## The insurer This insurance is offered and underwritten by Aioi Nissay Dowa Insurance Co., Ltd. ## Solvency To see current solvency ratios for Aioi Nissay Dowa Insurance Co., Ltd head to our website. ## Financial rating Aioi Nissay Dowa Insurance Co., Ltd has a Financial Strength Rating of A+ (Stable) given by A. M. Best Company and A+ (Stable) given by Standard & Poors. The Financial Strength Rating is an independent opinion of an insurer's financial strength and ability to meet its ongoing insurance policy and contract obligations. ### A.M. Best's Financial Strength Rating Scale: | Rating | Description | |--------|-------------| | A+ | Superior | | A | Excellent | | B+ | Good | | B | Fair | | C+ | Marginal | | C | Weak | | D | Poor | ### Standard & Poors Financial Strength Rating Scale: | Rating | Description | |--------|-------------| | AAA | Extremely Strong | | AA | Very Strong | | A | Strong | | BBB | Good | | BB | Marginal | | B | Weak | | CCC | Very Weak | | CC | Extremely Weak | | R | Under Regulatory Supervision | The rating scales may be modified by the addition of a plus (+) or minus (-) sign to show relative standing within the major categories. For further details and a full explanation of these ratings please use the following links: www.ambest.com/ratings/guide.pdf or www.spratings.com/en_US/understanding-ratings --- # 12. Fair Insurance Code We support the Insurance Council of New Zealand and the principles Fair Insurance Code (the Code). The objectives of the Code are to establish high standards of service, promote confidence in the general insurance industry and improve relationships between insurers and their customers. Further information about the Code is available on the ICNZ website or on request. It is important you review the code in conjunction with this policy document as it contains important responsibilities and provides guidance for consumers as well as outlines the duties insurers have towards you. We expect all our customers to observe the responsibilities noted in the Code and a breach of those responsibilities may be considered a breach of this policy also.