My Vet Knows Best Pet Insurance Discount Program Insure your pet within 10 days for a 10% discount and reduced waiting periods Don’t Delay! To be completed by pet owner Save over $500* Pet Name:___________________________________________ Pet Gender: Male Female Pet Type: Dog Cat Pet Breed:___________________________________________ Veterinary Clinic Name & Address (or stamp) Pet Age at time of Exam: ________ Date of Exam: ___________ Pet Owner Name: _____________________________________ Pet Owner Email: _____________________________________ Zip Code: _______________ Phone:________________________ Best day/time to call: _____________________________________ To be completed by Vet Clinic Representative 1 Are you aware of any illness, injury or condition this pet may have been diagnosed with or treated for in the past two years or is this pet currently being treated for or showing symptoms of an illness, injury Yes No If yes, please provide an explanation: or condition? __________________________________________________________________________________ __________________________________________________________________________________ 2 _A comprehensive physical exam was completed on the date listed above for the pet listed above and I confirm to the best of my knowledge that all statements provided on this form are true. ____________________________ Vet Clinic Representative (name) _________________________________ Signature _________________ Date To enroll with a 10% discount and reduced waiting periods: 1. Complete the pet owner information. 2. Have your veterinarian complete a physical exam for your dog or cat. 3. Have a vet clinic representative sign and complete the medical history information above. 4. Send form via fax to 1-877-893-6410 or via email to [email protected] 5. Call 1-866-609-PETS (7387) to sign up within 10 days of your pet’s exam date. This certificate is not an application for insurance and does not guarantee coverage. Discount is valid for the pet listed on the certificate for plans purchased within 10 days of the exam. Discounts do not apply to Accident Only Plans or the optional BestWellness add-on. The offer and continuation of discounts are subject to underwriter and regulatory approval in your state. Insurance plans offered and administered by Pets Best Insurance Services, LLC are underwritten by Independence American Insurance Company. *Lifetime savings based on a mixed breed puppy in California enrolled for 10 years under the BestBenefit Level 1 plan with 90% reimbursement and $100 annual deductible. Actual savings may be higher or lower depending on insurance rates. Rates vary based on location, breed, age and inflation. CNS-CTVD-V1-0912-IAIC Affordable plans to help cover the cost of veterinary care. When it comes to pet health, you may be caught off-guard by the cost of veterinary care. Pets Best Insurance plans help cover the cost of unexpected veterinary bills. A choice of plans with affordable premiums Insurance plans offered by Pets Best Insurance start at less than $1 per day. This affordable coverage helps pay for quality care when your pet needs it most. Here’s a look at the key features and an overview of average plan prices: Use any licensed veterinarian or emergency center anywhere in the world. Quick claims processing and direct deposit reimbursement. No upper age limit for pets. Real Life Example “I want to give kudos to Pets Best… you did what you said you would do. I will be eternally grateful.” Joe Hamilton, Buddy’s owner Buddy: 10-year-old dog treated for spleen cancer Total Bill...............................................................$5,955 Plan Deductible......................................................$100 Reimbursement from Pets Best Insurance — 80%............................$4,681 Different deductible amounts and reimbursement percentages may apply based on the plan selected. This claim example refers to a condition that is not pre-existing. Actual reimbursement amount may vary based on whether deductible has been met or whether veterinary fees included taxes and other non-covered expenses. Claim administration is subject to all terms, conditions, limitations and exclusions in the policy. Protect Your Pet Today Call 1-866-609-PETS (7387). BestBenefit Plans for Cats & Dogs • Deductible Options: $0, $50, $100, $200, $500, $1,000 • Reimbursement Options: 70%, 80%, 90% or 100% Level 1 Level 2 Level 3 Annual Coverage $5,000 $10,000 $20,000 Monthly Premium: Dogs* $15-$40 $35-$75 $45-$90 Monthly Premium: Cats* $10-$20 $20-$40 $25-$50 *Example rates based on 4-year old mixed breed dog/cat. Rates will vary based on location, breed, age and inflation. Actual rates may be higher or lower. BestBenefit plans include limited coverage for certain hereditary conditions as well as acupuncture and chiropractic treatments. Optional Routine Care Coverage & Other Plans As add-on coverage to any of the BestBenefit plans above, our BestWellness option helps pay for annual exams, teeth cleaning, vaccinations and more. For $22 per month, BestWellness offers up to $480 in benefits for dogs and up to $545 in benefits for cats each year. We also have other plans for just accidents or specific conditions. Cancer Only and Feline Illness plans, available for $5-$10 per month, can be purchased separately or in addition to a BestBenefit plan for extra coverage. This material provides a brief plan description. Coverage may vary depending on your plan selection and your state of residence. Information is accurate as of the production date; however is subject to change. For complete details about the policy terms, conditions and exclusions, please review generic policy form number IAIC-PET-POL 1211 or the applicable form for your state of residence. Insurance plans offered and administered by Pets Best Insurance Services LLC underwritten by Independence American Insurance Company, a Delaware Insurance company. Independence American Insurance Company is a member of The IHC Group, an insurance organization composed of Independence Holding Company (NYSE: IHC) and its operating subsidiaries. The IHC Group has been providing life, health and stop loss insurance solutions for nearly 30 years. For information on The IHC Group, visit www.ihcgroup.com. CNS-CTVD-V1-0912-IAIC
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