We use Fetch, formally PetPlan. We put in claims and were reimbursed as expected. I got insurance for my dogs the day I got them. I presume the preconditions would not be covered, and thinks like elbows and hips have a grace period that may be waved if your vet attests that the dog has no issues. As is the case with all tru insurance you pay in a lot more than you use. The insurance is there in case you have a really major incident, or to give you the option to pursue treatment without trying to figure out where you are going to come up with the money to pay it. A surgery done by your local vet will probably amount to $1500 to $2000 including the initial visit, tests, the surgery itself and the medicine. A procedure that needs to be done at a medical center will likely be upwards of $5000. Prices will vary depending on the condition, where you live, etc. Pet insurance usually does not cover wellness visits, vaccinations, spaying, neutering, and other preventive stuff.