General Terms and Conditions

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​Translation: In case of disputes or unclear translations, the original German text shall be decisive. The English text does not alter the original German text in either a positive or negative sense.

The pets listed in the insurance contract whose keeper or owner is the policyholder are insured.

The policyholder and all persons permanently living with them in the shared household are insured.

The insurance is valid worldwide. 
There is no cover if treatment was carried out abroad that is not permitted in Switzerland according to the Animal Welfare Act or contradicts the ethical principles of the Society of Swiss Veterinarians (SVS).

If the policyholder moves abroad, the cover expires immediately, i.e. as of the deregistration date at the previous municipality of residence.

If the owner of the insured pet changes, for example as a result of selling or giving away the pet, simpego must be informed of the new owner/keeper in writing within 14 days of the change in ownership. The rights and obligations from the insurance contract then transfer to the new owner/keeper.

The new owner/keeper may decline to take over the insurance contract by giving written notice within 30 days of the change of ownership. If the insurance contract is declined, the insurance cover will end immediately.

Simpego reserves the right to withdraw from the contract within 14 days of receiving notification of the change of ownership. If simpego withdraws from the contract, the contract will terminate 30 days after the new owner/keeper has been notified of the withdrawal.

The insurance contract applies only to the pets specified in the contract. If one of the insured pets is replaced, for example following an exchange with the breeder, simpego must be informed without delay. The insurance cover does not automatically transfer to the new pet.

If the insured pet dies, the insurance contract expires as of the date of death.

From the start date of the contract, a 30-day waiting period applies to all types of cover except Accident, Preventive Care Budget and Rescue & Recovery. If cover is added as part of a contract amendment, the waiting period for that cover will begin on the effective date of the contract amendment. No insurance benefits are payable during the waiting period. Any illness, condition, injury or loss that first occurs during the waiting period, and any related complications, consequential conditions, follow-on claims or associated costs, will not be covered, even after the waiting period has ended.

The annual deductible and the annual sums insured always refer to a full contract year. The contract year is always the full year (365 or 366 days) ending on the contract end date specified in the insurance contract. If, on conclusion of the contract, a specific date was set for the start of each new contract year (e.g. 1 January), this may result in the first contract year running for only part of a year, i.e. being shorter than a full year. Even if the contract term is shorter than one year, the annual deductible and the annual sums insured apply in full without any reduction.

The insurance does not cover the following:

All sections of cover are provided on an indemnity basis. This means that, if an insured event occurs, any claim payment will be based on the actual loss incurred.

The pet owner is responsible for the health and the well-being of the insured pet. The pet owner must take all reasonable precautions and measures to prevent the insured pet from suffering unnecessary illness or injury. This includes, in particular:

The following service providers are recognised by simpego:

A list of the recognised qualifications for chiropractors, therapists and homeopaths can be found here: https://help.simpego.ch/en/article/recognised-training-programmes-1rhtpz2/

The date of the insured event is the date on which the insured pet first shows symptoms of an illness. If no symptoms are apparent, the date of the insured event is the date of the first suspected diagnosis, confirmed diagnosis or first recorded clinical finding, including any incidental findings.

In the case of an accident, the date of the insured event is the date on which the accident occurred.

The following documents and information must be submitted when making a claim:

If a dispute arises between the policyholder and simpego regarding a claim, the policyholder may request that the matter in dispute be assessed by an independent veterinary surgeon. The independent veterinary surgeon shall be appointed by mutual agreement between the parties and must not have any relationship of trust with either an insured person or simpego. Simpego will pay the costs of the veterinary surgeon’s assessment. Any costs incurred by the policyholder, including travel expenses, time spent and any other personal expenses, shall be borne by the policyholder. The decision of the independent veterinary surgeon shall be final and binding on both parties.

For each insured event, simpego will pay for the following:

The treatment or the required medical aid must have been provided or prescribed by a veterinary surgeon or another recognised service provider. simpego will not cover the cost of any treatment or aid that has not been prescribed, recommended or carried out by a veterinary surgeon or another recognised service provider.

Regardless of the annual sum insured, simpego will pay a maximum of CHF 25,000 per contract year for any one illness or accident. This includes all costs related to that illness or accident, including diagnostic investigations, treatment, follow-up treatment, prescription diet food, medication and any other associated veterinary expenses.

Insured benefits are limited to 50% of the eligible costs where the claim relates to a hereditary condition or a congenital condition. This restriction also applies to any secondary or consequential conditions that are directly caused by, or can be attributed with a high degree of certainty to, the hereditary or congenital condition. The 50% benefit restriction is applied before the annual deductible, the cost coverage and, subsequently, the annual benefit limit under the relevant cover section.

This benefit restriction does not apply to the Pre-existing Conditions and Accident cover.

This benefit restriction does not apply if the additional benefit “Full cover in the event of hereditary/congenital conditions” has been included in the policy.

If veterinary-recommended or prescribed measures, including but not limited to treatment, follow-up examinations or the administration of medication, are not carried out, or are not carried out in a timely manner, and compliance with those measures could have prevented the insured event from occurring or significantly reduced the extent of the claim, the benefits payable may be reduced.

An illness is any impairment of the insured pet’s physical or mental health that is not the direct result of an accident and requires examination or treatment by a veterinarian. Behavioural disorders are also considered mental health disorders and are covered under this policy.

The following are regarded as insured events:

An insured accident is defined as a sudden, unintended and harmful event caused by an external factor. The following are not considered accidents: events where the external factor does not exceed the normal stresses of everyday activity or conditions resulting from wear and tear or degeneration. The policy also covers: dental treatment required as a direct result of an insured accident, including any necessary dental prostheses, and behavioural disorders directly attributable to the insured accident, provided the treating veterinary surgeon confirms the causal link between the accident and the behavioural disorder.

Provided they are attributable to an insured event for which simpego has paid benefits, late-onset consequences of accidents are also covered. These include, but are not limited to, chronic pain, complications relating to surgical implants and reduced mobility associated with ageing or following prolonged or intensive physical strain. Degenerative musculoskeletal conditions resulting from wear and tear or abnormal loading, such as osteoarthritis, muscle tension or musculoskeletal pain, are also regarded as illnesses.

Pre-existing conditions include all illnesses, health complaints, clinical symptoms, injuries, consequences of accidents (including late-onset consequences), malformations, developmental disorders, congenital or hereditary conditions, as well as behavioural disorders of the insured animal that first occurred before the start of the contract, were identified, investigated, treated or documented by a veterinary surgeon, or were known to the policyholder.

Pre-existing conditions also include any complaints or findings which, before the start of the contract, had not yet been conclusively diagnosed but were already identifiable through symptoms, suspected diagnoses, veterinary advice, recommended investigations, treatments, medication, diets, follow-up appointments or other medical measures.

The relevant date is the point in time when the first symptoms, complaints, findings, suspected diagnoses or veterinary indications occurred or were documented.

Treatment costs relating to pre-existing conditions that existed at the start of the contract are covered. Treatment, investigations, recurrences, deterioration, complications, consequential illnesses, late-onset consequences and secondary diagnoses, provided there is a medically justifiable link to the pre-existing condition, are covered.

A medical link is deemed to exist, in particular, in the following cases:

Exclusion: there is no cover for pre-existing conditions, nor for any related consequential conditions (unless the attending veterinary surgeon can confirm that there is no connection to the pre-existing condition), where the pre-existing condition first occurred within the three months immediately preceding the start date of the first policy. This includes cases where the first symptoms, clinical signs, findings, suspected diagnoses or veterinary observations arose or were recorded during this period, even if no definitive diagnosis had yet been made.

Addition of pre-existing condition cover after contract inception: Where cover for pre-existing conditions is added to an existing contract at a later date, such cover applies only to pre-existing conditions that existed before the original start date of the contract, meaning that the first symptoms, clinical signs, findings, suspected diagnosis or veterinary indications had already occurred or been documented before that date. Any pre-existing condition that first occurred within the three months immediately preceding the original start date of the contract, or during the applicable waiting period, is not covered, including any related treatment costs, consequential illnesses or complications. The effective date of the contract amendment determines only the date from which, subject to the applicable waiting period, costs relating to covered pre-existing conditions may be claimed. Any costs incurred before the effective date of the contract amendment are not covered under any circumstances.

Claims requirements: when assessing a claim, and where requested by simpego, the policyholder must provide complete and accurate information regarding all symptoms, clinical signs, suspected diagnoses, confirmed diagnoses, known or apparent illnesses, accident-related conditions, veterinary treatment, prescribed medication, therapeutic diets, recommended investigations and planned treatment relating to the insured pet. Incomplete or inaccurate information may, in accordance with the applicable law and the terms of this contract, result in claims being declined, exclusions or endorsements being applied, or the contract being amended or terminated.

Pre-existing conditions include, in particular, but are not limited to:

The following shall not be considered pre-existing conditions: one-off, acute and fully resolved minor incidents, provided that there are no indications of a chronic, recurring or ongoing condition and there is no medical connection to the claim subsequently submitted.

These may include, in particular:

However, such events are considered a pre-existing condition if they recur, persist for a longer period, require further diagnostic investigation or are medically related to later symptoms or if there are indications of an underlying condition.

Depending on the agreement stated in the insurance contract, the following benefits are covered up to the amount specified for each individual benefit in the contract per contract year.

A benefit is always structurally linked to a main area of cover (illness and/or accident, pre-existing condition, etc.). This means that:

Covered are costs relating to dental illnesses, diseases of the supporting structures of the teeth (periodontal disease) and any resulting secondary conditions. Costs for dental prostheses, such as crowns, are not covered.

In connection with an insured event, the following forms of treatment are covered:

This list is exhaustive. Other forms of treatment are not covered.

In the event of an insured accident, complementary medicine treatments are covered for a maximum period of one year after the injury has successfully healed. An accident is considered to have fully healed where, in the veterinary surgeon’s opinion, no further examinations, monitoring or veterinary treatment are required. If complementary medicine treatment following an insured accident continues for longer than one year, any costs incurred thereafter are no longer covered.

Covered are veterinary diets, nutritional supplements and nutritional advice prescribed by a veterinary surgeon or another recognised service provider as part of the treatment of an insured event. Veterinary diets and nutritional supplements must be obtained directly from the veterinary surgeon or supplied with an appropriate prescription.

If an emergency occurs in connection with an insured event, the additional treatment costs arising from the emergency are covered, including any applicable emergency surcharges. This also includes the costs of a veterinary ambulance (excluding helicopter transport), where medically necessary, for transporting the pet to an emergency clinic or for the emergency transfer of the pet from a veterinary surgeon to a larger veterinary hospital. If no other means of transport is available that would allow the quickest possible transport of the pet for emergency treatment, the costs of a taxi or similar transport service will be covered. This applies only to the transport of the sick or injured pet to the nearest emergency clinic or emergency veterinary surgeon. Where home visits are medically necessary, we will cover the additional costs incurred as a result.

An emergency is defined as a sudden illness or injury requiring immediate, unforeseen and unplanned medical treatment because otherwise the pet’s health would be seriously at risk. This means that symptoms occur acutely or worsen suddenly to such an extent that any delay in treatment would be dangerous. No emergency treatment costs will be covered for conditions that have existed for some time and have not suddenly deteriorated.

Preventive care includes the following treatments:

This list is exhaustive.

If the insured illness event is a hereditary or congenital condition as defined in Article B.8.2., the benefit restriction does not apply.

The following are not covered:

Where agreed in the insurance contract, the following additional coverage are included.

The costs of accommodating the insured pets in a boarding facility or the costs of a professional pet sitter are covered up to the amount per day and the maximum number of days per contract year specified in the insurance contract.

Up to the amount specified in the insurance contract, the insurance covers the costs of recovering and rescuing the insured pet. This includes assistance provided by specialist rescue organisations, such as air rescue services or animal ambulances, as well as rescue operations carried out by the police, fire brigade, or other organisations and persons equipped to perform rescue and recovery operations.

The insurance does not cover the following:

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