VPI Pet Insurance Plan Summary for your pets.

Contents
Your selected coverage for Buttons Medical Plan benefit schedule

This quote was created on January 14, 2013, and is good for 30 days. 1-877-263-6008 petinsurance.com

This Policy Summary is not an actual policy. Quoted amounts are for policy premium and eligible discounts only. Total cost may vary due to applicable fees and state surcharges. Per paycheck pricing is based on a 26 pay period per year cycle; your pricing may vary depending on the payment schedule of your employer. Your final total may vary based on your pets detailed information and the plan options you select. Plan type and benefits are subject to state availability. Pre-existing conditions are not covered by our policies. Pre-existing condition means any condition that began or was contracted, manifested, or incurred before the effective date of the policy, whether or not the condition was discovered, diagnosed, or treated. All applications are subject to Underwriting approval. Read your policy for complete coverage details. Insurance plans are offered and administered by Veterinary Pet Insurance Company in California and DVM Insurance Agency in all other states. Underwritten by Veterinary Pet Insurance Company (CA), Brea, CA, an A.M. Best A rated company (2012); National Casualty Company (all other states), Madison, WI, an A.M. Best A+ rated company (2012). 2012 Veterinary Pet Insurance Company. Nationwide Insurance is a service mark of Nationwide Mutual Insurance Company.

Plan Summary for Buttons.

About you & your pet:
You live in New York, 11003 with your 2-month-old Mixed (Large 51-110 Lbs.), named Buttons.

Your selected coverage:

Medical Plan

economical

SM

$250 annual deductible

Accidents & injuries Illnesses Cancer X-rays Surgeries Use any vet

$7,000 maximum annual benefit

$22.25/mo.
$22.25/mo.

Your monthly premium:

This quote was created on January 14, 2013, and is good for 30 days. 1-877-263-6008 petinsurance.com

This Policy Summary is not an actual policy. Quoted amounts are for policy premium and eligible discounts only. Total cost may vary due to applicable fees and state surcharges. Per paycheck pricing is based on a 26 pay period per year cycle; your pricing may vary depending on the payment schedule of your employer. Your final total may vary based on your pets detailed information and the plan options you select. Plan type and benefits are subject to state availability. Pre-existing conditions are not covered by our policies. Pre-existing condition means any condition that began or was contracted, manifested, or incurred before the effective date of the policy, whether or not the condition was discovered, diagnosed, or treated. All applications are subject to Underwriting approval. Read your policy for complete coverage details. Insurance plans are offered and administered by Veterinary Pet Insurance Company in California and DVM Insurance Agency in all other states. Underwritten by Veterinary Pet Insurance Company (CA), Brea, CA, an A.M. Best A rated company (2012); National Casualty Company (all other states), Madison, WI, an A.M. Best A+ rated company (2012). 2012 Veterinary Pet Insurance Company. Nationwide Insurance is a service mark of Nationwide Mutual Insurance Company.

VETERINARY PET INSURANCE VPI MEdICAl PlAN BENEFIT SCHEdUlE

A
Code Diagnosis
Primary Allowance

B
Secondary Allowance

Stomach
Conditions 1222 gastropathy 1226 gastric ulcer 1230 hemorrhagic gastroenteritis 1220 gastric foreign Object(s)-Medical 1228 Acquired Pyloric hypertrophy-Medical 1223 gastric Dilatation-Medical 1229 Stomach Neoplasia-Medical Procedures 1235 feeding tube 1221 gastric foreign Object(s)-Surgical 1227 Acquired Pyloric hypertrophy-Surgical 1224 gastric torsion-Surgical 1225 Stomach Neoplasia-Surgical $430 390 485 310 250 360 325 $0 0 0 0 0 $170 155 195 125 100 140 130 $115 750 510 1035 565

(Effective 1-09. Subject to change)

Column A Primary Allowance is the benefit limit for the primary condition or procedure. this includes exam, diagnostic testing, prescriptions, injections, hospitalization, treatment, anesthesia and surgery. Column B Secondary Allowance is the benefit limit for the condition or procedure that is treated along with the Primary Diagnosis condition or procedure. A
Code Diagnosis
Primary Allowance

B
Secondary Allowance

Small Intestine
Conditions 1241 Enteropathy 1240 Endotoxic Shock 1249 IBD or Acquired Lymphangiectasia (Biopsy Required) 1242 Intestinal foreign Object(s)-Medical 1244 Intussusception-Medical 4005 Small Intestine Neoplasia-Medical Procedures 1243 Intestinal foreign Object(s)-Surgical 1248 Intestinal Resection and Anastomosis or Enteroplication 1247 De-Rotation of Intestinal Volvulus 1246 Small Intestine Neoplasia-Surgical $315 0 580 310 185 390 $0 0 0 0 $185 165 230 125 75 155 $765 630 150 465

CARDIOVASCULAR SYSTEM (Heart & Vessels)

Conditions 1101 Arrhythmia or Syncope 1102 thromboembolism 1103 Acquired Cardiomyopathy 1105 Myocarditis or Endocarditis or Pericarditis 1107 Congestive heart failure 1108 Valvular heart Disease or Murmur 1106 Pericardial Effusion 1111 Cardiovascular Collapse (Shock) 1123 heart and Pericardium Neoplasia-Medical 1125 Peripheral Vessel Neoplasia-Medical Procedures 1114 Pacemaker 1122 Pericardectomy or Pericardial Window 1104 heart and Pericardium Neoplasia-Surgical 1109 Peripheral Vessel Neoplasia-Surgical $240 745 380 335 0 330 0 0 345 315 $0 0 0 0 $95 295 150 135 115 130 180 175 140 125 $1000 290 1145 445

Large Intestine
Conditions 1250 Colitis 4011 Constipation 1251 Acquired Megacolon 1257 Rectal Prolapse 4012 Large Intestine Neoplasia-Medical Procedures 4013 Large Intestine Disorder-Surgical 1255 Large Intestine Neoplasia-Surgical $240 240 205 175 390 $0 0 $95 95 80 70 155 $540 540

DIGESTIVE SYSTEM
Oral Cavity
Conditions 1402 tonsillitis or Pharyngitis 2510 ulcerative Stomatitis 2512 Acquired Oronasal fistula 2520 tooth Resorption 2505 Oral trauma or fractured tooth 2502 tooth Infection, Cavity or Abscess 2503 Carnassial or Canine tooth Infection, Cavity or Abscess 2522 Retropharyngeal Abscess 2508 Oral foreign Object(s) 2521 Benign Oral Neoplasia-Medical 2525 Malignant Oral Neoplasia-Medical Procedures 2514 tooth Extraction(s) 2524 Carnassial or Canine tooth Extraction(s) 2511 Root Canal therapy 1407 tonsillectomy 2526 Benign Oral Neoplasia-Surgical 2504 Malignant Oral Neoplasia-Surgical $135 160 0 145 365 315 300 220 220 225 325 $0 0 0 0 0 0 $55 65 160 55 145 100 120 85 85 90 130 $250 275 490 315 125 255

Perineal
Conditions 1262 Perianal or Perineal fistula-Medical 4022 Perineal hernia-Medical 4023 Perineal Neoplasia-Medical 4025 Anal Sac Neoplasia-Medical Procedures 1263 Perianal or Perineal fistula-Surgical 1264 Perineal hernia-Surgical 1265 Perineal Neoplasia-Surgical 4021 Anal Sac Neoplasia-Surgical $195 155 220 190 $0 0 0 0 $75 60 90 75 $340 405 220 275

PANCREATIC, CHOLANGIO & HEPATIC (Pancreas, Gall Bladder & Liver)

Pancreas
Conditions 1270 Pancreatitis 1271 Acquired Exocrine Pancreatic Insufficiency 2950 Diabetes Mellitus 2953 Ketoacidosis 1272 Pancreatic Cyst or Abscess-Medical 2952 Pancreatic Neoplasia-Medical Procedures 1274 Pancreatic Cyst or Abscess-Surgical 2951 Pancreatic Neoplasia-Surgical

Salivary Gland
Conditions 2601 Sialocele-Medical 2605 Salivary gland Abscess or granuloma 2606 Salivary gland Neoplasia-Medical Procedures 2602 Sialocele-Surgical 2604 Salivary gland Neoplasia-Surgical $180 295 335 $0 0 $70 115 135 $655 555

$580 185 435 0 0 330 $0 0

$230 75 175 450 205 130 $315 395

Esophagus
Conditions 1202 Esophagitis 1201 Acquired Esophageal Dysfunction-Medical 1203 Esophageal foreign Object(s)-Medical 4001 Esophageal Neoplasia-Medical Procedures 1209 Acquired Esophageal Dysfunction-Surgical 1205 Esophageal foreign Object(s)-Surgical 1207 Esophageal Neoplasia-Surgical $190 315 250 310 $0 0 0 $75 125 100 125 $200 355 355

Gall Bladder
Conditions 1281 gall Bladder Disorder-Medical 1284 gall Bladder Neoplasia-Medical Procedures 1280 gall Bladder Disorder-Surgical 1283 gall Bladder Neoplasia-Surgical $280 315 $0 0 $110 125 $895 895

Liver Abdominal Wall

Conditions 1211 Peritonitis-Medical 1214 Abdominal Wall Disruption 1218 Peritoneal Neoplasia-Medical Procedures 1212 Peritonitis-Surgical 1217 Exploratory-Surgical 1213 Peritoneal Neoplasia-Surgical $445 485 290 $0 0 0 $175 195 115 $540 325 290 Conditions 1290 hepatopathy 1297 hepatic Encephalopathy 1293 hepatic Abscess 4041 hepatic Neoplasia-Medical Procedures 4042 hepatic Biopsy 1294 Partial or Complete hepatic Lobectomy-Surgical 1292 hepatic Neoplasia-Surgical (Lobectomy) $360 0 365 285 $0 0 0 $145 120 145 115 $150 665 665

VS-G-2-a(11-08)
2008 Veterinary Pet Insurance Company

VPI MEDICAL PLAN BENEfIt SChEDuLE PAgE 1

Continued on page 2

Continued from page 1 Code Diagnosis

A
Primary Allowance

B
Secondary Allowance

A
Code Diagnosis
Primary Allowance

B
Secondary Allowance

DERMATOLOGY (Skin)
Wounds
Conditions 1304 Puncture(s) 1305 Abrasion(s) 1307 Burn(s) 1308 Seroma or hematoma 1302 Laceration or Bite Wound 1303 Lacerations or Bite Wounds (Multiple) 1306 Dermal Abscess or granuloma or Pressure ulcer 1301 Dermal foreign Object(s) 1313 Degloving Injury Procedures 1311 Dehiscence Repair 1310 Skin graft $240 175 125 135 375 485 195 185 0 $0 0 $95 70 50 50 150 195 75 70 320 $190 225

Procedure 1506 Vaginal Neoplasia-Surgical

$0

$210

Uterine
Conditions 1510 Pyometra or Metritis-Medical 1516 uterine or Ovarian Neoplasia-Medical Procedures 1517 Remnant Ovary-Surgical 1511 Pyometra or Metritis-Surgical 1513 uterine or Ovarian Neoplasia-Surgical $225 200 $0 0 0 $90 80 $325 520 325

Mammary Gland
Conditions 1520 Mastitis 1527 Mammary Neoplasia-Medical Procedures 1526 Mammary Neoplasia-Simple Mastectomy 1521 Mammary Neoplasia-Regional or Partial Mastectomy 1522 Mammary Neoplasia-unilateral or Complete Mastectomy $150 185 $0 0 0 $60 75 $150 330 590

Dermatoses
Conditions 1366 Dermatopathy 1322 Atopic or Other Allergic Dermatitis 1323 fungal Skin Disease 1326 Pyoderma and/or hot Spot 1328 Lick granuloma 1331 Immune Mediated Skin Disease 1332 Eosinophilic granuloma Complex 1346 toe Nail Disease 1367 Solar Dermatitis 1321 Cellulitis or Subcutaneous Emphysema 1368 hepatocutaneous Syndrome 1369 Benign Skin Neoplasia-Medical 1370 Malignant Skin Neoplasia-Medical Procedures 1329 Benign Skin Neoplasia-Surgical 1336 Malignant Skin Neoplasia-Surgical $280 280 135 200 140 240 150 190 130 130 0 225 300 $0 0 $110 110 50 80 55 95 60 75 50 50 55 90 120 $480 480

Scrotal & Testicular

Conditions 1531 Orchitis or Epididymitis 1532 testicular torsion or trauma 1536 testicular Neoplasia-Medical Procedures 1533 Scrotal Ablation 1530 testicular Neoplasia-Surgical (Includes Castration) $235 315 160 $0 0 $95 125 65 $85 160

Penis & Prepuce

Conditions 1540 Paraphimosis or Phimosis 1544 Balanoposthitis 1541 Penile trauma 1543 Penile or Preputial foreign Object(s) 1545 Penile Neoplasia-Medical Procedure 1542 Penile Neoplasia-Surgical $155 115 160 210 130 $0 $60 45 60 80 55 $290

RESPIRATORY SYSTEM (Airways & Lungs)

Nasal Cavity
Conditions 2401 Rhinitis or Sinusitis or Canine upper Respiratory Infection 2404 Nasal or Sinus trauma 2403 Nasal Cavity foreign Object(s) 2405 Nasal or Sinus Neoplasia-Medical Procedure 2406 Nasal or Sinus Neoplasia-Surgical $175 180 230 290 $0 $85 70 90 115 $190

Prostate
Conditions 1551 Prostatitis or Benign Prostatic hypertrophy-Medical 1553 Prostatic Neoplasia-Medical Procedures 1554 Prostatic Biopsy 1552 Prostatitis or Benign Prostatic hypertrophy-Surgical (Includes Castration) 1550 Prostectomy or Prostatic Neoplasia-Surgical (Includes Castration) $215 250 $0 0 0 $85 100 $150 160 390

Upper Airway
Conditions 1408 Laryngitis or tracheitis 1405 upper Airway trauma(s)-Medical 1401 upper Airway foreign Object(s)-Medical 1409 Laryngeal Paralysis-Medical 1427 upper Airway Neoplasia-Medical Procedures 1428 upper Airway trauma(s)-Surgical 1410 Laryngeal Paralysis-Surgical 1423 upper Airway foreign Object(s)-Surgical 1406 upper Airway Neoplasia-Surgical $130 265 210 280 270 $0 0 0 0 $50 105 80 110 105 $125 950 240 460

CHEMICAL & PHYSICAL (Poisonings, Toxicities, Reactions & Accidents)

Chemical
Conditions 1601 Metaldehyde toxicity (Snail & Slug Bait) 1602 Strychnine toxicity (Pesticide) 1603 Ethylene glycol toxicity (Antifreeze) 1604 Insecticide Poisoning 1605 Rodenticide toxicity (Pesticide) 1606 household Chemicals toxicity (Detergents, Cleaners) 1608 toad Poisoning 1609 Poisoning of Plant Origin 1611 Drug toxicity or Overdose 1612 Methylxanthine toxicity (Chocolate, Caffeine) 1613 Alcohol toxicity 1615 heavy Metals toxicity (Lead, Zinc) 1619 Other toxicity Procedure 1618 gastric Lavage for toxin Ingestion $450 255 455 245 320 215 185 290 440 235 260 375 350 $0 $180 100 180 95 125 85 70 115 175 95 100 150 140 $140

Thorax (Chest)
Conditions 1442 Asthma or Allergic Bronchitis 1447 Pneumonia 1441 Pulmonary Edema 1440 Pulmonary Contusions 1444 Pleural Effusion 1460 Interstitial Lung Disease 1451 Mediastinal Disease 1454 Pyothorax 1455 Chylothorax 1462 thoracic foreign Object(s)-Medical 1448 Lung Consolidation or torsion 1449 Pneumothorax or Pulmonary Bulla 1453 thoracic Neoplasia-Medical Procedures 1446 traumatic Diaphragmatic hernia-Surgical 1458 Chest tube 1450 thoracic foreign Object(s)-Surgical 1445 thoracic Neoplasia-Surgical 1461 Lung Lobectomy $220 305 0 0 0 205 460 1135 1135 315 260 445 280 $0 0 0 0 0 $90 120 165 155 215 85 185 455 455 125 105 180 110 $800 415 1145 1145 1145

Physical
Conditions 1650 Insect Bites and Stings 1651 Snakebite 1662 Wild Mammal Encounter 1663 Crushing or Blunt trauma 1664 Strangulation 1652 Near Drowning 1665 Smoke or Inhalation toxicity 1653 heat Stroke (hyperthermia) 1654 hypothermia 1655 frostbite 1656 Electric Shock 1657 hypoglycemia 1661 Systemic Allergic Reaction 1666 Anaphylactic Shock $240 275 165 240 165 195 390 350 170 320 180 225 195 260 $95 110 65 95 65 75 155 140 65 125 70 90 80 105

REPRODUCTIVE SYSTEM
Vaginal
Conditions 1501 Vaginitis 1505 Vaginal trauma 1504 Vaginal foreign Object(s) 1515 Vaginal Neoplasia-Medical $120 255 220 205 $45 100 85 80

VS-G-2-a(11-08)
2008 Veterinary Pet Insurance Company

VPI MEDICAL PLAN BENEfIt SChEDuLE PAgE 2

Continued on page 3

Continued from page 2 Code Diagnosis

A
Primary Allowance

B
Secondary Allowance

A
Code Diagnosis
Primary Allowance

B
Secondary Allowance

Procedure 1658 Anti-Venom or Antizol

$0

$395

URINARY SYSTEM
Renal (Kidney)
Conditions 1724 Pyelonephritis 1703 Nephrotic Syndrome 1718 Acute Renal failure 1716 Chronic Renal failure 1709 glomerulonephritis 1701 Nephrolithiasis or ureterolithiasis 1719 Renal Neoplasia-Medical Procedures 1720 Dialysis or hemofiltration 1706 Renal Biopsy 1707 Acquired Renal or ureter Disorder-Surgical 1715 Kidney transplant 1721 Renal Neoplasia-Surgical $285 200 340 340 340 210 200 $0 0 0 0 0 $110 80 135 135 135 85 80 $450 150 1145 1145 1145

Bladder
Conditions 1806 Acquired urinary Incontinence or Atony 1802 Canine Cystitis 1805 feline Cystitis or fLutD-Medical 1809 urolithiasis-Medical 1807 Bladder Neoplasia-Medical Procedures 1820 feline Cystitis or fLutD-Obstructed Male 1801 Acquired Bladder Disorder-Surgical 1803 traumatic Bladder Rupture-Surgical 1804 Bladder Neoplasia-Surgical $230 415 415 180 280 $0 0 0 0 $90 165 165 70 110 $230 745 360 185

2132 Ocular trauma 2161 Corneal Sequestrum 2121 Ocular foreign Object(s) 2165 Descemetocele-Medical 2115 Secondary glaucoma-Medical 2136 Secondary Cataract(s)-Medical 2138 Lens Luxation or Subluxation-Medical 2134 Retinal Detachment-Medical 2122 Meibomian gland Disorder 2166 Eyelid Neoplasia-Medical 2167 Ocular Neoplasia-Medical Procedures 2111 Corneal ulcer-Debridement or Keratotomy 2127 Corneal ulcer-graft or Keratectomy 2123 Proptosed Eye Replacement 2126 Enucleation or Evisceration 2112 Descemetocele-Surgical 2116 Secondary glaucoma-Surgical 2117 Secondary Cataract-Surgical 2118 Lens Luxation or Subluxation-Surgical 2137 Retinal Detachment-Surgical 2120 Iris Prolapse-Surgical 2102 Eyelid Neoplasia-Surgical 2129 Ocular Neoplasia-Surgical

$135 140 155 190 225 110 150 225 115 115 225 $0 0 0 0 0 0 0 0 0 0 0 0

$55 55 60 75 90 45 60 90 45 45 90 $370 670 310 635 710 785 1145 400 395 250 175 205

NEUROLOGY (Brain, Spinal Cord & Nerves)

Conditions 2205 Epilepsy or Seizure(s) or Idiopathic tremor Syndrome 2213 Neuritis (Peripheral Nerve) 2240 horners Syndrome 2202 Polyradiculoneuritis 2204 Encephalitis or Meningitis or gME 2228 Degenerative Encephalopathy or Canine Cognitive Dysfunction 2242 Neck or Back Sprain 2206 Intervertebral Disc Disease-Medical 2217 Diskospondylitis 2218 Cauda Equina Syndrome-Medical 2210 Neurologic trauma 2203 Myelopathy 2227 Paresis or Paralysis or Ataxia 2211 Cranial Vascular Accident or Stroke 2220 fibrocartilaginous Embolism 2221 Vestibular Syndrome 2222 Acquired Myasthenia gravis 2243 Peripheral Nerve Neoplasia-Medical 2215 Brain or Spinal Cord Neoplasia-Medical Procedures 2208 Intervertebral Disc Disease-Surgical 2216 Cauda Equina Syndrome-Surgical 2235 Craniotomy 2244 Peripheral Nerve Neoplasia-Surgical 2223 Spinal Cord Neoplasia-Surgical $310 200 200 315 540 165 225 370 335 285 305 300 0 345 320 285 505 205 305 $0 0 0 0 0 $125 80 80 125 215 65 90 150 135 115 120 120 115 135 130 115 200 80 125 $1060 1060 1260 305 545

Urethra
Conditions 1901 urethrolithiasis-Medical 1902 urethral trauma-Medical 1912 urethral Neoplasia-Medical Procedures 1911 urethrotomy or urethral trauma-Surgical 1903 Perineal urethrostomy 1905 urethral Neoplasia-Surgical $205 200 270 $0 0 0 $80 80 105 $225 1130 625

INFECTIOUS (Virus, Bacteria & Fungus)

Conditions 2001 Papillomatosis 2003 Canine Parvovirus 2005 Canine Coronavirus 2006 feline upper Respiratory Disease Complex 1452 tracheobronchitis or Kennel Cough 2007 feline Infectious Peritonitis (fIP) 2008 haemobartonella (Mycoplasmosis) 2009 feline Panleukopenia Virus (fPV) 2010 Canine Distemper 2013 Brucellosis 2014 Leptospirosis 2015 tetanus 2016 Botulism 2017 Coccidioidomycosis (Valley fever) 2019 feline Leukemia Virus (feLV) 2021 Ehrlichia or Anaplasma or Other Rickettsial Diseases 2022 Salmon Disease 2023 Lyme Disease 2024 Rocky Mountain Spotted fever 2039 Viral Infection-Other 2040 Blastomycosis-Systemic Mycosis 2041 histoplasmosis-Systemic Mycosis 2042 Cryptococcosis-Systemic Mycosis 2043 Bartonella 2045 tuberculosis or Other Mycobacteria 2046 feline Immunodeficiency Virus (fIV) 2047 West Nile Virus 2048 Canine Influenza 2049 Systemic Mycosis-Other $150 650 210 260 255 245 175 300 425 170 445 435 390 325 150 245 280 165 185 180 325 325 325 130 170 150 185 200 325 $60 260 85 105 100 95 70 120 170 65 180 175 155 130 60 95 110 65 75 70 130 130 130 50 65 60 75 80 130

AURAL (Ears)
Conditions 2305 Otitis Externa 2306 Otitis Media or Interna 2301 Auricular hematoma-Medical 2308 Ear foreign Object(s) 2304 Ear Canal Neoplasia-Medical Procedures 2317 Auricular hematoma-Surgical 2311 Ear Canal Neoplasia-Surgical 2307 Bulla Osteotomy 2309 Lateral or Vertical Ear Resection 2310 total Ear Canal Ablation $325 230 260 145 215 $0 0 0 0 0 $130 90 105 55 85 $225 270 245 635 710

MUSCULOSKELETAL
Conditions 2710 Immune Mediated Myositis 2777 hypertrophic Osteodystrophy 2727 Panosteitis 2715 Osteomyelitis or Septic Joint-Medical 2724 Musculoskeletal Sprain 2729 Soft tissue trauma 2734 torn Nail 2711 Degenerative Arthritis 3304 Immune Mediated Arthritis 2717 Spondylosis 2739 tendonitis or Synovitis or Bursitis 2784 hyperextension or Ligamentous Injury 2720 tendon Rupture-Medical 2701 Cruciate and/or Meniscus-Medical (see policy: Section 6, D) 2704 traumatic Elbow Luxation-Medical 2787 traumatic Shoulder Subluxation or Luxation-Medical 2706 traumatic hip Luxation-Medical 2735 hygroma-Medical 2788 Muscle Neoplasia-Medical 2725 Bone Cyst 2722 Bone or Joint Neoplasia-Medical $225 185 185 255 380 380 335 300 240 200 250 210 300 335 320 270 380 140 230 270 285 $90 70 70 100 150 150 130 120 95 80 100 85 120 130 125 105 150 55 95 105 110

OPHTHALMOLOGY (Eyes)
Conditions 2105 Plugged tear Duct 2106 Corneal Edema 2131 Blepharitis 2107 Conjunctivitis 2108 Keratoconjunctivitis Sicca or Keratitis 2110 Corneal ulcer 2114 uveitis or Retinitis 2156 Iritis or Acquired Iris Cyst 2158 Episcleritis or Scleritis 2135 Sudden Acquired Retinal Degeneration Syndrome 2119 Retrobulbar Abscess $105 115 115 210 175 300 150 150 115 160 300 $40 45 45 85 70 120 60 60 45 60 120

VS-G-2-a(11-08)
2008 Veterinary Pet Insurance Company

VPI MEDICAL PLAN BENEfIt SChEDuLE PAgE 3

Continued on page 4

Continued from page 3 Code Diagnosis

A
Primary Allowance

B
Secondary Allowance

A
Code Diagnosis
Primary Allowance

B
Secondary Allowance

Procedures 2721 tendon Repair-Surgical 2702 Cruciate and/or Meniscus-Surgical (see policy: Section 6, D) 2705 traumatic Elbow Luxation-Surgical 2740 traumatic Shoulder Subluxation or Luxation-Surgical 2708 traumatic hip Luxation-Surgical 2789 Bone or Joint Biopsy 2716 Osteomyelitis or Septic Joint-Surgical 2731 Dewclaw Amputation (Non-Elective) 2732 tail Amputation 2733 toe Amputation 2737 fore Leg Amputation 2738 Rear Leg Amputation 2795 Limb Sparing Procedure 2741 Mandibulectomy or Maxillectomy 2736 hygroma-Surgical 2728 Muscle Neoplasia-Surgical 2723 Bone or Joint Neoplasia-Surgical

$0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

$375 1310 355 430 870 150 405 125 175 215 450 450 520 865 170 290 775

Pituitary
Conditions 2960 Diabetes Insipidus 2962 Pituitary Neoplasia-Medical Procedure 2967 Pituitary Neoplasia-Surgical $245 245 $0 $95 100 $370

HEMATOLOGY (Blood Disorders)

Conditions 3001 Immune Mediated hemolytic Anemia 3003 heinz-Body Anemia 3004 Anemia of Chronic Disease 3005 Aplastic or hypoplastic Anemia 3006 Acute Anemia-Injury Related 3032 Immune Mediated or Idiopathic thrombocytopenia 3007 Myeloproliferative Disorders 3008 Leukemia 3009 Septicemia 3010 Myelodysplastic Disorders 3014 Multiple Myeloma Procedure 3011 transfusion $620 0 0 630 0 395 410 505 0 570 395 $0 $245 130 215 250 165 155 165 200 225 225 155 $290

FRACTURES
Skull, Jaw, Scapula, Rib & Patella
Procedures 2801 Cage Rest 2802 Bandage 2803 Sling 2811 Wires 2812 Pins or K Wires 2813 Plate 2814 External Apparatus or fixator 2815 Plate Removal 2816 hardware Removal $280 265 285 555 600 890 850 0 0 $0 105 110 300 320 435 420 255 160

LYMPHATIC SYSTEM
Conditions 3101 Lymphadenopathy 3103 Lymphosarcoma (Lymphoma) $235 615 $90 245

SPLENIC (Spleen)
Conditions 3204 Splenomegaly 3202 Splenic torsion-Medical 3206 Splenic Neoplasia-Medical Procedures 3203 Splenectomy 3201 traumatic Splenic Rupture-Surgical (Includes Splenectomy) 3205 Splenic Neoplasia-Surgical (Includes Splenectomy) $265 335 270 $0 0 0 $105 135 110 $630 630 630

Humerus, Femur, Radius, Ulna & Tibia

Procedures 2820 Bandage (RBt Jones/temporary) 2821 Splint or Cast 2830 IM Pins/Wires/Screws 2831 Plate 2832 External Apparatus or fixator 2834 Bone graft or Implant 2835 Plate Removal 2836 hardware Removal $260 355 905 1275 980 0 0 0 $100 140 440 590 470 200 275 160

MISCELLANEOUS
Conditions
7003 7004 2020 7002 1717 1607 3302 3034 7001 Complication of Spay or Neuter Orthopedic Device Removal Open or undefined Diagnosis Ascites hypertension Adverse Medication Reaction Systemic Lupus Erythematosus DIC or Systemic Inflammatory Response Syndrome (SIRS) Metastatic or Infiltrative Neoplasia $25 25 210 0 165 0 285 0 0 $0 0 100 115 100 100 110 225 275

Pelvis & Vertebrae

Procedures 2840 Cage Rest 2850 IM Pins/Wires/Screws 2851 Plate 2852 External Apparatus or fixator 2853 Plate Removal 2854 hardware Removal $285 1000 1420 1000 0 0 $160 480 685 480 325 160

Carpus, Metacarpus, Tarsus, Metatarsus & Phalanges

Fractures or Dislocations
Procedures 2860 Bandage 2861 Cast or Splint 2870 IM Pins/Wires/Screws 2871 Plate Arthrodesis 2872 Plate Removal 2873 hardware Removal $195 345 780 0 0 0 $75 135 390 995 255 160

Specialized Procedures
7100 7102 7103 7104 7105 7106 7107 7108 7109 1110 1000

ENDOCRINOLOGY
Adrenal
Conditions 2902 Addisons Disease 2961 Cushings Disease 2904 Adrenal Neoplasia-Medical Procedure 2903 Adrenal Neoplasia-Surgical $450 385 245 $0 $180 155 100 $370

Chemotherapy or Radiation treatment Mechanical Ventilation tracheostomy ultrasound Assist-guided Procedure Laparoscopy or thoracoscopy Spinal tap Joint tap(s) Bone Marrow Aspiration or Biopsy Endoscopy or Arthroscopy Cardiopulmonary Resuscitation (CPR) Euthanasia and/or Remains Care

$0 0 0 0 0 0 0 0 0 0 0

$1000 110 150 20 200 175 135 175 225 120 65

Specialized Diagnostic Tests*

7200 7201 7202 7203 7204 7205 7206 7207 7208 7209 7210

Thyroid
Conditions 2920 hypothyroidism 2921 hyperthyroidism 2924 thyroid Neoplasia-Medical Procedures 2923 hyperthyroid (I-131) 2922 thyroid Neoplasia-Surgical $315 360 215 $0 0 $125 145 85 $425 325

Allergen test Contrast Radiographs fluoroscopy Metastatic Check-thoracic Radiograph Ct Scan MRI Scan Myelogram Nuclear or Isotope Imaging full Diagnostic Ocular or Soft tissue ultrasound full Diagnostic Abdominal ultrasound full Diagnostic Echocardiogram or thoracic ultrasound

$0 0 0 0 0 0 0 0 0 0 0

$150 175 225 75 450 750 325 350 75 200 200

*this allowance is in addition to the primary or secondary benefit allowance as listed on this schedule. Maximum benefit for Specialized Diagnostic tests is $750 per policy term.

Parathyroid
Conditions 2940 hyperparathyroidism 2942 hypoparathyroidism 2944 Parathyroid Neoplasia-Medical Procedure 2943 Parathyroid Neoplasia-Surgical $335 240 280 $0 $135 95 110 $425

VS-G-2-a(11-08)
2008 Veterinary Pet Insurance Company

VPI MEDICAL PLAN BENEfIt SChEDuLE PAgE 4