Horse medical insurance long pre-dates ‘pet’ insurance. There is a lot of provider experience behind it. It evolves over time with that experience.
Anyway. If you take your horse in for diagnostics first, they won’t cover anything diagnosed as it will be a pre-existing condition.
It’s been so long since I enrolled a new horse, I don’t know if they require a medical exam first.
I’ve had horse medical insurance for many years. There were years when I had no claims and years when I had several. There were years when the insurance claims were more than the annual premium. One was more than several years’ annual premiums. They paid, promptly.
The biggest thing insurance did for me was saving the life of a horse in serious colic. Financially, he might have been beyond saving, without the insurance paying 80% of the cost (promptly & no fuss). I was on the phone with the insurance company almost every day the horse was in ICU. They were very kind and helpful as we figured out the way forward. I had to call them on Friday afternoon to warn them that the horse might not last the weekend, and with some of the admin insurance personnel not taking calls over the weekend, what should I do if the moment of decision came and I needed to proceed correctly. She told me calmly what to do if it came to that. Fortunately it didn’t. She called Monday morning to check in! Horse survived and continued living his full life.
There are various strategies people use to ‘insure’ their horse other than actual insurance. Maybe their own savings, maybe a credit card with an open balance. Care Credit is active in horse and pet insurance.
Fwiw my agent is Rhonda with Independent Equine Agents, 502-802-6371. They have made it easy for me. Rhonda found coverage in years that I didn’t think a horse could get it, due to pre-existing conditions. Right now the horse is covered through Great American, which has been doing horse insurance for a long time.