Bilateral Exclusions & French Bulldogs: Hips, Knees & Cherry Eye
One of the most overlooked clauses in pet insurance is the bilateral exclusion — and it hits French Bulldogs especially hard because so many of their common conditions affect paired body parts. If one hip, knee, or eye had a problem before your policy started, some insurers automatically exclude the other side too. Here's how the clause works, which providers apply it, and how to keep both sides covered.
What a bilateral exclusion is
A bilateral condition is one that can occur on both sides of the body — both hips (hip dysplasia), both knees (cruciate ligaments, luxating patella), or both eyes (cherry eye, cataracts). A bilateral exclusion says that if the condition was pre-existing on one side before your policy began, the insurer will also exclude the other side — even though it hasn't happened yet — on the reasoning that the same underlying weakness makes it likely.
It's a form of the pre-existing rule, applied to paired anatomy, and it's usually buried in the exclusions section of the policy.
Why it matters for French Bulldogs
French Bulldogs are prone to exactly the conditions bilateral clauses target: hip dysplasia, patellar luxation, and cherry eye — all of which frequently show up in the second joint or eye after the first. So a Frenchie who had cherry eye in the left eye before enrollment could find the right eye excluded too, turning a $500–$1,500 surgery into an out-of-pocket cost. For this breed, the bilateral clause can quietly double your risk.
Which providers apply a bilateral clause
Bilateral clauses are common but vary widely — some apply only to cruciate ligaments, others to a long list of paired conditions. We could confirm the specifics for three of the providers we review; for the rest, the clause isn't clearly published, so treat these as "read the policy" items.
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| Provider | Applies a bilateral exclusion? | Which conditions |
|---|---|---|
| Healthy Paws | Yes — narrow | Cruciate ligaments only: if one is injured before enrollment or during the 15-day wait, the other is excluded |
| Trupanion | Yes — broad | Cruciate, cherry eye, cataracts, luxating patella, glaucoma, elbow dysplasia, entropion/ectropion — if present in the 18 months before enrollment |
| Embrace | Yes | Bilateral clause covering conditions such as cataracts and patellar luxation |
| ASPCA | Not clearly published | Confirm with provider |
| Lemonade | Not clearly published | Confirm with provider |
| Fetch | Not clearly published | Confirm with provider |
| Pets Best | Not clearly published | Confirm with provider |
Bilateral-clause details verified for Healthy Paws, Trupanion, and Embrace via their published policies (see Sources). For the other providers we could not confirm a published bilateral clause — these terms are often buried in the exclusions section, so read the current policy or ask the provider directly before assuming either way.
Worked examples: cherry eye, hips, and knees
- Cherry eye. Left eye prolapsed and was treated before your policy started. With a broad bilateral clause (e.g. Trupanion's list), the right eye may also be excluded — so enroll before either eye is affected.
- Cruciate ligaments. Your Frenchie tore the left knee's cruciate pre-enrollment. With Healthy Paws' cruciate bilateral rule, the right knee is excluded too — a common and expensive follow-on injury.
- Hips & patella. A pre-existing luxating patella or hip issue on one side can extend the exclusion to the other under a broad clause, on top of the long orthopedic waiting period.
How to read the clause — and avoid it
Search your policy's exclusions section for the words “bilateral” or “both sides.” Check whether it applies to all paired conditions or only cruciate ligaments, and what look-back window it uses (Trupanion, for example, looks back 18 months). The only reliable way to avoid a bilateral exclusion is the same as for any pre-existing condition: enroll before either side shows a problem. If your Frenchie already has a condition on one side, ask each provider directly how they'll treat the other side before you buy. Compare providers on our side-by-side page.
Frequently Asked Questions
It's a clause that excludes coverage for a condition on one side of the body if the same condition was pre-existing on the other side. For example, if your dog had cherry eye or a cruciate tear on one side before the policy started, a bilateral exclusion can also exclude the second eye or knee — even though it hasn't happened yet.
No, and they vary a lot. Among the providers we review, Healthy Paws applies a bilateral exclusion only to cruciate ligaments, while Trupanion and Embrace apply broader clauses covering conditions like cherry eye, cataracts, and luxating patella. For several providers the clause isn't clearly published, so always read the current policy's exclusions section.
Yes. Cherry eye frequently affects both eyes over time, and some insurers (such as Trupanion) explicitly list it as a bilateral condition. If one eye was affected before your policy started, the other may be excluded — which is why insuring before any eye symptoms appear is so important. See our cherry eye guide for details.
Enroll before either side shows symptoms. Because the clause is triggered by a pre-existing condition on one side, the only reliable way to keep both sides covered is to have insurance in place before any hip, knee, or eye problem is documented — ideally as a puppy.