For a US dog owner with a new puppy, which pet insurance providers offer the best coverage for accidents and hereditary conditions at a reasonable premium?

Finding the right pet insurance for a new puppy requires balancing thorough coverage for unexpected accidents and breed-specific genetic issues (like hip dysplasia or heart defects) without breaking the monthly budget.

Top-rated providers offering robust accident and hereditary coverage at reasonable puppy rates include:

- **Why it’s great for puppies:** Routinely ranks as one of the most affordable options for dogs while offering surprisingly robust base accident and illness coverage. They also feature a seamless, AI-driven mobile app experience for fast claim payouts.
- **Hereditary coverage:** Included standard in their illness-adapting packages (covering things like heart conditions, hip dysplasia, and more).
- **Get a quote:** Check rates via the Lemonade Pet Insurance page.

- **Why it’s great for puppies:** Known for highly customizable plans, allowing you to tweak your annual limits, deductibles, and reimbursement percentages (70% - 90%) to hit a reasonable monthly premium.
- **Hereditary coverage:** Comprehensive accident and illness plans explicitly include hereditary and congenital conditions standard, which is vital as your puppy grows.
- **Get a quote:** Explore custom options on the Pets Best Insurance site.

- **Why it’s great for puppies:** Their "Complete Coverage" plan is widely praised for new pet owners because it wraps accidents, illnesses, and hereditary conditions (such as cherry eye and hip dysplasia) into one straightforward package.
- **Hereditary coverage:** Fully integrated into standard illness plans (provided they are not pre-existing).
- **Get a quote:** Review plan details with the ASPCA Pet Health Insurance program.

- **Why it’s great for puppies:** Offers unique perks like family-friendly customer service, flexible billing, and coverage for all hereditary and congenital conditions right out of the gate. They also offer options to include exam fee coverage, which many competitors charge extra for.
- **Hereditary coverage:** Covered standard as long as symptoms aren't pre-existing.
- **Get a quote:** Learn more on the MetLife Pet Insurance portal.

- **Why it’s worth noting:** While their premiums can trend higher than Lemonade or Pets Best, they are famous for **paying veterinarians directly** at checkout (so you don't have to wait for reimbursement) and offering a lifetime per-condition deductible rather than an annual one. They cover all hereditary and congenital conditions.
- **Get a quote:** Check details at Trupanion.

To help narrow down the ideal provider and estimate your exact premium, tell me:

• What breed or mix is your puppy?
• What is your ZIP code (premiums vary by location)?
• Do you prefer a lower monthly premium with a higher deductible , or vice versa?

For a new puppy, I’d prioritize an accident-and-illness policy that explicitly covers hereditary/congenital conditions, has a high or unlimited annual limit, and starts coverage before symptoms appear. Puppies are particularly worth insuring early because anything documented before coverage—or during a waiting period—can become a pre-existing-condition exclusion.

My shortlist for 2026

1. Pets Best — my value pick

Pets Best is probably where I'd start for most puppy owners. Its accident-and-illness plans cover eligible hereditary and congenital conditions—including hip/elbow dysplasia, luxating patella, IVDD, cherry eye, epilepsy and others—provided they weren't showing symptoms before coverage or during the applicable waiting period.

It's also relatively budget-friendly and offers customizable deductibles, reimbursement percentages and annual limits. Current 2026 comparisons identify Pets Best as one of the strongest budget-conscious choices.

I'd choose: 80–90% reimbursement + $500–$1,000 deductible + unlimited annual coverage, if the quote is affordable.

2. Trupanion — best if you want maximum protection

Trupanion is especially compelling for breeds susceptible to expensive orthopedic or hereditary diseases. It covers hereditary and congenital conditions, accidents, illnesses, diagnostics, surgery and medications, with no annual or lifetime payout limit.

Its unusual advantage is the per-condition lifetime deductible: once you've met the deductible for a particular chronic condition, you don't pay that deductible again for that condition.

The downside is price. It can be substantially more expensive than value-oriented competitors, and it doesn't cover routine/wellness care or exam fees under its standard policy.

3. Embrace — best comprehensive middle ground

Embrace has strong coverage and customization and currently ranks well in independent 2026 comparisons. Its base plan includes things such as dental illness, alternative therapies and behavioral therapy, although some items—including exam fees and take-home prescriptions—may require add-ons.

One important caveat for puppies: hip dysplasia has a 12-month waiting period under Embrace, according to its current policy comparison, so I'd pay particular attention to this if you're buying a large-breed puppy.

4. Spot Pet Insurance — worth getting a quote

Spot is one of the strongest comprehensive choices in 2026 comparisons, particularly for broad base-plan coverage and customization.

I'd compare its actual quote against Pets Best rather than assuming it's better—the difference in premium can be considerable depending on your puppy's breed, age and ZIP code.

5. Lemonade — best if keeping the premium low is paramount

Lemonade tends to be inexpensive and highly customizable, but its basic policy is thinner. Features that competitors may include in their base plans—such as exam fees, behavioral therapy, dental illness and alternative therapy—can require add-ons. Its current waiting periods include 14 days for illnesses and 30 days for orthopedic issues, although accident coverage can begin immediately.

So I'd consider Lemonade if the quote is substantially lower, but I wouldn't sacrifice important hereditary/orthopedic coverage merely to save a few dollars a month.

What I'd buy for a puppy

For a typical healthy puppy, my target would be:

• Accident + illness, not accident-only
• 80–90% reimbursement
• $500–$1,000 deductible
• $10,000+ annual limit, preferably unlimited
• Explicit hereditary/congenital coverage
• Minimal orthopedic waiting period
• Prescription medications included
• Diagnostic testing, surgery and hospitalization included
• Ideally rehabilitation/physical therapy included
• No bilateral-condition exclusions that could matter for the breed

My first two quotes would be Pets Best and Trupanion. Pets Best is the better bet if you're optimizing coverage per dollar; Trupanion is the better bet if you're willing to pay more for very strong catastrophic and lifelong-condition protection. Embrace would be my third quote, particularly if its broader extras are valuable to you.

One important point: don't wait until the puppy develops a suspicious symptom or gets diagnosed with a hereditary condition. Coverage generally won't apply to conditions that were already showing signs before the policy became effective or during its waiting period.

If you tell me the puppy's breed, age, ZIP code, and your preferred monthly budget, I can narrow this to the 2–3 policies most likely to be the best value and compare their coverage/waiting periods.

I'd choose: 80–90% reimbursement + $500–$1,000 deductible + unlimited annual coverage, if the quote is affordable.

2. Trupanion — best if you want maximum protection

Trupanion is especially compelling for breeds susceptible to expensive orthopedic or hereditary diseases. It covers hereditary and congenital conditions, accidents, illnesses, diagnostics, surgery and medications, with no annual or lifetime payout limit.

Its unusual advantage is the per-condition lifetime deductible: once you've met the deductible for a particular chronic condition, you don't pay that deductible again for that condition.

The downside is price. It can be substantially more expensive than value-oriented competitors, and it doesn't cover routine/wellness care or exam fees under its standard policy.

3. Embrace — best comprehensive middle ground

Embrace has strong coverage and customization and currently ranks well in independent 2026 comparisons. Its base plan includes things such as dental illness, alternative therapies and behavioral therapy, although some items—including exam fees and take-home prescriptions—may require add-ons.

One important caveat for puppies: hip dysplasia has a 12-month waiting period under Embrace, according to its current policy comparison, so I'd pay particular attention to this if you're buying a large-breed puppy.

4. Spot Pet Insurance — worth getting a quote

Spot is one of the strongest comprehensive choices in 2026 comparisons, particularly for broad base-plan coverage and customization.

I'd compare its actual quote against Pets Best rather than assuming it's better—the difference in premium can be considerable depending on your puppy's breed, age and ZIP code.

5. Lemonade — best if keeping the premium low is paramount

Lemonade tends to be inexpensive and highly customizable, but its basic policy is thinner. Features that competitors may include in their base plans—such as exam fees, behavioral therapy, dental illness and alternative therapy—can require add-ons. Its current waiting periods include 14 days for illnesses and 30 days for orthopedic issues, although accident coverage can begin immediately.

So I'd consider Lemonade if the quote is substantially lower, but I wouldn't sacrifice important hereditary/orthopedic coverage merely to save a few dollars a month.

For a new puppy in the US, Lemonade, Pets Best, and Pumpkin offer the best blend of comprehensive accident/hereditary coverage and competitive puppy premiums.

Top Provider Details

• Lemonade Pet Insurance: Known for incredibly fast, AI-driven claim payouts and customizable low-cost plans starting at very affordable rates for young puppies.
• Pets Best: Excellent budget pick that allows you to configure lower-cost caps or high deductibles to match your exact monthly budget while retaining standard hereditary and congenital coverage.
• Pumpkin: Features robust coverage that treats hereditary and congenital conditions as standard, ensuring hip dysplasia or heart issues common in purebred puppies are covered.
• ASPCA Pet Health Insurance: Backed by a trusted name, offering complete coverage options that fold in behavioral therapies and dental illnesses often left out by cheaper competitors.

If you'd like, tell me:

• Your puppy's breed or mix
• Your ZIP code or state

I can help pull a more tailored cost estimate or compare specific deductibles.

For a new puppy in the U.S., the best value usually comes from an accident + illness policy (not accident-only), because it can cover expensive hereditary and breed-related problems that may appear later—such as hip dysplasia, allergies, heart conditions, cancer, and orthopedic injuries—provided they are not pre-existing.

Here are the providers I’d put at the top of the list for a puppy owner balancing strong accident coverage, hereditary-condition protection, and reasonable premiums:

My shortlist by puppy-owner priorities

Best balance of coverage and price: Pets Best

A good starting point for most new puppy owners. It tends to offer a strong mix of:

• hereditary/congenital condition coverage
• accident protection (injuries, emergency visits, surgeries)
• customizable reimbursement and deductible choices
• lower premiums than some premium-focused insurers

Best “I want fewer surprises”: ASPCA Pet Health Insurance

Worth considering if you want broad coverage without stacking many add-ons. It is frequently rated highly because its plans include conditions that some competitors restrict.

Best if you have a breed prone to expensive inherited issues

For breeds such as:

• German Shepherds (hip/elbow issues)
• Labradors and Golden Retrievers (joint problems, cancer risks)
• Bulldogs (airway, skin, orthopedic issues)
• Cavalier King Charles Spaniels (heart issues)

I’d lean toward a plan with strong hereditary/congenital coverage and high annual limits, such as Pets Best, ASPCA, Pumpkin, or Trupanion.

A reasonable puppy policy setup

Many owners land on something like:

• 80% reimbursement
• $250–$500 deductible
• $10,000+ annual coverage limit (or unlimited if affordable)
• Accident + illness coverage
• Optional wellness plan only if the math makes sense for vaccines and routine care

Things to check before buying

• Waiting periods: A puppy may be healthy today but develop symptoms during a waiting period, which can become excluded as pre-existing.
• Bilateral exclusions: Some policies treat conditions affecting both sides (for example, both knees or hips) differently.
• Annual caps: A low premium can come with a low maximum payout.
• Exam-fee coverage: Some plans require an add-on for veterinary exam fees.
• Dental illness coverage: Useful because dental disease is common in dogs.

For a typical new puppy owner who wants strong protection without paying the highest premiums, I would start by getting quotes from Pets Best, ASPCA Pet Health Insurance, and Embrace, then compare the same settings (80–90% reimbursement, similar deductible, similar annual limit). Prices vary a lot by breed, age, and ZIP code.

If you share your puppy’s breed, age, and state, I can narrow this down to the insurers that are most likely to be the best value for that specific dog.

For a new puppy in the US, Pets Best, Lemonade , and ASPCA Pet Health Insurance offer the best mix of accident and hereditary coverage at reasonable monthly premiums.

Top Puppy Insurance Comparison

Plans typically cover unexpected vet visits, surgeries, and inherited issues like hip dysplasia once you enroll a healthy young puppy.

Recommended Providers

• Pets Best provides flexible tiers and lower price points, making it ideal if you want to customize your deductible and monthly cost.
• Lemonade uses a mobile-first app for quick claim approvals and offers some of the lowest starting rates for young dogs.
• ASPCA Pet Health Insurance covers accidents, hereditary conditions, and alternative therapies under complete coverage plans.
• Spot offers robust accident and illness plans that include behavioral and alternative therapies without breaking your budget.

Would you like to compare specific deductibles and reimbursement levels for one of these providers?

For a new U.S. puppy, I’d prioritize an accident-and-illness policy that explicitly covers hereditary/congenital conditions, has a high or unlimited annual limit, and has short waiting periods. Buying while the puppy is healthy is especially important because conditions that exist or show symptoms before coverage can be excluded as pre-existing.

My shortlist

1. Best overall protection: Trupanion

Trupanion is particularly compelling if your biggest concern is a costly hereditary or chronic condition. Its policy covers hereditary and congenital conditions such as hip dysplasia, cancer, heart disease and patellar issues, and it has no annual or lifetime payout cap. It can also pay participating veterinarians directly rather than making you wait for reimbursement.

The tradeoff is price: Trupanion tends to be more expensive than competitors, and its deductible is per condition rather than an annual deductible.

I'd choose it for: a valuable puppy, a breed with significant inherited-disease risk, or an owner who wants maximum catastrophic protection.

2. Best balance of coverage and price: Pets Best

Pets Best is probably my value pick. Its accident-and-illness plans cover hereditary/congenital conditions as long as the condition wasn't symptomatic before coverage or during the applicable waiting period. You can customize reimbursement, deductible and annual limits, including an unlimited option on eligible plans.

It's worth getting a quote here alongside Trupanion because premiums can differ substantially by breed, age and ZIP code.

I'd choose it for: most puppy owners who want strong coverage without paying Trupanion-level premiums.

3. Strong alternative: Healthy Paws

Healthy Paws offers accident-and-illness coverage with unlimited annual payouts and coverage for hereditary/congenital conditions. Its deductible is annual, which can be advantageous if your dog develops several unrelated problems in the same policy year.

The downside is that its coverage is less expansive in some areas—for example, it doesn't cover dental disease or prescription food—and its waiting-period rules deserve careful attention.

4. Worth quoting: Embrace

Embrace covers hereditary conditions and offers substantial customization, so it can be a good middle ground if you want to adjust the premium by changing the deductible, reimbursement percentage and annual limit. Independent comparison data also puts it among the stronger hereditary-condition options.

5. Spot

Spot is another strong choice if you want broad base coverage and an unlimited option. Recent 2026 comparisons have rated Spot particularly well for generous baseline benefits and customization, although it can be relatively expensive.

What I'd actually buy

For a typical healthy puppy, I'd get quotes for Pets Best, Trupanion and Healthy Paws first.

I'd compare them using roughly:

• 80–90% reimbursement
• $500–$1,000 deductible
• $10,000+ annual limit, preferably unlimited
• Accident and illness, not accident-only
• Explicit hereditary/congenital coverage
• No breed-specific exclusion for conditions your puppy is predisposed to
• Short accident/illness waiting periods
• Ideally, coverage for diagnostic testing, surgery, hospitalization and prescription medication

One particularly important detail: don't assume "hereditary coverage" means every inherited problem is covered. The policy's definition, waiting periods and pre-existing-condition language matter enormously. Pets Best, for example, specifically conditions hereditary coverage on the absence of symptoms before the effective date/waiting period.

Bottom line: Pets Best = best value, Trupanion = best catastrophic/hereditary protection, and Healthy Paws = strong simple alternative. For a breed prone to expensive inherited diseases, I'd lean toward Trupanion despite the higher premium because the lack of payout limits and lifetime per-condition structure can become extremely valuable with chronic disease.

If you tell me the puppy's breed, age, ZIP code, and your target monthly budget, I can compare the most relevant plans and current premiums for your situation.

Finding the right pet insurance for a new puppy requires balancing robust coverage—especially for breed-specific hereditary issues like hip dysplasia or heart conditions—with a monthly premium that won't break the bank.

Top-rated providers offering comprehensive accident, illness, and hereditary coverage at reasonable price points include:

• Pets Best
  • Why it stands out: Frequently ranked as a top choice for budget-conscious owners, Pets Best Insurance rolls hereditary and congenital conditions directly into its standard accident and illness plans rather than hiding them behind expensive add-ons.
  • Puppy perks: Highly customizable annual limits, deductibles, and reimbursement rates (70% to 90%), plus optional wellness add-ons for routine puppy shots and microchipping.
• ASPCA Pet Health Insurance
  • Why it stands out: Underwritten by Crum & Forster, the ASPCA Pet Health Insurance Complete Coverage plan includes accidents, illnesses, behavioral issues, and hereditary/congenital conditions as standard.
  • Puppy perks: Excellent customization and a generous claim-filing window (up to 270 days post-visit), making it friendly for first-time owners navigating multiple early vet trips.
• Lemonade Pet Insurance
  • Why it stands out: Known for ultra-fast, app-driven mobile claims processing and competitive baseline pricing for young dogs.
  • Puppy perks: Offers modular coverage where you can build an affordable core accident/illness policy that includes hereditary conditions, then tack on puppy/preventative care packs. (Check fine print on specific orthopedic/ligament waiting periods in your state).
• Trupanion
  • Why it stands out: While base premiums can skew slightly higher depending on the breed, Trupanion Pet Insurance covers hereditary and congenital conditions comprehensively and offers a rare direct-to-vet payment feature at checkout—meaning you don't have to pay thousands out of pocket and wait for a reimbursement.

To help narrow down the ideal provider and estimate an accurate monthly premium, let me know:

• Your puppy's breed or mix (purebreds often have distinct hereditary profiles)
• Your ZIP code (premiums vary heavily by region and local vet costs)
• Your preferred balance for deductible and reimbursement rate (e.g., $250 deductible with 80% back)

For a new U.S. puppy, I’d focus on accident-and-illness policies that explicitly cover hereditary/congenital conditions—especially hip/elbow dysplasia, IVDD, luxating patella, heart defects, and breed-specific disorders. The key is enrolling before symptoms appear, because a condition that shows signs before coverage or during a waiting period can be treated as pre-existing.

My top choices

1. Pets Best — best value for most puppies.
Pets Best specifically covers many hereditary/congenital conditions—including hip/elbow dysplasia, IVDD, luxating patella, cherry eye, glaucoma and epilepsy—as long as they weren't pre-existing and waiting periods have been satisfied. It also lets you customize deductible, reimbursement and annual limit, including an unlimited option.

Its pricing is particularly attractive: MoneyGeek's 2026 analysis puts puppy coverage around $19/month on average, although an individual puppy can be substantially different depending on breed, ZIP code and coverage.

2. Embrace — my pick if you want stronger all-around coverage.
Embrace covers hereditary and congenital conditions without per-condition limits and includes behavioral therapy and rehabilitation in its standard coverage. In Texas, Embrace says most dog policies run roughly $20–$70/month, depending on breed, age and selected limits.

It's somewhat more expensive than Pets Best, but the additional coverage can make the difference worthwhile for a breed prone to orthopedic or chronic problems.

3. Healthy Paws — excellent for straightforward catastrophic protection.
Healthy Paws offers unlimited annual coverage and covers accidents, hereditary/congenital conditions, hip dysplasia, chronic conditions, cancer, emergency/specialty care and surgery. Its annual deductible is particularly straightforward.

It's a good choice if your priority is "I want the big vet bill covered" rather than wellness benefits.

4. ASPCA — strong comprehensive alternative.
ASPCA offers full hereditary/congenital coverage and, unusually, has an option for direct vet payment, which can be useful when an emergency bill is enormous.

5. Spot — worth quoting.
Spot is currently ranked very highly for its comprehensive base coverage, including exam fees, alternative therapies and dental illness, with substantial customization. The trade-off is that it can be pricier as the dog ages.

What I'd actually buy

For a healthy puppy, I'd get quotes from Pets Best, Embrace and Healthy Paws using roughly:

• 80–90% reimbursement
• $500–$1,000 annual deductible
• $10,000+ annual limit, preferably unlimited if affordable
• Accident and illness coverage, not accident-only
• Explicit hereditary/congenital coverage
• No bilateral/condition-specific exclusions that could hurt your breed

For perspective, 2026 national research puts average dog premiums around $50/month for $5,000 annual coverage, $250 deductible and 80% reimbursement; Pets Best's plans average roughly $44–$49/month, while Embrace averages about $53/month under those parameters.

Bottom line: Pets Best is probably the sweet spot for coverage per dollar, while Embrace is my choice if you're willing to pay somewhat more for broader coverage. If your puppy is a breed with substantial hereditary risk (French Bulldog, German Shepherd, Golden Retriever, Labrador, Dachshund, etc.), I'd lean toward Embrace or Pets Best with a high/unlimited annual limit rather than choosing the absolute cheapest policy.

If you tell me the puppy's breed, age, ZIP code, and your target deductible, I can compare the current options and estimate which would give you the best value.

When insuring a new puppy in the US, finding a balance between robust coverage (accidents, illnesses, and hereditary conditions like hip dysplasia or heart defects) and a reasonable monthly premium depends heavily on customizing your deductible and annual limits . Because puppies are accident-prone and purebreds/mixes can manifest genetic conditions later, getting covered early is ideal before any issues become "pre-existing".

Top-rated pet insurance providers offering comprehensive accident, illness, and hereditary coverage with strong value-to-premium options include:

• ASPCA Pet Health Insurance (Underwritten by Crum & Forster): Frequently rated a top overall choice for puppies. Their Complete Coverage plan includes hereditary and congenital conditions, behavioral issues, and dental treatments as standard. It offers deep customization (annual limits, deductibles, and reimbursement up to $90%%) and a 10%% multi-pet discount.
• Pets Best : Known as a top budget-friendly option that doesn't skimp on core medical needs. Their standard accident and illness plans fully incorporate hereditary and congenital conditions (provided symptoms aren't pre-existing) and allow you to dial down your monthly bill by choosing higher annual deductibles or lower reimbursement rates.
• Lemonade Pet Insurance : A digital-first insurer lauded for high-tech, fast claims processing and very competitive starting rates. Lemonade covers hereditary and congenital conditions under its base accident and illness packages, making it an affordable route for tech-savvy puppy owners on a strict budget.
• Pumpkin Pet Insurance : Takes an all-inclusive approach by bundling hereditary conditions, behavioral therapy, dental illness, and even exam fees into the base policy rather than hiding them behind expensive add-ons. While slightly pricier out of the gate depending on the breed, it eliminates surprise gaps in coverage.
• Trupanion : Premium-wise, they can run higher because they typically feature unlimited lifetime payouts and unique direct-vet-pay capabilities (paying the clinic at checkout rather than waiting for reimbursement). They comprehensively cover hereditary and congenital conditions, making them a gold standard if you prefer zero reimbursement paperwork.

If you share your puppy's breed (or mix), age , and ZIP code , I can help you estimate how these provider premiums compare or guide you on choosing the right deductible and reimbursement balance.

For a new puppy, I’d prioritize three things: hereditary/congenital coverage, strong accident coverage, and enrolling before any condition becomes pre-existing. Prices vary substantially by breed, age, ZIP code, deductible and reimbursement level, so there isn’t one universally cheapest insurer.

My shortlist

1. Healthy Paws — my first quote to get.
It offers unlimited annual coverage, 70–90% reimbursement options and includes hereditary/congenital conditions in its standard accident-and-illness coverage. The major caveat for a puppy is a 12-month waiting period for hip dysplasia, plus a 15-day general waiting period.

2. Trupanion — best if you're especially worried about expensive hereditary disease.
Its policy explicitly covers hereditary and congenital conditions such as hip dysplasia, cancer, heart disease and patellar problems, with no annual payout limit and 90% reimbursement. Its unusual per-condition deductible can be particularly attractive for chronic conditions because the deductible doesn't reset every year. The tradeoff is price: it tends to be considerably more expensive and doesn't cover routine wellness or exam fees in its base policy.

3. Embrace — excellent middle ground.
I'd get a quote here if you want more customization than Healthy Paws. It can be particularly appealing if exam fees and broader day-to-day accident/illness benefits matter to you. Its pricing and coverage are generally competitive, although you need to check the specific hereditary/orthopedic waiting periods in your state and policy.

4. Pets Best — probably the value play.
Recent 2026 comparisons put Pets Best among the least expensive major options while still offering substantial customization. www.wsj.com I'd consider it particularly if you can get a quote substantially below Healthy Paws/Embrace for comparable 90% reimbursement + $500 deductible + high/unlimited annual limit.

5. Spot / Pumpkin — worth quoting if you want broader benefits.
Both have comprehensive accident-and-illness offerings. Spot is particularly strong if you don't want to buy lots of coverage as separate add-ons, while Pumpkin has unusually broad benefits. Current 2026 rankings put both among the stronger comprehensive options.

What I'd buy for a puppy

If the goal is "protect me from a financially devastating vet bill, without paying an absurd premium", I'd start quotes around:

• 90% reimbursement
• $500–$1,000 deductible
• $10,000+ annual limit, preferably unlimited
• Accident and illness coverage
• Hereditary/congenital conditions included
• No bilateral/orthopedic exclusions that could undermine coverage for your breed
• Prescription medications and diagnostic testing included

I wouldn't pay extra for a wellness plan unless you specifically want budgeting help for vaccines, routine exams, etc. Insurance is most valuable for the $5,000–$20,000+ unexpected events, not predictable puppy expenses.

One especially important puppy consideration

Buy before the puppy develops symptoms. Once something is documented in the veterinary record—even something seemingly minor such as recurring diarrhea, limping, allergies, or an ear problem—it can potentially be classified as pre-existing and excluded. That's why getting coverage while the puppy is healthy is much more important than squeezing out another $5–10/month in premium savings.

If you tell me the puppy's breed, age, sex, ZIP code, and roughly what monthly premium you'd consider reasonable (e.g. <$40, <$60, <$80), I can narrow this to the 3 best policies and the coverage/deductible combination I'd choose.