Our premiums remained about the same for the first 4 years of our policy, after which time my 4 year old Cavapoo was diagnosed with Cushings. Animal Friends paid out promptly for diagnosis, treatment and medication where necessary over the space of 2 years. The premiums only increased slightly the following two years despite us maxing out our coverage each year with all the tests. When she finally passed at age 6 with a brain tumour, they paid out for her death (although an receipt/invoice from the breeder was required so be sure to keep yours). I would definitely recommend.