What is Health Insurance for Sjögren's Syndrome?

Choosing Health Insurance for Sjögren’s Syndrome: Coverage Essentials

Normally, our immune system protects us from viruses and infections. But sometimes, it mistakenly attacks healthy parts of the body, leading to autoimmune diseases such as Sjögren’s syndrome.

Sjögren’s syndrome is an autoimmune disorder in which the body struggles to produce enough moisture, resulting in symptoms such as dry eyes and a dry mouth. It can occur on its own (primary) or in conjunction with other diseases, such as lupus or rheumatoid arthritis, which can be expensive to treat.

However, health insurance can significantly help cover the treatment expenses associated with Sjögren’s syndrome. Continue reading to learn more about this disease and how health insurance may help cover its treatment costs.

Does Health Insurance Cover Sjögren’s Syndrome?

In many cases, health insurance covers Sjögren’s syndrome. Critical illness insurance offers you a lump sum of money if you are diagnosed with a serious condition listed by the insurer, like cancer or a stroke. For Sjögren’s syndrome, critical illness coverage is usually possible after you have had the condition for at least one year.

The cost and approval generally depend on the severity of your symptoms. If you have major eye issues, the policy might exclude coverage for blindness. However, if Sjögren’s is linked to other conditions such as lupus or rheumatoid arthritis, you will need to share complete details of those diagnoses in your application.

At Star Health, we also offer coverage for Sjögren’s syndrome under our Star Comprehensive Insurance Policy. We also provide hassle-free claim settlements with a reduced turnaround time across over 14,000 network hospitals in India.

What is the waiting period for Sjögren’s syndrome in health insurance?

Health insurance that generally covers Sjögren’s syndrome may have a waiting period before you can make a claim. For regular plans, this is usually 30 days after the policy starts. However, if you buy a critical illness policy, the waiting period is 90 days, plus a 30-day survival period after diagnosis.

Moreover, if you already have Sjögren’s, when purchasing the health insurance plan, it is treated as a pre-existing condition. In that case, several plans will cover it after 2 to 4 years, depending on the insurer. Therefore, it is required to always check your policy’s terms and conditions for exact details.

Health Insurance Reimbursement Tips for Sjögren’s Syndrome

Getting health insurance coverage for treatment can be challenging, as Sjögren’s syndrome mainly affects the mouth and other parts of the body. Even though it’s a medical condition, insurers often treat mouth-related issues as dental, which can make it harder to get care reimbursed under health insurance.

Here are some simple tips to help you get your health insurance to cover the costs of Sjögren’s syndrome:

• Read your insurance plan carefully. Know what it covers, what it doesn't, and what's unclear-you may be able to argue for coverage if it's not denied.
• Always file an appeal if your claim is denied. Don’t be discouraged by the initial rejection.
• It’s essential to maintain accurate records. If the claim is denied, request the reason and retain all relevant documents. Send appeals by certified mail with proof of delivery.
• Check for the right address. The appeal address may be different from the claim address-ensure that you send it to the correct one.
• Include all the essential information in your appeal, such as claim number, date, treatment date, charges, policy number, reason for denial, dentist’s name, and why you are requesting coverage.
• Do not send original X-rays, as they may get lost.
• Add two or more medical journal articles that support your treatment as medically necessary.
• Stay organised and polite-keep notes of every call, email, or letter you send or receive from the insurer.

Sjögren’s syndrome is becoming more common in India. Since there is no cure for the condition, ongoing treatment is typically required to manage symptoms and maintain the immune system's balance, which can lead to high medical expenses.