Obtain a Quote Now

Individual Insurance Policy

• Alternative Care treatments must be received from providers who are licensed and/or credentialed in the state where the practitioner is physically located.  You may choose not to use an aegis Alternative Network provider, but you are responsible for ensuring that your care provider is licensed prior to receiving care.  Benefits will not be paid for services provided by practitioners who do not possess the appropriate credentials. 
• Use of aegis Alternative Network providers is not required for alternative care visits or treatments. Benefits are reduced by 10% when obtaining services from an alternative care provider who is not a member of the aegis Alternative Network.
• Office visits to alternative care and naturopathic providers are limited to six combined per calendar year with no deductible.  Annual routine well care is not counted against the six office visits. Beginning with the seventh office visit, a $500 calendar year deductible will apply before further alternative care benefits are paid, and a $1000 deductible will apply before further naturopathic benefits are paid.  Expenses incurred toward satisfying one deductible can be applied to either deductible.
• There is no limit on the total number of covered office visits annually.
• Tele-consults are scheduled for 15 minute phone calls with a naturopath who participates in the aegis Tele-Consult network. Tele-consults do not count toward the office visit calendar year limitation.
• All deductibles are per person, per calendar year, except for the separate maternity deductible, which is per occurrence. The $5000 deductible for non-network services is limited to 2-persons per family, per calendar year.
• Routine child well-care visits and immunizations are covered at intervals required by state legislation, with zero calendar year deductible. Member will be responsible for 30% co-insurance for all well child benefits when using an aegis Alternative Network provider, 35% when using an aegis Naturopathic Network provider, and 50% when using a Beech Street Network provider.
• Members should be aware that county health departments often provide child well-care visits and immunizations at no charge, or for very minimal cost compared to private practitioners.  aegis will reimburse child well-care visits and immunizations obtained at county-operated health clinics at the 70% benefit level, regardless of network status.  We recommend that you research the link between autism and preservatives used in childhood vaccinations, prior to deciding whether you should request vaccinations that contain no preservatives. 
• Outpatient mental health benefits are covered only under our Life Shapers program.  Inpatient mental health benefits are not covered. 
• ONLY nutrition supplements on the aegis endorsed list are covered by our health plan. Nutrition supplements are covered only when prescribed by an alternative care or naturopathic practitioner for treatment of illness which was diagnosed while the member was covered under this plan.
• Approved nutrition supplements are covered only when purchased through the aegis Insurance Solutions website.
• Covered nutrition supplements will be paid at the plan's specified benefit level for a maximum of sixth months after diagnosis, unless written authorization is obtained from the company for additional payments.  Additional payment authorization is automatic for internal cancer patients 
• Nutrition supplements maximum benefit is $600 per person per calendar year. Maximum is waived for cancer patients.
• Zap the Habit smoking cessation are paid once in a lifetime, and are considered mental health benefits.
• Substance abuse treatment is covered only under our Life Shapers and Zap the Habit programs, limited to one course of treatment in each program, per member, per lifetime.  Benefits are considered mental health, and are paid in combination with office visit benefits.
• Routine maternity and childbirth is covered only when care is provided by an aegis Alternative Network certified nurse midwife and the birth takes place in a non-hospital environment.  Facility charges are not covered.  Additional policy rider must be purchased to obtain this benefit. Do not purchase the rider if you plan to obtain routine maternity care from an obstetrician or give birth in a hospital-owned maternity facility.  Benefits will NOT be paid for those services, regardless of whether the routine maternity rider was purchased or not. There is an 18-month waiting period after the policy effective date before routine maternity benefits will be paid.
• Use of the aegis Naturopathic Network when seeking medical care from physicians is strongly recommended.  ALL claims incurred for treatment by physicians who are not in the aegis Naturopathic Network, as well as all claims for prescription drugs, are subject to the $5000 calendar year deductible, except for treatment of injury.  The supplemental accident rider waives the deductible for injury.
• The maximum annual combined benefit for adult routine well care is limited to $300 per insured member, when care is obtained from aegis alternative or naturopathic network providers.  Routine adult well care is not covered when services are provided by someone outside of the aegis networks.
• There is a 12-month waiting period from the policy effective date before a vasectomy will be covered. The procedure is covered when performed only in an aegis Naturopathic Network provider's office.  Vasectomy is not covered if performed in an outpatient medical facility or a hospital outpatient department.  Reversal of vasectomy is not covered.
• Claims for allopathic (western medicine) benefits are paid only when services are provided by Beech Street network members. 
• All allopathic benefits combined are subject to a maximum limit in covered charges of $50,000 per member annually, except for treatment of injury when the supplemental accident rider has been purchased.  Maximum annual benefit limit for injuries under the supplemental accident rider is increased to $1 million per person.
• Exceptions to the Beech Street network requirement for allopathic care can be considered in life threatening situations where the patient has no control over where treatment is obtained.  However, in such cases where exception is granted, payment of claims will be made based on "reasonable" charges, not actual charges billed. We determine reasonable charges to be 50% profit added to the cost of providing service. The federal government pays Medicare claims at cost plus 5% profit. Hospitals typically bill non-Medicare patients 300% to 1000% over cost. To prevent your insurance premiums from increasing at unreasonable levels, we will not pay out-of-network allopathic claims billed at excessive profit levels.  Charges disallowed as being excessive do not count toward satisfying the annual out-of-pocket maximum.
• To avoid incurring excessive personal out-of-pocket expense, we recommend that our members seek treatment first from aegis network alternative and naturopathic providers.
• Complications of pregnancy are not covered when in-vitro fertilization has been used to achieve pregnancy
• Infertility treatments are not covered
• Premature delivery is not considered a complication of pregnancy
• Maximum 30 days per calendar year benefit for skilled nursing care. Maximum daily benefit is $100. Maximum lifetime benefit is $15,000
• Maximum of 30 (4-hour) visits per calendar year benefit for home health care.
• Outpatient rehabilitation therapy benefit maximum 30 days per calendar year.
• Prescription drug benefits are subject to the $5000 calendar year deductible.
• Tobacco users are not eligible to purchase coverage until they successfully complete our Zap the Habit smoking cessation program and remain tobacco free for 60 days.  We will reimburse the cost of treatment up to $100, according to plan benefits, after coverage has been issued.   
• Coverage can be issued for a child/children only if at least one parent is also covered.
• Organ and/or tissue transplantation is not covered under this plan, except when required as an immediate, life-saving measure due to traumatic injury or birth defect.
• Pre-existing condition waiting period is 6 months for alternative or naturopathic care and 24 months for allopathic care (western medicine) 
• Supplemental accident rider should be purchased in addition to the basic health plan

No benefits will be paid for:
a) charges that are not medically necessary
b) occupational or on the job injury
c) charges that you are not legally required to pay
d) charges incurred as a result of military service or war
e) dental services, except treatment of injury to natural teeth
f) cosmetic surgery or expense (except certain reconstructive surgeries)
g) routine eye exams, glasses, or contact lenses
h) radial keratotomy
i) hearing aids or tinnitus maskers
j) self-inflicted injury or attempted suicide
k) injury resulting from participation in an illegal act or riot
l) non-surgical treatment of toes or feet
m)charges for service rendered by a family member
n) surgical treatment of obesity
o) infertility treatment or reversal of sterilization
p) sexual dysfunction, sex transformation
q) therapeutic appliances or devices
r) private duty nursing
s) congenital conditions, except in children covered from birth
t) custodial care
u) personal comfort items

This is not a complete list of covered expenses or policy benefits. For a complete list of benefits, limitations, and exclusions, refer to the policy.