Please
read the Policy Brochure available on our website to make sure that the plan you are buying meets your own needs as well as your school requirements.
1. Go to WWW.PSISERVICE.COM(home page)
2. Select Your School to Find the Right Plan that meets your university insurance requirements.
3. Fill out our Easy Online Application Form(Other Languages Available: Chinese, Korean, Japanese, Spanish)
4. Make Your Insurance Payment Online with a credit or debit card. You may also pay in cash through any Wells Fargo Bank. For details, see Payment Options.
5. Download/Print the following PSI Insurance Documents and submit to your university:
Insurance Policy Brochure
ID Card and Claim Form
Confirmation Letter
Sales Receipt
Waiver/Compliance Form *
*If your school has a Waiver/Compliance Form for alternative insurance companies to fill out and it's not available in your PSI account, please email to psi@psiservice.com or fax to 1-703-935-1313.
To make a payment, you may choose among the available options below:
1. By Card ( Local/ International Card )
Visa/Mastercard /Discover Card
Billing address may be an International address, but the Zip Code has to be a US zip code.
2. By Cash payment through Wells Fargo Bank. Fill out a deposit slip with the following info:
Account Name : Professional Service, Inc.
Account Number : 20000 3268 6380
Amount : should match the pending balance from their account
*Please call or email us once you have made your cash payment so we can activate your account.
3. If you are unable to find what you're looking for on the website, please call 1-800-505-4160, 7am-7pm CST (if asked, your policy is ACSA - PSI Health Insurance Plans - Plan C, D or E).
4. For Medical Claims, You only have to submit their ID Card to Provider (Doctor/Hostpital), and they will submit claims on your behalf. The only time you will need to submit a medical claim form is if for any reason you paid out of pocket in full up front for office visit. Your ID card contains all the information needed in order for Provider to submit claims, such as Students Name, Policy Number, and PSI ID#. The ID Card will also have instructions on how to submit claims such as Mailing address and Electronic Payer ID# of where claims need to be submitted. The mailing address and Electronic Payer ID# is as followed:
BY MAIL - Send this Claim Form & All Itemized Bills to: First Student P.O. Box 809025 Dallas, TX 75380-9025
ONLINE - Doctors/Hospitals can also send claims billing via Electronic Data interchange (EDI) Payor ID:74227
For Benefit and Claim Questions, please call 1-800-505-4160. The provider will need to submit a HCFA 1500 or UB04 to the mailing address or electronic Payer ID above. No other action is needed from the student in order to submit claims if the ID Card is provided, unless First Student requests information needed such as medical records, Primary Insurance EOBs, ETC. In this event student will be notified of what is needed in order to process claims.
If for any reason, student paid out of pocket in full up front for an office visit or hospital visit and would like to be reimbursed for whatever should have been covered under the policy, the student will have to Complete the Medical Reimbursement Claim form attached and follow the instructions below:
1. Attach Itemized Receipt to completed Reimbursement Claim Form (Clip, do not staple receipt). Itemized Receipt will need to include the following information:
name & address
Provider’s Tax ID #
ICD-9 (diagnosis code)
CPT (procedure code)
Amount charged & amount paid
Primary Insurance Explanation of Benefits (For those who have other insurance only)
2. Submit Reimbursement Claim Form and Itemized Receipt to First Student in a timely Manner.
3. Please mail completed claim form and receipt(s) to: FIRST STUDENT P.O. Box 809025 Dallas, TX 75380-9025
If you would like to submit a paper claim for reimbursement for a prescription that you paid for out of pocket, please print a copy of this Prescription Claim Form. After filling
out the necessary information, please read the acknowledgement carefully (located at the bottom of page) and sign and date in the space provided. To submit a Generic
Reimbursement Claim Form, please be sure your receipts are complete. In order for your request to be processed, all receipts must contain the information listed below:
Date prescription filled
Name and address of pharmacy
Doctor name or ID number
NDC number (drug number)
Name of drug and strength
Quantity and days’ supply
Prescription number (Rx number)
DAW (Dispense As Written)
Amount paid
This information can usually be found on the receipt which is stapled on the outside of the packaging or in some cases located inside. Your pharmacist can provide
the necessary information as well.
Please mail completed form and receipt(s) to: FIRST STUDENT P.O. Box 809025 Dallas, TX 75380-9025
In the event of sickness or injury, the student should:
1. Report at once to the Student Health Center, if available.
2. For referral to a participating provider (doctor, hospital, or lab) please visit: http://www.firststudent.com/schools/PSIInternationalStudentInsurancePlans/find_a_doctor.htm
3. If you are unable to find what you're looking for on the website, please call 1-800-505-4160, 7am-7pm CST (if asked, your policy is ACSA - PSI Health Insurance Plans - Plan C, D or E).
4. Submit Medical Claims by MAIL or ELECTRONICALLY:
BY MAIL - Send this Claim Form & All Itemized Bills to:
First Student P.O. Box 809025 Dallas, TX 75380-9025
Please fill out the entire first page and be sure to indicate your current address when you submit this. Your doctor will need to fill out the second page of the form
ELECTRONICALLY - Doctors/Hospitals can also submit a claim electronically, using Emedeon (formerly WebMD). This gives a faster turn-around time than submitting a claim by mail. Check with your doctor to see if they are a participant. If they are, show them your ID Card. Electronic Data interchange (EDI) Payor ID: 74227
For claims and benefit inquiries under 2010-11 Plans please contact Brokerage Concepts, Inc. (BCI) at 1-800-963-2200 or 610-491-5041. You can also send email to psi@hnas.com.
1. Always bring your PSI ID Card & Claim Form when you visit the hospital. You can download this from your PSI online account.
2. If you pay for your medical bills upfront, please complete a Claim Form and attached all itemized bills, statements, and receipts attached, and send it to our claims division by Mail. For details on how to file claims, please click here
3. If a Network Doctor is not available in your area, benefits with be paid at the level of benefits shown as preferred provider benefits (In-Network Claims). Please keep in mind, although the website is updated frequently, it does not always reflect the most up to date information. Prior to being seen, you should always confirm the Preferred Provider is part of the network, as this can change without notice by calling 1-800-505-4160 and/or by asking the Doctor/Hospital. Network Area is 50 mile radius around your school campus.
4. In case of medical emergency or if there are no network doctors or hospitals in your area, you can see any doctors, and the benefits will be the same as if you are seeing a network doctor. In such cases, please attach a brief explanation when you file your claim(s).
Effective July 1, 2011, PSI will no longer allow cancellation of coverage unless entry into the armed forces. Please double check with your university before making the
purchase.
Eligible students have the choice of enrolling in one of three ACSA PSI Health Insurance Plans – Plan C, Plan D or Plan E. Plan E has the highest benefits and premiums of
all three plans. Plan C has higher benefits and premiums than Plan D. Please review the benefits and make your selection carefully. You cannot upgrade coverage after your
initial purchase of the plan for this policy year. Please be aware that if you choose to upgrade coverage in any subsequent policy year, a new Pre-existing Condition
exclusion and waiting period will apply.
