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University of Texas at Dallas
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How to Waive School Plan
After purchasing your insurance with PSI, print off your insurance documents and policy brochure from your online account, complete the SHI Waiver Form (linked above and available within your PSI online account) and submit these materials to issoinsurance@utdallas.edu or to ISSO in person. Be sure to provide a copy of the insurance policy providing the following information: 1) Identifies you as a covered individual; 2) Provides the dates of your coverage; 3) Clearly indicates that the coverage meets or exceeds the UT System minimum requirements, including coverage amounts stated in U.S. dollars. NOTE: You must highlight, underline, or circle the coverage information, as well as your name and the effective dates of your insurance coverage on your insurance documentation.
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Money Back Guarantee Policy
If your university does not accept your PSI Plan coverage, we'll give you FULL refund.
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Be sure to Download & Print your PSI ID Card/Claim Form and keep them with you at all times while in the United States.
= Recommended Plans according to your school's requirements. Check with your health insurance administrator.
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| School Term |
Plan I |
Plan III |
Plan V |
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24 & Under |
25 - 29 |
30 and above |
24 & Under |
25 - 29 |
30 and above |
24 & Under |
25 - 29 |
30 - 39 |
|
Annual 2010-11: 08/23/2010 to 08/22/2011 |
$576 |
$612 |
$1,140 |
$1,068 |
$1,176 |
$2,088 |
$480 |
$720 |
$1,920 |
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Semi-Annual 2010-11: 08/23/2010 to 02/22/2011 |
$288 |
$306 |
$570 |
$534 |
$588 |
$1,044 |
$240 |
$360 |
$960 |
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Policy #: GLB9499907
Max coverage: $250,000
Evacuation: $50,000
Repatriation: $50,000
Policy Brochure WEB
or PDF
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Policy #: GLB9499909
Max coverage: $500,000
Evacuation: $50,000
Repatriation: $50,000
Policy Brochure WEB
or PDF
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Policy #: GLB9499913
Max coverage: $350,000
Evacuation: $75,000
Repatriation: $75,000
Policy Brochure WEB
or PDF
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