F1, J1, F2, J2 visa holders
Who can enroll ?

International students who

1) have vaild F1 and J1 visa status, AND
2) an associate, bachelor, master or Ph.D. or formal university ESL program, and,
3) are currently registered with no less than 6 credit hours* are eligible and qualified to enroll.

The Company maintains its right to investigate student status and attendance records to verify that the policy eligibility requirements have been met.
If and whenever the Company discovers that the policy eligibility have not been met, its only obligation is refund of premium.

*The six credit hour requirement is waived for summer, if the applicant will continue to register as a full time student in the following fall term.
What are the Choice of Plans?

Under each premium rates table, you can Review the Policy Brochure for every plan in detail. The Diamond Plan has the most expensive benefits of all four plans, followed by the Platinum Plan, then the Gold Plan, and finally the Silver Plan. You cannot upgrade benefit 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.



2014-15 SILVER PLAN Up to $500,000 Per Injury or Sickness Maximum Benefit
Includes Medical Evacuation & Repatriation
Policy Number 2014-202822-1 2014-202822-3
$0 Deductible $500 Deductible
Age Group Monthly Annual Monthly Annual
24 & Under $47 $559 $42 $492
25 - 29 $69 $828 $60 $704
30 & Above $187 $2,242 $166 $1,985
Spouse $499 $5,991 $435 $5,214
Child $107 $1,283 $94 $1,119
All Charges shown include Insurance Premium, Association, and Credit Card Fees. The programs offered here are sponsored by the policyholder, Global Traveler Organization Cayman Limited.



2014-15 GOLD PLAN Up to $1,000,000 Per Insured Person, Per Policy Year Maximum Benefit
Includes Medical Evacuation & Repatriation
Policy Number 2014-202820-1 2014-202820-3
$0 Deductible $500 Deductible
Age Group Monthly Annual Monthly Annual
24 & Under $57 $684 $48 $568
25 - 29 $79 $948 $69 $831
30 & Above $221 $2,649 $189 $2,264
Spouse $570 $6,836 $475 $5,700
Child $127 $1,519 $108 $1,291
All Charges shown include Insurance Premium, Association, and Credit Card Fees. The programs offered here are sponsored by the policyholder, Global Traveler Organization Cayman Limited.



2014-15 PLATINUM PLAN No Overall Maximum Dollar Limit Per Insured Person, Per Policy Year
Includes Medical Evacuation & Repatriation
Policy Number 2014-202819-1 2014-202819-3
$0 Deductible $500 Deductible
Age Group Monthly Annual Monthly Annual
24 & Under $83 $988 $67 $798
25 - 29 $130 $1,552 $107 $1,284
30 & Above $282 $3,390 $241 $2,885
Spouse $749 $8,990 $628 $7,536
Child $165 $1,979 $140 $1,674
All Charges shown include Insurance Premium, Association, and Credit Card Fees. The programs offered here are sponsored by the policyholder, Global Traveler Organization Cayman Limited.



2014-15 DIAMOND PLAN No Overall Maximum Dollar Limit Per Insured Person, Per Policy Year
Includes Medical Evacuation & Repatriation
Policy Number 2014-202821-1 2014-202821-3
$0 Deductible $500 Deductible
Age Group Monthly Annual Monthly Annual
24 & Under $154 $1,836 $131 $1,558
25 - 29 $179 $2,132 $149 $1,777
30 & Above $307 $3,671 $256 $3,069
Spouse $583 $6,982 $514 $5,808
Child $219 $2,624 $186 $2,222
All Charges shown include Insurance Premium, Association, and Credit Card Fees. The programs offered here are sponsored by the policyholder, Global Traveler Organization Cayman Limited.



2014-15 SHORT-TERM PLAN Up to $250,000 Per Injury or Sickness Maximum Benefit
Includes Medical Evacuation & Repatriation
Offered only to PSI Customers insured for at least 3 consecutive months under PSI Student Plans
Policy Number 2014-202852-1
$500 Deductible Per Insured, Per Policy Year
Age Group Monthly 6 Months of Coverage Maximum
24 & Under $62 $372
25 - 29 $92 $552
30 & Above $241 $1,446
Spouse $657 $3,942
Child $140 $840
All Charges shown include Insurance Premium, Association, and Credit Card Fees. The programs offered here are sponsored by the policyholder, Global Traveler Organization Cayman Limited.


2014-15 GOLD HIGH SCHOOL PLAN Up to $1,000,000 Per Insured Person, Per Policy Year Maximum Benefit
Includes Medical Evacuation & Repatriation
Policy Number 2014-202897-2
$0Deductible
Monthly Annual
High School Student $57 $684
 
All Charges shown include Insurance Premium, Association, and Credit Card Fees. The programs offered here are sponsored by the policyholder, Global Traveler Organization Cayman Limited.



2014-15 PLATINUM HIGH SCHOOL PLAN No Overall Maximum Dollar Limit Per Insured Person, Per Policy Year
Includes Medical Evacuation & Repatriation
Policy Number 2014-202897-1
$0 Deductible
Monthly Annual
High School Student $83 $988
 
All Charges shown include Insurance Premium, Association, and Credit Card Fees. The programs offered here are sponsored by the policyholder, Global Traveler Organization Cayman Limited.



Includes Medical Evacuation and Repatriation

International Students studying at a U.S. university are eligible for FrontierMEDEX, both on campus and while traveling in a country that is not their country of origin, for the duration of their studies. FrontierMEDEX arranges and pays for ALL medical evacuation and repatriation services it provides. There is NO maximum limits on the assistance service arranged and provided by FrontierMEDEX. For details, see FrontierMEDEX Brochure.

How to enroll ?

Fill out the Enrollment Form and pay the premium online through PSI's secured website. You may then retrieve your Insurance ID Card, Claim Form, Policy Brochure and other insurance documents from the PSI website.

Sickness or conditions of any kind resulting in the payment of benefits, including maternity, are paid under the policy benefits where the condition or sickness first manifested itself.
How to use the insurance ?
You need to download and print your ID Card & Claim Form from your PSI online account then 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.

~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ IMPORTANT THINGS TO KNOW ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~

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 1-888-302-6182 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).


Please send your claim form and all your itemized bills to this address below:
First Student
P. O. Box 809025
Dallas, TX 75380-9025
1-888-302-6182

You may call the Claims Division to check the status of your claim(s).
This is for introduction purposes only, please read the Policy Brochure prior to purchasing this plan.
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