Montgomery College
Health Insurance

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School Coverage Periods & Rates

SPRING & SUMMER
01/01/2021 - 07/31/2021
SPRING
01/01/2021 - 05/15/2021
30-DAY RATE
PSI Bronze Plan

Bronze Plan

  • In-Network Provider - UHC Options PPO
  • No Lifetime Limits on Benefits
  • $150,000 per Injury/Illness - Annual max of $500,000
  • Coinsurance: 100% In-Network / 60% Out-Network, max benefits apply
  • Diagnostic Services and Laboratory Tests
  • Mental Illness and Substance Abuse Benefits
  • Prescription Drugs: 100% up to $100 per Illness/Injury
  • Urgent Care Facilities - 100% to $50 per visit
  • Pre-Existing Conditions - Waiting period of 180 days
  • Deductible at SHC - $45 per Injury/Illness
  • Evacuation & Repatriation - $60,000 maximum
PSI Silver Plan

Silver Plan

  • In-Network Provider - UHC Options PPO
  • No Lifetime Limits On Benefits
  • $500,000 per Injury or Sickness
  • Coinsurance: 80% In-Network, 70% Out-Network
  • Diagnostic Services and Laboratory Tests
  • Mental Illness & Substance Use Disorder Treatment
  • Prescription Drugs: 70% up $1,000 max per year
  • Urgent Care Facilities - $50 copay
  • Pre-Existing Conditions - Six months waiting period
  • Deductibles & Copays Waived at the SHC
  • Evacuation & Repatriation - 100% for services provided
PSI Gold Plan

Gold Plan

  • In-Network Provider - UHC Options PPO
  • No Lifetime Limits On Benefits
  • $2,000,000 per Person per Policy Year
  • Coinsurance: 80% In-Network, 70% Out-Network
  • Preventive Care Services per ACA - 100% In-Network
  • Mental Illness & Substance Use Disorder Treatment
  • Prescription Drugs: 70% of U&C Charges
  • Urgent Care Facilities - $50 copay
  • Pre-existing Conditions - $2500 benefit; No exclusion after 6-mos
  • Deductibles & Copays Waived at the SHC
  • Evacuation & Repatriation - 100% for services provided

Claim Procedures

Step 1: Bring Your Insurance ID card

Login to your PSI account and print your Insurance ID Card. Always present your Insurance ID Card to your Doctor or Hospital so they can submit your claim directly to us.

Step 2: Visit your Student Health Center or a Preferred Provider

If you are sick or injured, please visit the Student Health Service first. If not available, proceed to a Preferred Provider Network.
We encourage students to use a Preferred Provider whenever possible for two reasons:

1) They have a contract to bill us directly for services so you don't have to pay out of pocket and then file a claim yourself;

2) They have agreed to contracted pricing for covered medical expense, which means your medical cost and charges are kept as low as possible and never exceed the set price which providers accept as payment.

If you visit an Out-of-Network Doctor or Hospital, ask if they can submit claims on your behalf. If they cannot, you will be required to pay for your medical bills during your visit. Afterwards, seek reimbursement by filing a claim. Simply download a Claim Form, Complete, and Sign then include a copy of your ID Card with your medical bills or receipts.

FAQs