University of Central Florida

School Coverage Periods & Rates

ANNUAL
08/15/2018 - 08/14/2019
FALL / SPRING
08/15/2018 - 05/04/2019
FALL
08/15/2018 - 12/31/2018
30-DAY RATE

Gold Plan

  • 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
View Summary of Benefits

Platinum Plan

  • Unlimited Max Benefit of per Person per Policy Year
  • Out-of-Pocket Maximum $6350 / policy year
  • Coinsurance: 80% In-Network, 70% Out-Network
  • Preventive Care Services per ACA - 100% In-Network
  • Mental Illness & Substance Use Disorder Treatment
  • Prescription Drug Card: $20/$40/$60 copay
  • Coverage for Intramural, Club, & Recreational Sports
  • Pre-existing Conditions - No Limitations or Exclusions
  • Deductibles & Copays Waived at the SHC
  • Evacuation & Repatriation - 100% for services provided
View Summary of Benefits

Platinum Plus Plan

  • Unlimited Max Benefit of per Person per Policy Year
  • Out-of-Pocket Maximum $6350 / policy year
  • Coinsurance: 80% In-Network, 70% Out-Network
  • Preventive Care Services per ACA - 100% In-Network
  • Mental Illness & Substance Use Disorder Treatment
  • Prescription Drug Card: $15 copay for Tier 1; 20% Coinsurance for Tier 2
  • Coverage for Intramural & Intercollegiate Sports ($10,000 max for each injury)
  • Pre-existing Conditions - No Limitations or Exclusions
  • Deductibles & Copays Waived at the SHC
  • Evacuation & Repatriation - 100% for services provided
View Summary of Benefits

Claim Procedures

For Claim and Benefit questions, please call PSI Benefits at 1-888-302-6182 (8am to 8pm EST) or email customerservice@uhcsr.com. For students who do not speak English, upon request a translator would be provided for all languages.

If you are sick or injured you should:

Step 1

Be sure to have your Insurance ID Card

www.uhcsr.com/CREATEACCOUNT, for New Customers. www.uhcsr.com/MYACCOUNT, for Returning Customers.

Get the ID card on your smartphone with the UHCSR app:

Search in iTunes (Apple) or Google Play (Android)

Step 4

Check Your Claim Status

If you would like to check on the status of a claim that you or a provider have submitted, please contact 1-888-302-6182 or customerservice@uhcsr.com. The hours of operation are 8am to 8pm EST, Monday through Friday.

Step 5

Filing a Claim Yourself

If you visit an  Out-of-Network Doctor or Hospital, ask if they can submit claims for you. If they cannot, you may be required to pay for your medical bills during your visit. Afterwards, seek reimbursement by filing a claim by yourself. Download your Claim Form in your PSI account. Complete, sign, and date the Claim Form. Attach a copy of your ID card and/or Confirmation Letter, your medical bills or receipts, and submit by:

  • Mail: Student Resources  P.O. Box 809025 Dallas, TX 75380
  • Email: claims@uhcsr.com
  • Fax: 469-229-5625 (Attention to Claims Department)

Claim Forms must be submitted within 90 days of the date of service.

FAQs

International students who:

  • have vaild F1 and J1 visa status, AND
  • an associate, bachelor, master or Ph.D. or formal university ESL program, and,
  • 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 was enrolled in the Silver, Gold, Platinum, or Diamond Plan as a full-time student in the immediately preceding Spring term.

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
  • 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 info@psiservice.com or fax to 1-703-935-1313.

To make a payment, you may choose among the available options below:

1. By Card: US or International Card
  • Visa/Mastercard/Discover Card
  • Under Billing address, please use a US address.
2. By ACH Payment:
  • If you have a US bank account, simply select "ACH Payment" then fill in your Routing Number and Account Number.
  • Your bank information can be found in your bank statement and/or in your Online Banking Account.
3. By Cash payment through Wells Fargo Bank. Fill out a deposit slip with the following info:
Account Name : Professional Service, Inc.
Account Number : 2608424731
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.
  1. In the event of sickness or injury, you should visit your Student Health Center, if available.
  2. You can find a doctor or hospital here. You should always confirm that a Preferred Provider is participating at the time services are required by calling 1-888-302-6182 and/or by asking the doctor/hospital when making an appointment for services.
  3. For mental health provider or facility, please click here.

Remember to bring you UnitedHealthcare ID Card because it contains important phone numbers and claim filing instructions. You can access your ID Card here.


If you purchased the coverage within 7 days, you can temporarily use your Confirmation Letter to show proof of coverage to your school or provider until your ID becomes available. You can access your Confirmation Letter in your PSI account.

PSI does not allow cancellation of coverage. Cancellation and refund is ONLY allowed if the PSI Plan purchased does not meet the school insurance requirements. A letter from the student's school with detailed explanation showing which insurance requirement it does not specifically meet must be received by PSI within 30 days of the coverage purchase date.

If you want to Change the Plan, please contact PSI Customer Service: 703-879-8828 or info@psiservice.com .
International students with F-1 visas who are enrolled in a full-time associate, bachelor, master or Ph.D. degree program, or formal ESL program at a university, who are currently registered with no less than 6 credit hours (unless such school’s full-time status requires less credited hours), and International Visiting Scholars with J-1 visas are eligible to enroll in this insurance plan. The six credit hours requirement is waived for summer, if the applicant was enrolled in this plan as a full-time student in the immediately preceding spring term.

Students must actively attend classes for at least the first 31 days after the date for which coverage is purchased. Home study, correspondence and online courses do not fulfill the eligibility requirements that the student actively attend classes. The Company maintains its right to investigate Eligibility or student status and attendance records to verify that the policy Eligibility requirements have been met. Valid Visa also required. If the Company discovers that the policy Eligibility requirements have not been met, its only obligation is to refund premium.

Eligible students who do enroll may also insure their Dependents. Eligible Dependents are the spouse (husband or wife) and children under 26 years of age. Dependent eligibility expires concurrently with that of the Insured student.
Included with your student health insurance policy is the UnitedHealth Allies discount card. We’re confident that the UnitedHealth Allies program can help you stretch your health care dollar on a variety of health services.

For Students under Silver, Platinum and Diamond, please use this handbook: UnitedHealth Allies

For Students under Gold Plan, please use this handbook: UnitedHealth Allies with RX
Discount services include:

Dental Care:

Save from 10% to 35% on a range of dental services including:
  • Routine cleaning
  • X-rays
  • Cosmetic dentistry procedures, such as teeth whitening.
  • And more!

Vision Care:

  • Pay no more than $40 for an annual eye exam
  • Save 10% – 20% on eyeglasses from participating eye care professionals and retail vision chains
  • Save 10% – 20% on fittings for contact lenses (not included in annual eye exams) and 5% on the lenses themselves
  • Laser vision correction discounts
  • And more!

Wellness Products & Services:

Be healthier and save money with discounts of 10% – 50% on:
  • Weight management programs
  • Fitness memberships and equipment
  • Relaxation resources
  • Natural products and vitamins and supplements.
  • Smoking Cessation programs
  • And more!

Prescription Drugs:

Save at the pharmacy or through the mail. Prescription discounts include:
  • Save an average of 20% off the retail price of your prescriptions when you visit a participating retail pharmacy
  • Save an average of 50% off the retail price when you use the mail pharmacy service for your recurring prescriptions, and enjoy the convenience of home delivery.
  • 24 hour telephone access to pharmacist
  • Access to online features:
    • Price checks
    • Prescription drug guide
    • Online refills
    • Drug interaction information
    • And more!
UnitedHealth Allies is not insurance. UnitedHealth Allies provides discounts at certain health care providers for medical services. UnitedHealth Allies does not make payments directly to the providers of medical services. The program member is obligated to pay for all health care services but will receive a discount from those healthcare providers who have contracted with the discount plan organization.


Medical Evacuation & Repatriation

Any student under the PSI Silver, Gold, Platinum or Diamond Plan are eligible for global emergency and medical assistance services provided by UnitedHealthcare Global. These benefits are available if you are traveling 100 miles or more from your permanent home, campus address, or while you are abroad. These services are accessible 24 hours a day, 365 days a year!

Sometimes while traveling you may feel “if it can go wrong, it will go wrong with me”. With this service, you have a caring partner to provide peace of mind for all issues that may occur while traveling. UnitedHealthcare Global is committed to resolve emergencies by doing whatever it takes…their goal is to save lives and solve problems!

One phone call to UnitedHealthcare Global connects you to:
  • A state-of-the-art Emergency Response Center with worldwide response capabilities
  • Experienced crisis management professionals
  • A global network of over 41,000 pre-qualified medical providers
  • Air and ground ambulance service providers


To learn more about this valuable benefit, review the UHCG Program Guide

There are many services provided by this program, below is just a sample of what is offered:

Program Summary

Worldwide Medical and Dental Referrals

We will provide referrals to help you locate appropriate treatment and quality care.

Facilitation of Hospital Admittance Payments

We will issue a prompt financial guarantee (or wire funds) up to five thousand dollars ($5,000) to facilitate admittance to a foreign (non-US) medical facility. To the extent additional funds are required; we will issue a prompt financial guarantee (or wire funds) to facilitate admittance upon securing such funds from you, your family, or your friends via wire transfer or credit card(s). You are ultimately responsible for the payment of the cost of medical care and treatment, including hospital expenses.

Dispatch of Doctors/Specialists

In an emergency where we determine that you cannot adequately be assessed by telephone for possible evacuation from your initial medical facility, or you cannot be moved and local treatment is unavailable, we will endeavor to send an appropriate medical practitioner to you when we deem it appropriate for medical management of a case. We will pay for the transportation and related expenses of the medical practitioner. You are responsible for the payment of the cost of medical care and treatment.

Transfer of Medical Records

Upon your consent, we will assist with the transfer of medical information and records to you or the treating physician.

Updates to Family, Employer, and Home Physician

With your approval, we will provide periodic case updates to appropriate individuals you designate in order to keep them informed.

Hotel Arrangements for Convalescence

We will assist you with the arrangement of hotel stays and room requirements before or after hospitalization for ongoing care. You are responsible for costs of lodging and incidental expenses.

Emergency Medical Evacuation

If you sustain an injury or illness, that in the opinion of UnitedHealthcare Global and the treating healthcare provider, requires urgent medical attention and adequate medical treatment is not available at your initial medical facility, we will arrange and pay for a medically supervised evacuation to the nearest medical facility we determine to be capable of providing appropriate medical treatment. Your medical condition and situation must be such that, in the professional opinion of the health care provider and UnitedHealthcare Global, you require immediate emergency medical treatment, without which there would be a significant risk of death or serious impairment. All such arrangements must be coordinated and approved in advance by us.

Transportation to Join a Hospitalized Participant

If you are traveling alone and are or will be hospitalized for more than three (3) days due to an illness or injury, we will coordinate and pay for economy round-trip airfare for a person of your choice to join you. We will also assist with the arrangement of their hotel stay during your hospitalization. Costs of lodging, meals, and incidental expenses are the responsibility of the traveler.

Return of Minor Children

If your minor child(ren) age 18 or under are present but left unattended as a result of your injury or illness, we will coordinate and pay for one-way economy airfare (or upgraded transportation to match your originally booked travel) to send them back to your home country. We will also arrange and pay for the services, transportation expenses, and required accommodations of a non-medical escort, if required and as determined by UnitedHealthcare Global.

Repatriation of Mortal Remains

In the event of your death, we will assist in obtaining the necessary clearances for your cremation or the return of your mortal remains. We will coordinate and pay for commercially reasonable efforts for the expenses of the preparation and transportation of your mortal remains to your home country or place of primary residence, as well as obtain and pay for the number of certified death certificates required by the Host Country and home country to release and receive the remains.

Replacement of Lost or Stolen Travel Documents

We will assist you in taking the necessary steps to replace passports, tickets, and other important travel documents.

Transfer of Funds

We will provide you with an emergency cash advance subject to us first securing funds from you or your family. You are responsible for any fees for the wiring of these funds.

Legal Referrals

Should you require legal assistance, we will direct you to an attorney.

Message Transmittals

You may send and receive emergency messages toll-free, 24-hours a day, through our Emergency Response Center.

IMPORTANT: Insureds must call UnitedHealthcare Global first in order to activate this benefit. UnitedHealthcare Global does not reimburse monies spent for services not dispatched and rendered by UnitedHealthcare Global.

To access services please call:

(800) 527-0218 Toll-free within the United States

(410) 453-6330 Collect outside the United States

Services are also accessible via e-mail at operations@unitedhealthcareglobal.com

When calling the UnitedHealthcare Global Operations Center, please be prepared to provide:

  • Caller’s name, telephone and (if possible) fax number, and relationship to the patient;
  • Patient’s name, age, sex, and UnitedHealthcare Global ID Number as listed on your Medical ID Card;
  • Description of the patient’s condition;
  • Name, location, and telephone number of hospital, if applicable;
  • Name and telephone number of the attending physician;
  • Information of where the physician can be immediately reached


UnitedHealthcare Global is not travel or medical insurance but a service provider for emergency medical assistance services. All medical costs incurred should be submitted to your health plan and are subject to the policy limits of your health coverage. All assistance services must be arranged and provided by UnitedHealthcare Global. Claims for reimbursement of services not provided by UnitedHealthcare Global will not be accepted.

Login to PSI with THIS LINK, You can generate, download, and print your Worldwide Coverage Certificate

What is an EOB?

Explains the EOB, (i.e. Explanation of Benefits) that you receive once your claim is processed.

Even though you may not have received your ID card, you can still seek treatment. Request that the provider contact the appropriate Customer Service number listed on your Confirmation of Coverage Letter for verification of coverage.

Students can enroll in any PSI Plan posted to the school they are attending. PSI reserves the right to cancel the plan and refund premium to students in all other cases.