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
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
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:
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
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.
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
Insurance Policy Brochure
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 firstname.lastname@example.org or fax to 1-703-935-1313.
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
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 schoolâs 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
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
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.
The Kittitas Valley Healthcare is In-Network (603 South Chestnut Street, Ellensburg, WA 98926; NPI # 1528507464). You can also go to any CVS/Caremark network pharmacy. Search your local area: https://www.caremark.com/portal/asset/seabury_smith_pharmloc.htm
October 08, 2018
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