A non-profit 501(c)(3) premium and copayment foundation
New Assistance Application
Set up your portal access:
Your contact information
Your Profile Name*
Your date of Birth*
I acknowledge that I am 18 or older
Have you been approved and/or already applied/been referred to PSI for assistance?
Connect to existing patient data with your PSI PIN Number.
The Patient Is:
Family (I am Parent/Guardian)
Date of Birth*
No match found
Success! We have a record that matches your input.
To access this patient data you must acknowledge that you are authorized.
I acknowledge that I am authorized to access this patient data.
What is the last name of your favorite teacher in high school?
What is your mother's maiden name?
What is your security PIN?
What was your high school mascot?
At least one letter
At least one capital letter
At least one number
At least one special character (! # ^ & * $ % @ -)
Be at least 8 characters
To apply for PSI assistance, please create a portal account