Phase 2: Settlement

Health Insurance Guide

Last updated: 2026-03-07 | For: Engineers, Spouses

Taiwan's NHI is so simple you never had to think about it. US health insurance is the opposite. You need to choose a plan, understand the terminology, and know what's covered and what isn't. This guide breaks down every concept for someone coming from Taiwan's single-payer system.

Insurance Terminology Reference

These are the core terms you must understand. Most have no equivalent in Taiwan's NHI system:

Term	What It Means
Premium	Monthly fee paid whether or not you see a doctor. TSMC covers most of it; your share is deducted from your paycheck.
Deductible	Amount you pay out of pocket each year before insurance kicks in. No Taiwan equivalent.
Copay	Fixed amount per visit ($20-50). The closest thing to Taiwan's registration fee.
Coinsurance	After deductible, you and insurance split costs by percentage (e.g., 80/20 — insurance pays 80%, you pay 20%). No Taiwan equivalent.
Out-of-pocket Max	Maximum you'll pay in a year. After this, insurance pays 100%. This is your "worst case" number.
In-network	Doctors contracted with your insurance. Dramatically lower costs.
Out-of-network	Doctors without a contract. Can cost 2-5x more. Avoid unless it's an emergency.
Prior Authorization	Some procedures require insurance company approval before they'll cover it. Your doctor recommends it; insurance may say no. No Taiwan equivalent.
EOB	Explanation of Benefits — a statement from insurance (NOT a bill). Shows what was charged, what insurance paid, and what you owe.

TSMC Insurance Plan Options

TSMC typically offers two main types of medical insurance. Understanding the difference is one of your most important financial decisions:

	PPO	HDHP (High Deductible)
Monthly premium	Higher	Lower
Deductible	$500-1,500 (individual)	$1,500-3,000 (individual)
Copay	$20-50/visit	Usually none (you pay full cost until deductible is met)
HSA eligible	No	Yes (this is the biggest advantage)
Best for	Families with children, frequent doctor visits	Healthy individuals/couples who want tax advantages

Simple advice: If you have children or a family member with a chronic condition, choose PPO. If you and your spouse are healthy and rarely visit doctors, HDHP + HSA will save more money long-term.

HSA and FSA

These are US-specific tax-advantaged accounts for paying medical expenses. Taiwan has nothing like them.

HSA (Health Savings Account)

Only available if you choose an HDHP plan
Contributions are tax-free, withdrawals for medical expenses are tax-free, investment growth is tax-free — triple tax advantage
2026 contribution limits: $4,300 individual / $8,550 family (adjusted annually)
The money is yours forever — it rolls over year after year, even if you leave your job
Can be invested like a retirement account for long-term growth
Strong recommendation: If you choose HDHP, max out your HSA contributions

FSA (Flexible Spending Account)

Available with any insurance plan
Contributions are tax-free, withdrawals for medical expenses are tax-free
2026 limit: $3,200 (adjusted annually)
Important: Unspent money disappears at year's end (use it or lose it). Only contribute what you're confident you'll spend
Can be used for copays, prescriptions, glasses, dental work, and more

How to Read an EOB

Two to four weeks after a medical visit, you'll receive an EOB (Explanation of Benefits) from your insurance company. The first one will be confusing. Here's what to look for:

Total Charged — The provider's original price. This number is usually alarming, but you don't pay this amount.
Plan Discount — The negotiated discount between your insurance and the provider. This is why being "in-network" matters.
Plan Paid — The amount your insurance actually paid.
Your Responsibility / You Owe — This is the amount you need to pay. Note: the EOB itself is not a bill, but this number tells you what the actual bill will be.

Dental and Vision Insurance

This surprises most people from Taiwan: dental and eye care are not included in your medical insurance. They are separate policies:

Dental insurance — Separate plan. Preventive services (cleanings, exams) are typically fully covered, twice a year. Major work (root canals, crowns) is only 50-80% covered. Annual maximum is usually $1,500-2,000.
Vision insurance — Separate plan. Covers annual eye exams. Provides an allowance for glasses or contacts ($100-200/year).

Enroll in both dental and vision during your initial enrollment period. The cost is modest ($20-50/month for family coverage), but if you miss the window, you'll have to wait until the next Open Enrollment.

Open Enrollment

Every fall (typically October-November), you get one chance to change your insurance plan. During this window you can:

Switch from PPO to HDHP, or vice versa
Add or remove family members
Open or adjust HSA/FSA contributions
Change dental and vision plans

Important: Miss Open Enrollment and you wait another year, unless you have a Qualifying Life Event (marriage, birth, spouse arriving in the US). Arriving in the US is itself a Qualifying Life Event — that's why you get the 30-day special enrollment period when you start.

Annual Insurance Review Checklist

How much did our family spend on healthcare last year? (copays + deductible + prescriptions)
Are there expected major expenses next year? (pregnancy, surgery)
Is my doctor in-network under each plan option?
How much is in my HSA? Should I adjust contributions?
Have I used up my dental annual maximum?

How to Compare Plans

Don't just compare premiums. Calculate your "worst case annual cost" to make an informed decision:

Annual Cost Formula

Annual Premiums + Out-of-pocket Maximum = Worst Case Annual Cost

Compare the "worst case" and "typical case" (premiums + estimated copays and deductible) for each plan. If the difference is small, choose the plan with lower copays (PPO) — your spending will be more predictable.

$500-3K

Individual Deductible

$1K-6K

Family Deductible

$4,300

HSA Individual Limit

30 days

Enrollment Window