State RegulationsTX specificDifficulty 1/5
Under ACA Section 1302, how must a non-grandfathered individual health plan treat mental health and substance use disorder services?
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
Under ACA Sections 1302 and 18022, mental health and substance use disorder services, including behavioral health treatment, is one of the required essential health benefit categories for non-grandfathered individual and small group health plans. A plan may not exclude the category, condition it on benefits offered elsewhere, or confine coverage to a single treatment setting. Practically, a Texas agent can tell an applicant that behavioral health and substance use treatment must be part of the covered benefit package.
Why the other options are wrong
- A) The requirement is not conditional on offering pediatric oral and vision benefits. Mental health and substance use disorder services is an independent required category.
- B) Confining coverage to inpatient care would be an impermissible limitation. The category covers services across settings as part of the essential health benefits.
- C) An employee assistance program is not a substitute. The benefit category must be part of the plan's covered essential health benefits.
Memory hook
Mental health and substance use are essential, not optional add-ons.