State RegulationsTX specificDifficulty 2/5
A Texas health benefit plan contains a provision excluding all treatment for drug or alcohol dependency. Under the Texas chemical dependency coverage statute, what is the status of that provision?
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
Under TIC 1368.005, a health benefit plan must provide coverage for the treatment of chemical dependency, so a blanket exclusion that removes all drug and alcohol dependency treatment defeats the statutory requirement. The plan does not lose all control: it may still apply its ordinary medical necessity standards, require that treatment be provided by appropriately licensed providers or in a licensed facility, and apply the same utilization review and cost sharing it applies to other covered conditions.
Why the other options are wrong
- A) Chemical dependency coverage is not optional; the statute requires the benefit to be provided.
- B) Detoxification alone is not a substitute; the required benefit is treatment of chemical dependency, not only its acute phase.
- C) The requirement is not limited to individual policies; it attaches to the health benefit plans the statute governs.
Memory hook
You can manage chemical dependency treatment, but you cannot exclude it.