State RegulationsTX specificDifficulty 2/5
Under TIC 1368.005, a Texas group health benefit plan's required chemical dependency coverage generally must include which of the following?
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
Under TIC 1368.005, chemical dependency benefits are delivered on the same basis as medical and surgical benefits, so detoxification and treatment services are covered in the same manner as care for other illnesses. A Texas plan may not confine the benefit to a single treatment setting, condition it on court involvement, or require a failed course of treatment before paying a claim. TIC Chapter 1368 applies to group health benefit plans, and the chapter excludes Medicare supplement and other policies designed for issuance to persons eligible for Medicare.
Why the other options are wrong
- A) A court order is not a coverage trigger. The benefit responds to the insured's need for treatment, not to involvement with the criminal justice system.
- B) A step-therapy style precondition that is not applied to other illnesses is inconsistent with the requirement to provide chemical dependency coverage in the same manner as other care.
- C) Restricting the benefit to inpatient care and pushing outpatient treatment into a rider imposes a setting-based limitation that other illnesses do not face.
Memory hook
Chemical dependency coverage follows the medical benefit, no special gates.