Under TIC 1368.005, how must a Texas group health benefit plan that provides coverage for the treatment of chemical dependency provide that coverage?
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
Under TIC 1368.005, coverage for the treatment of chemical dependency must be provided in the same manner and under the same terms, limits, and conditions as coverage for any other illness covered by the plan. The practical effect is parity: the issuer may not carve chemical dependency out as a second-class benefit with its own lower maximums or heavier cost sharing, and a Texas agent should expect the benefit to follow the plan's general medical benefit structure. The statutory standard is that the coverage may not be less favorable than the coverage provided for physical illness generally. TIC Chapter 1368 applies to group health benefit plans, and the chapter excludes policies designed for issuance to persons eligible for Medicare, so the requirement does not reach individual coverage or Medicare supplement policies.
Why the other options are wrong
- A) Limiting coverage to state-operated facilities would be a restriction not applied to other illnesses and is inconsistent with the same-terms requirement.
- B) More restrictive limits are exactly what TIC 1368.005 forbids. The benefit must match the limits applied to treatment of other illnesses.
- C) The statute does not subordinate chemical dependency benefits to another program. Coverage operates as a plan benefit, not as a payer of last resort.
Memory hook
Chemical dependency is covered like any other sickness.