State RegulationsTX specificDifficulty 1/5
The Texas Insurance Code addresses coverage for treatment of chemical dependency. How must a health benefit plan that provides such treatment benefits treat them?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
Under TIC 1368.005, benefits for the treatment of chemical dependency must be provided under the same terms and conditions as benefits for any other illness, so a plan may not attach a smaller annual maximum, a larger deductible, an exhaustion requirement, or a court-order condition to chemical dependency care. For an agent, this parity rule is the answer to the client who assumes addiction treatment is carved down: the benefit must stand on the same footing as treatment for diabetes or cancer.
Why the other options are wrong
- A) A court order is not a lawful condition of payment; the benefit must be available on the same terms as care for any other illness.
- B) A lower annual maximum is a less favorable financial requirement, which TIC 1368.005 forbids by requiring the same terms as any other illness.
- D) Requiring exhaustion of other plan benefits before chemical dependency benefits are paid is not permitted under TIC 1368.005.
Memory hook
Chemical dependency is treated like any other illness, same terms, period.