A Texas health benefit plan provides coverage for the treatment of chemical dependency. The insured seeks treatment at a licensed chemical dependency treatment facility rather than in a general hospital. Which statement is correct?

Why C is correct

Under TIC 1368.005, coverage for the treatment of chemical dependency must be provided on the same terms as care for any other illness and may not be confined to a single setting such as a general hospital or to detoxification alone; treatment that is medically necessary and provided by or under the direction of a licensed provider or facility must be covered. A criminal conviction or court referral is likewise not a lawful condition of payment, so an insured who enters a licensed treatment program voluntarily is covered on the ordinary illness terms.

Why the other options are wrong

• A) Limiting payment to detoxification is an impermissible narrowing of the chemical dependency benefit.
• B) Confining the benefit to general hospital care would be a less favorable treatment limitation, which TIC 1368.005 does not allow.
• D) Payment cannot be conditioned on a criminal conviction; the benefit must be available on the same terms as treatment for any other illness.

Memory hook

Same illness terms: any licensed setting, no court order needed.