State RegulationsTX specificDifficulty 2/5
A Texas health benefit plan is subject to the chemical dependency coverage statute. Which of the following is the plan prohibited from doing?
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
Under TIC 1368.005, chemical dependency coverage is a required benefit for a covered Texas plan, so the plan may not exclude the treatment of chemical dependency from what it offers. What the statute does not do is dictate the mechanics of delivery: the plan may still apply its ordinary cost-sharing provisions, may still require the treatment to be rendered by a licensed or approved provider, and may still use utilization review to test medical necessity.
Why the other options are wrong
- A) Cost-sharing parity with other covered illness is ordinary plan design and is not prohibited; excluding the benefit is the prohibited act.
- C) Utilization review of medical necessity is a normal plan control that the chemical dependency statute does not forbid.
- D) Requiring a licensed or approved treatment provider is a permissible delivery condition, not a violation of the mandate.
Memory hook
Mandated benefit, ordinary mechanics: cover it, then cost-share and review it like any other illness.