Under Texas Insurance Code §1368.004, which of the following correctly describes an insurer's obligation regarding chemical dependency treatment coverage in Texas?
Why this is the answer
Texas Insurance Code §1368.004(a) states that a group health benefit plan 'shall provide coverage for the necessary care and treatment of chemical dependency', so this is a mandated benefit for group plans, not merely a mandatory offer. §1368.005 adds that the coverage generally may not be less favorable than coverage for physical illness and must carry the same durational limits, dollar limits, deductibles and coinsurance, although a plan may set less favorable dollar or durational limits that are sufficient under the department's treatment standards. The chapter applies only to group health benefit plans (§1368.002): §1368.003 excludes individual policies and individual HMO evidences of coverage, so a rule covering all individual and group policies overstates it. Nothing in the chapter makes the coverage optional, and there is no 50-employee threshold; the only size-based exception is for self-funded plans with 250 or fewer employees or members.
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