US OPM restricts FEHB coverage of gender transition procedures
FEHB and PSHB plan administrators must exclude sex-rejecting procedures in 2026
Change
US Office of Personnel Management (OPM) has implemented Plan Year 2026 guidance that bars Federal Employees Health Benefits (FEHB) and Postal Service Health Benefits (PSHB) plans from covering sex-rejecting (gender transition) procedures, requires coverage for specified counseling services, and mandates an exceptions process for beneficiaries already undergoing treatment.
Why it matters
The Equal Employment Opportunity Commission has ruled that OPM lawfully allowed federal health carriers to exclude certain sex-rejecting procedures. The EEOC decision binds OPM to set FEHB coverage standards that prioritise program sustainability and stewardship of taxpayer resources.
Implications
- — FEHB and PSHB plan administrators, participating federal health carriers' claims and compliance teams, and federal agency human resources and benefits offices must, immediately and for Plan Year 2026, update plan documents, claims-adjudication systems, and enrollee communications to implement exclusions for sex-rejecting procedures and to operate the mandated exceptions process — claims for procedures excluded by OPM guidance will be denied.
Unlock the full brief.
Implications — what this forces you to change
Who is affected — which roles and obligations are exposed
What to watch — binding deadlines and enforcement dates
Real-time alerts — delivered the moment a binding change is published
Clarify with AI — turn any brief into a decision for your role
Start free trial
No credit card · $29/month (~₹2,400) after trial · Active in seconds
Source
View on opm.gov