REGULATORY · MARKET STRUCTURE · COMPETITIVE · USA
EEOC upholds OPM restriction on FEHB gender-transition coverage
Change
The EEOC upheld OPM's authority to allow FEHB and PSHB plans to exclude coverage for gender-transition procedures.
Why it matters
EEOC's ruling confirms OPM may require FEHB and PSHB carriers to exclude specified gender-transition (sex-rejecting) procedures. This restricts routine FEHB-funded coverage of those procedures under standard benefits, limiting access to exceptions and certain counseling provisions that OPM requires carriers to maintain. Carriers must implement the exclusions for Plan Year 2026 while preserving exceptions for individuals already undergoing treatment.
Implications
- · Routine FEHB coverage for gender-transition procedures will be restricted for Plan Year 2026.
- · FEHB and PSHB carriers are required to maintain exceptions processes and cover specified counseling services per OPM guidance.
Who is affected
- · Federal employees and retirees
- · FEHB and PSHB plan carriers
- · OPM and federal benefits administrators
Source
Topics
Regulatory & Compliance Policy & Regulation Compliance Health & Medicine Public Health Healthcare Systems