The six plans (eight options) dropping out of the FEHB are: NALC Health Benefit Plan CDHP; NALC Health Benefit Plan Standard; Health Alliance HMO Standard; AvMed Health Plan HDHP; AvMed Health Plan Standard; Independent Health High; Blue Care Network of Michigan High; and Priority Health High. Image: Carolyn Franks/Shutterstock.com
By: FEDweek StaffOPM has spelled out more details of health insurance coverage changes and plan availability for the 2026 plan year, with several increases in the former but decreases in the latter.
The six plans (eight options) dropping out of the FEHB are: NALC Health Benefit Plan CDHP; NALC Health Benefit Plan Standard; Health Alliance HMO Standard; AvMed Health Plan HDHP; AvMed Health Plan Standard; Independent Health High; Blue Care Network of Michigan High; and Priority Health High.
In the PSHB, the GEHA Indemnity Benefit Plan Elevate Plus and GEHA Indemnity Benefit Plan Elevate are dropping out.
Affected enrollees will have to either elect a new plan in the open season November 10-December 8 or accept enrollment in a default plan—the GEHA Benefit Plan-High Option in the FEHB, and the Blue Cross and Blue Shield Service Benefit Plan – FEP Blue Focus in the PSHB.
Across both programs, major coverage changes include (in OPM’s words):
- Removed coverage for medical or surgical modification of sex traits, including gender transition procedures, for all ages.
- Required coverage for FDA-approved HIV PrEP drugs and related monitoring, with no cost sharing.
- HMO plans in states with IVF mandates were required to propose benefits that met those mandates, resulting in an expansion of coverage for the Federal family. OPM also requires, at a minimum, retrieval and cryopreservation of sperm and eggs, along with storage costs for at least one year, for individuals with iatrogenic infertility from non-elective procedures.
- Behavioral health access continues to expand. Carriers must broaden networks and allow out-of-network care when wait times are excessive.
- Opioid safety: Carriers must continue to provide at least one opioid rescue agent at no cost, with expanded education on safe usage.
- Anti-obesity care: Carriers must continue to cover FDA-approved medications, including at least one GLP-1 and two oral options, plus behavioral and nutritional programs.
Except for plans or options dropping out, current coverage continues in both programs unless the enrollee makes a change during the open season.
The open season also applies to the FEDVIP vision-dental insurance program where coverage of continuing plans also continues by default. In that program, the Health Partners Dental Plan will no longer be offered; its enrollees must select one of the continuing dental plans to maintain coverage in 2026 since there is no default plan for dropouts from the FEDVIP program.
In that program, dental carriers must now offer two routine exams and one emergency exam per year, and some have added coverage in areas including preventive benefits for children and pregnancy wellness coverage. For vision care, some carriers have added to diabetic coverage and coverage for orthoptic training.
Plan year 2026 premiums for FEHB are here; those for PSHB are here: and those for FEDVIP are here.
The open season further applies to flexible spending accounts for 2026 for active employees (not retirees) through the FSAFEDS program. In that program, a new election must be made each year for a dependent care expenses account, a health care expenses account, or both.
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Financial Impact of Shutdown Starts to Hit Home; WH Threatens No Back Pay
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See also,
TSP Takes Step toward Upcoming In-Plan Roth Conversions
5 Steps to Protect Your Federal Job During the Shutdown
Over 30K TSP Accounts Have Crossed the Million Mark in 2025
The Best Ages for Federal Employees to Retire
