The directive broadens an earlier one telling health plans to “exclude coverage for pediatric transgender surgeries or hormone treatments for the purpose of gender transition” for those under age 19. Image: Robert V Schwemmer/Shutterstock.com
By: FEDweek StaffOPM has told health plan carriers that their 2026 offerings in the FEHB and PSHB programs may not cover “chemical and surgical modification of an individual’s sex traits through medical intervention (to include ‘gender transition’ services)” regardless of the covered person’s age.
The directive broadens an earlier one telling health plans to “exclude coverage for pediatric transgender surgeries or hormone treatments for the purpose of gender transition” for those under age 19. That directive had said that for individuals age 19 or above, carriers “may propose to cover, but are not required to cover, transgender surgeries or hormone treatments for the purpose of gender transition.”
The new “carrier letter,” coming just weeks ahead of the annual announcement of coverage terms and premium rates under the two health-care programs, eliminates the prior distinction by age. It further says that provider directories “must not list or otherwise recognize” providers for purposes of providing chemical or surgical modification of an individual’s sex traits.
However, it says that “counseling services for possible or diagnosed gender dysphoria must still be covered. Covered counseling services must be provided by a licensed mental health provider and may include those who provide faith-based counseling.” Further, carriers are to establish “an exceptions process of excluded services for enrollees who are mid-treatment with a surgical and/or hormonal regiment for diagnosed gender dysphoria.”
Also, the exclusion on hormone treatments “only pertains to chemical and surgical modification of an individual’s sex traits” but not entire classes of pharmaceuticals that may be used for other purposes, such as during in-vitro fertilization, reduction of fibroids or cancer treatment.
The general government appropriations bill pending in the House committee level also would prohibit the coverage.
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