Issue Briefs

All FEHB Carriers continue to provide coverage for countermeasures against COVID-19, including over-the-counter tests, booster doses, therapeutics, and pharmacy access to therapeutics. Image: Stuart Monk/Shutterstock.com

Following is a summary from OPM of new and expanded FEHB benefits for 2023.


Maternal Health

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OPM remains committed to addressing inequalities in maternal health and mortality and asked FEHB Carriers to identify ways to expand coverage and services in support of prenatal and postpartum care by including childbirth education classes, group prenatal care, home visiting programs or home health care during pregnancy and postpartum, and care management for high risk pregnancies. FEHB Carriers responded favorably to OPM’s guidance to amplify communication efforts to FEHB members who are either pregnant or of childbearing age.

• OPM encouraged FEHB Carriers to adopt the Hear Her Campaign for patients and healthcare providers by providing information and raising awareness of potentially life threatening warning signs during and after pregnancy. For the 2023 plan year, most FEHB Carriers have adopted this campaign.

• FEHB Carriers have included innovative methods to improve overall maternal outcomes, such as paying more for high-value care than low-value care and increased reimbursement or expanded coverage for certified nurse midwives, birth centers, and perinatal support services such as doulas and nurse home visits.

• FEHB Carriers have shown interest in the CMS announcement on establishing a “Birthing Friendly” designation for hospitals to improve perinatal health outcomes and maternal health equity.

Gender Affirming Care and Services

OPM continues to focus on ways our Carriers can improve access to gender affirming care for transgender and gender diverse individuals. Since January 1, 2016, OPM has required that no FEHB Carrier have a general exclusion of services, drugs, or supplies related to the treatment of gender dysphoria. In Plan Year 2023, all FEHB Carriers:

• Have adopted one or more recognized entities in order to guide evidence-based benefits coverage and medical policies pertaining to gender affirming care and services, such as the World Professional Association of Transgender Health (WPATH) Standards of Care, the Endocrine Society, and the Fenway Institute. These entities provide evidence-based clinical guidelines for health professionals to assist transgender and gender diverse people with safe and effective pathways that maximize their overall health, including physical and psychological well-being.

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• Will provide individuals diagnosed with and/or undergoing evaluation for gender dysphoria the option to use a Care Coordinator to assist and support them as they seek gender affirming care and services. If network providers are not available to provide medically necessary treatment of gender dysphoria, FEHB Carriers will provide members direction on how to find qualified providers with experience delivering this specialized care.

• Have reviewed their formularies to ensure that transgender and gender diverse individuals have equitable access to medications and provide coverage of medically necessary hormonal therapies for gender transition care.

• Have reviewed and updated plan brochures for accurate description of benefits for those with gender dysphoria and to ensure the use of inclusive and gender-neutral terminology in communication materials and member-accessible resources.

• Will provide coverage for standard fertility preservation procedures for persons facing the possibility of iatrogenic infertility, including infertility associated with medical and surgical gender transition treatment.

Obesity

FEHB Carriers must have adequate coverage of FDA-approved anti-obesity medications on their formulary to meet patient needs and must provide an exception process in cases where the drug is not on the formulary. Adequate means a range of anti-obesity drugs at various costs for enrollees so cost will not be a barrier for enrollees.

COVID-19 Pandemic

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All FEHB Carriers continue to provide coverage for countermeasures against COVID-19, including over-the-counter tests, booster doses, therapeutics, and pharmacy access to therapeutics.

Telehealth

All FEHB Carriers are continuing initiatives that were encouraged and expanded during the pandemic related to telehealth. OPM believes that telehealth continues to have an important role in the provision of healthcare services, including the promotion of health equity by mitigating transportation difficulties faced in both urban and rural communities. Telehealth also improves access to mental health and substance use disorder services. The expansion of remote monitoring capabilities can also improve the quality of care for those with chronic disease.

Medical Foods

In Plan Year 2023, all FEHB Carriers will provide coverage for foods specifically formulated and prescribed to treat inborn errors of metabolism (IEM) without regard to age, mode of administration (oral vs. nasogastric tube), narrow arbitrary limitations to specific diseases, or whether it is the sole source of nutrition for that individual.

Assisted Reproductive Technology (ART)

OPM signaled support for Assisted Reproduction Technology2 (ART) in the 2023 Call Letter. FEHB Carriers were asked to consider assisting with the financial burden of ART treatment for those who may require it by negotiating discounted rates that members can access and to describe in the Affinity benefits shown on the non-FEHB page of the plan brochure. OPM is pleased that four new plan options will provide ART within their FEHB benefit package for a total of 18 plan options in 2023, and one new plan option will provide a non-FEHB benefit for discounted ART procedures for 2023.

Preventive Services

All FEHB Carriers will provide access to USPSTF “A” or “B” rated preventive services throughout the year as they become available. Additionally, all Carriers cover the full range of contraceptives and contraceptive care for adolescent and adult women as provided in the Women’s Preventive Services Guidelines supported by the Health Resources and Services Administration (HRSA) without cost sharing.

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See also,

FEHB: Federal Benefits Fast Facts

FEHB Open Season Ahead – Time to Shop

Watch for ‘Significant’ FEHB Plan Changes, OPM Says

Enrollee Share of FEHB Premiums to Rise 8.7 Percent on Average for 2023

January Retirement COLA Set: 8.7 Percent for CSRS, 7.7 Percent for FERS

FERS Retirement Planning Bundle: 2022 FERS Guide & TSP Handbook

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