Federal Health Plans to Expand Gender-Affirming Care Coverage for 2023

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The federal government often finds itself playing catch-up in competing with the private sector, whether in technology and innovation or in worker compensation and benefits.

To make federal health insurance plans comparable to what companies offer employees, the US government is expanding certain types of coverage for 2023, which beneficiaries can choose during the annual open enrollment season that begins next month. A quarter of Fortune 500 companies provide comprehensive transition-related care to employees, including popular providers such as Blue Cross Blue Shield and Aetna.

This year, coverage will again include gender-affirming care, defined by the Kaiser Family Foundation as “social, psychological, behavioral or medical interventions (including hormone therapy or surgery) designed to support and affirm an individual’s gender identity”.

The move dates back to President Joe Biden’s 2021 Executive Order on Diversity, Inclusion, and Accessibility in the Federal Workforce, which directs the Office of Personnel Management to “promote comprehensive coverage and services equitable healthcare for registered LGBTQ+ employees” and family members covered by the FFederal Employee Benefits Program.

Attention to this problem predates that. In January 2016, the OPM required that no FEHB carrier have a blanket exclusion for services, medications, or supplies related to the treatment of gender dysphoria. The Supreme Court also ruled in 2020 that benefit plans that deny coverage to transgender employees, charge them a higher premium, or fail to provide medically necessary services are discriminatory.

Yet a growing number of states have implemented or are considering actions to limit LGBTQ+ youth’s access to gender-affirming care, which could put them in conflict with the federal government. Alabama, Arkansas, Texas and Arizona have passed restrictions, and 15 states are considering similar legislation.

What gender-affirming care will federal plans cover?

For 2023 plans, all FEHB providers will be required to have adopted one or more recognized entities providing evidence-based clinical guidelines to healthcare professionals to support transgender and gender-diverse people, according to an OPM fact sheet.

Carriers will also offer those diagnosed and/or being evaluated for gender dysphoria the option of using a care coordinator. If network providers are not available to provide medically necessary treatment, FEHB carriers will be required to advise members on how to find qualified providers.

Carriers will also provide coverage for medically necessary hormone therapies for gender transition care and standard fertility preservation procedures.

Providers should have revised their formularies to ensure transgender and gender diverse people have equitable access to medications by providing coverage of medically necessary hormone therapies for gender transition care.

This also includes coverage of standard fertility preservation procedures for people facing the possibility of iatrogenic infertility, including infertility associated with gender transition medical and surgical treatment.

Expectations also go beyond providing physical resources, medications and procedures to eligible patients.

OPM asked carriers to review and update brochures using inclusive and gender-neutral terminology in communications materials and resources.

What to know before registration opens

The overall average cost increase for the FEHB program will be the highest in more than a decade.

The government’s average contribution will increase by 6.6%, while the subscriber’s share will increase by an average of 8.7%. This means that for a bi-weekly pay period, an employee on a self-insurance plan will pay approximately $8.11 more. Those with a family plan can expect an average increase of $20.87.

The open season for federal employees to re-enroll or change their health insurance for next year begins Nov. 14 and ends Dec. 12. With 271 plan options, OPM encourages enrollees to shop around.

Specific information on dental and vision care plans and rates will be available at BENEFEDS.com late October or early November.

Established in 1960, FEHB is the largest employer-sponsored health benefits program in the United States, covering more than 8.2 million federal civilian employees, annuitants and their families.

Molly Weisner is a reporter for the Federal Times, where she covers government labor, policy and contracts. She made previous stops at USA Today and McClatchy as a digital producer, and worked at The New York Times as an editor. Molly majored in journalism at the University of North Carolina at Chapel Hill.

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