US EEOC upholds OPM limit on FEHB gender-transition coverage
Change
US EEOC affirmed OPM may allow FEHB and PSHB plans to exclude sex-rejecting procedures for Plan Year 2026 while requiring counseling coverage and exceptions for enrollees already.
Why it matters
The ruling gives the federal benefits administrator discretion to narrow which services federal employee plans will finance, tightening the program's benefit scope. That reduces guaranteed federal coverage for gender-affirming medical and surgical treatments and increases the likelihood of out-of-pocket costs or denied claims for affected enrollees.
Implications
- • FEHB and PSHB plan administrators must update benefit designs to implement exclusions and maintain exceptions processes.
- • Federal benefits officers must notify employees and retirees about the Plan Year 2026 coverage changes.
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Source
Topics
Governance Policy & Regulation Compliance Public Health Healthcare Systems