OPM Removes Prohibition on Sex Change Coverage Under FEHB

OPM has removed the prohibition on federal employee health insurance for providing for sex change operations and “transition care” for someone who has undertaken this process.

On June 13, the Office of Personnel Management (OPM) quietly released a “program carrier document” related to the Federal Employee Health Benefits Program (FEHB). The subject of the letter is “Gender Identity Disorder/Gender Dysphoria.”

The effect of the letter is to allow federal employee health insurance carriers to provide insurance for sex change operations and for expenses related to a sex change operation. OPM describes this as the need to provide health benefits consistent with each person’s individual medical status before and after gender transition. The OPM letter also states that OPM is removing the requirement that FEHB brochures exclude “services, drugs, or supplies related to sex transformations.”

According to the OPM letter, health insurance carriers cannot remain silent on the issue. Instead, carriers will have to propose one of two options:

  1. Remove the General Exclusion language and provide to OPM the specific brochure text that describes the covered components and limitations of care for the diagnosis; or
  2. Maintain the General Exclusion language for the 2015 plan year.

The federal government’s Medicare program also lifted a ban on sex-reassignment surgeries about two weeks ago.

The OPM letter is reproduced below.

FEHB Letter 2014-17

About the Author

Ralph Smith has several decades of experience working with federal human resources issues. He has written extensively on a full range of human resources topics in books and newsletters and is a co-founder of two companies and several newsletters on federal human resources. Follow Ralph on Twitter: @RalphSmith47