Federal employees who are seeking treatment for gender dysphoria will have better care options through the Federal Employees Health Benefits Program (FEHB) next year.
According to the Office of Personnel Management (OPM), gender dysphoria and gender affirming care and services are among the enhanced benefit offerings being added to FEHB for 2023. Other categories include maternal health, obesity, COVID-19, assisted reproductive technology.
OPM said that it has required FEHB carriers not to have a general exclusion of services, drugs, or supplies related to the treatment of gender dysphoria.
These some of the details of gender affirming services being offered under FEHB in 2023:
- 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.
- Individuals diagnosed with and/or undergoing evaluation for gender dysphoria will be provided 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.
- FEHB carriers 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.
- Carriers will also provide coverage for standard fertility preservation procedures for people facing the possibility of iatrogenic infertility, including infertility associated with medical and surgical transition treatment.
What is Gender Dysphoria?
According to MedlinePlus, a service run by the National Institutes of Health (NIH):
Gender dysphoria is the term for a deep sense of unease and distress that may occur when your biological sex does not match your gender identity. In the past, this was called gender identity disorder. For example, you may be assigned at birth as a female gender, but you feel a deep inner sense of being male. In some people, this mismatch can cause severe discomfort, anxiety, depression, and other mental health conditions.
Other Enhanced Benefit Offerings Coming in 2023
These are some of the other areas OPM described as “enhanced benefit offerings” that FEHB carriers are being required or encouraged to provide for next year.
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.
Maternal Health
OPM has asked FEHB carriers to identify ways to expand both coverage and services surrounding childbirth 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. Among these include insurance carriers paying more for high-value care and increased reimbursement or expanded coverage for certified nurse midwives or birth centers.
Telehealth
OPM said it believes that telehealth is important in providing healthcare services and said that FEHB Carriers are continuing initiatives that were encouraged and expanded during the pandemic.
Assisted Reproductive Technology (ART)
OPM said that a total of 18 FEHB plans (four of which are new) will provide ART within their FEHB benefit package next year.
What is Assisted Reproductive Technology?
According to the Centers for Disease Control and Prevention (CDC):
ART includes all fertility treatments in which either eggs or embryos are handled. In general, ART procedures involve surgically removing eggs from a woman’s ovaries, combining them with sperm in the laboratory, and returning them to the woman’s body or donating them to another woman. They do NOT include treatments in which only sperm are handled (i.e., intrauterine—or artificial—insemination) or procedures in which a woman takes medicine only to stimulate egg production without the intention of having eggs retrieved.
Medical Foods
All FEHB carriers will provide coverage for foods in 2023 that are 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.
Additional details about these benefits can be found in OPM’s 2023 Open Season Highlights document.
2023 FEHB Premiums
2023 FEHB premiums are going up 7.2% on average. That is for the program as a whole. Federal employees’ share of premiums will increase by an average of 8.7% next year.
According to OPM, over the last decade, the overall average increase for premiums under the FEHB program has risen 4% per year. 2023 will be the biggest average annual increase in the last 10 years. Inflation has certainly been a factor, although a growing list of requirements from the government that insurance companies must adhere to in order to provide services adds to costs as well.
