WASHINGTON — The federal government often finds itself playing catch-up in competing with the private sector, whether in technology and innovation or in pay and benefits for workers.
To make federal health insurance plans comparable to what companies offer employees, the U.S. government is expanding some kinds of coverage for 2023, which beneficiaries can choose during the annual open enrollment season that starts next month. A quarter of Fortune 500 companies offer transition-related care to employees, including popular providers like 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 (including hormonal treatment or surgery) interventions designed to support and affirm an individual’s gender identity.”
This move traces 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 equitable healthcare coverage and services for enrolled LGBTQ+ employees” and covered family members through the Federal Employee Health Benefits program.
Attention to this issue predates even that. In January 2016, OPM required that no FEHB carrier have a general exclusion of services, drugs, or supplies related to the treatment of gender dysphoria. The Supreme Court also ruled in 2020 that benefit plans which deny coverage to transgender employees, charge them a higher premium or fail to provide medically necessary services are discriminatory.
Still, a growing number of states have implemented or are considering actions aimed at limiting LGBTQ+ youth access to gender-affirming care, which could bring them in conflict with the federal government. Alabama, Arkansas, Texas and Arizona have enacted 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 for health professionals to assist transgender and gender-diverse people, according to an OPM fact sheet.
Carriers will also provide individuals diagnosed with and/or undergoing evaluation for gender dysphoria the option to use a care coordinator. If network providers are unavailable to provide medically necessary treatment, FEHB carriers will be require to inform members on how to find qualified providers.
Carriers will also provide coverage for medically necessary hormonal therapies for gender transition care and standard fertility preservation procedures.
Providers are expected to have reviewed their formularies to ensure that transgender and gender diverse individuals have equitable access to medications in providing coverage of medically necessary hormonal therapies for gender transition care.
That also includes coverage for standard fertility preservation procedures for persons facing the possibility of iatrogenic infertility, including infertility associated with medical and surgical gender transition treatment.
The expectations also go beyond providing the physical resources, medications and procedures to eligible patients.
OPM directed carriers to review and update brochures with the use of inclusive and gender-neutral terminology in communication materials and resources.
What to know ahead of open enrollment
The overall average increase in costs for the FEHB Program will be the highest in more than a decade.
The average government contribution will increase by 6.6%, while the enrollee’s share will increase an average of 8.7%. That means for a biweekly pay period, an employee on a self-only plan will pay about $8.11 more. Those in a family plan can expect an average increase of $20.87.
Open season for federal employees to re-enroll or change their health insurance for next year starts on Nov. 14 and goes through Dec. 12. With 271 plan options, OPM encourages enrollees to comparison shop.
Specific plan information for dental and vision benefits and rates will be available on BENEFEDS.com in late October or early November.
Established in 1960, FEHB is the largest employer-sponsored health benefits program in the U.S., covering more than 8.2 million federal civilian employees, annuitants, and their families.
Molly Weisner is a staff reporter for Federal Times where she covers labor, policy and contracting pertaining to the government workforce. She made previous stops at USA Today and McClatchy as a digital producer, and worked at The New York Times as a copy editor. Molly majored in journalism at the University of North Carolina at Chapel Hill.