Impact of forthcoming executive orders on Federal Employees Health Benefits Program coverage next year
The Office of Personnel Management (OPM) has issued new guidelines for the Federal Employees Health Benefits (FEHB) Program, affecting plan year 2026. All federal departments and agencies participating in the FEHB news are required to comply with these new rules.
Under the new guidelines, covered dependents under the age of 19 will have access to gender-affirming care services. However, carriers are not mandated to offer these services for individuals aged 19 and older. Carriers are expected to identify any resulting premium reductions and incorporate them into their benefit and rate proposals for plan year 2026.
In a significant change, the OPM has removed the requirement for all carriers to offer a comprehensive obesity management program in plan year 2026. Carriers are allowed to offer additional plan benefits for 2026, as long as they align with applicable laws and guidance.
Since January 2016, OPM has mandated that no FEHB carrier exclude services, drugs, or supplies related to gender dysphoria treatment. However, under the second executive order issued by President Trump, all carriers will exclude coverage for pediatric transgender surgeries or hormone treatments for the purpose of gender transition.
The OPM's guidance emphasises that FEHB plans should deliver the best possible coverage at the lowest cost to plan members. Federal employees and annuitants are advised to carefully review their options this fall when selecting an FEHB news.
For those seeking further advice, the Guide to Health Plans for Federal Employees provided by Consumers' Checkbook may be available for free from your agency. Alternatively, the guide can be purchased with a 20% discount using promo code GOVEXEC.
It is crucial for federal employees who rely on these services to carefully review plan brochures this fall to determine which FEHB plans will continue to offer coverage and at what levels. All policies and documents from federal agencies will list two genders, male and female, with no additional options or gender identity requests, according to the first executive order issued by President Trump.
Carriers must comply with this new policy in time for plan year 2026. The OPM encourages all federal employees and annuitants to stay informed and make informed decisions about their health insurance choices.
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