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Transition-Related Health Costs Now Covered for Trans Federal Employees

Transition-Related Health Costs Now Covered for Trans Federal Employees

The Obama Administration quietly announced a huge change for transgender government workers: effective January 1, 2016, insurance companies that participate in the Federal Employees Health Benefits Program must include transition-related coverage.

The Office of Personnel Management let word slip on Tuesday evening, in a letter to insurers instructing them that they cannot maintain blanket exclusions of the coverage.

"No carrier participating in the Federal Employees Health Benefits Program may have a general exclusion of services, drugs or supplies related to gender transition or 'sex transformations,'” the letter states, beginning on January 1. "This letter clarifies OPM’s earlier guidance recognizing the evolving professional consensus that treatment may be medically necessary to address a diagnosis of gender dysphoria."

OPM alerted insurers a year ago that it had ended its ban on transition-related coverage, but did not require carriers to provide the benefits. A few months later, OPM "strongly encouraged" companies to provide coverage, but only three carriers opted to offer the transition-related benefits.

"The Office of Personnel Management's action eliminating blanket trans exclusions represents a huge step toward ending one of the last remaining ways the federal government itself discriminates against transgender people," according to National Center for Transgender Equality Executive Director Mara Keisling. "Until now, the federal government has been providing discriminatory healthcare plans to its trans employees. Transgender workers have been required to pay out of pocket to cover care deemed necessary by their doctor - often for services that are covered for non-transgender people."

“This critical change is a significant step forward in the right direction – one that will help our nation’s transgender civil servants gain access to many of the basic and vitally important healthcare services that they need,” said David Stacy, Government Affairs Director for the Human Rights Campaign. “HRC applauds OPM Director Katherine Archuleta for her strong leadership on this important issue.”

"Today's carrier letter has significant implications for all workers. Now, the nation's largest employer has taken a stand against trans health care discrimination. That makes it that much harder for any insurance company to hold on to these exclusions," Keisling added. "And you can guarantee that we're going ​to press the point with every insurance company and every state and federal regulator that the approach OPM has taken is not just good policy, it's the law. This is insurance discrimination and employment discrimination, and it needs to be eliminated in all types of plans."

Federal employees will be able to select healthcare plans offering this coverage during open enrollment season this fall.

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