OPM Carrier Letter 2025-01b: gender-affirming care excluded from FEHB/PSHB for 2026

OPM instructs all Federal Employees Health Benefits and Postal Service Health Benefits carriers that, for plan year 2026, plans must exclude coverage of "chemical and surgical modification of an individual's sex traits," including gender-transition services, regardless of age — expanding Carrier Letter 2025-01a, which had barred coverage for enrollees under 19. Carriers must still cover gender-dysphoria counseling (expressly including faith-based counseling), must run a case-by-case exceptions process for enrollees mid-treatment, and must scrub provider directories of providers offering the excluded care. The exclusion reaches roughly 8–10 million covered federal employees, retirees, and dependents. (See also section 2.)