Sex-Trait Modification Services

In accordance with guidance from the U.S. Office of Personnel Management, the FEHB Program will no longer cover medical interventions involving the surgical or chemical modification of an individual’s sex traits, including gender transition services.

We will continue to cover counseling services for diagnosed gender dysphoria. Search our online provider directory for licensed mental health providers.

If you are mid-treatment under our Plan, you are eligible for our continuation of care exception process if you satisfy all the requirements listed below:

• You were enrolled in FSBP in 2025.
• You enrolled in FSBP for 2026 because your 2025 plan was discontinued.
• Requirements for surgical services:
  • Preauthorization approval was completed prior to January 1, 2026
  • Treatment or services under approved treatment plan began before January 1, 2026
  • Your attending physician must complete and submit the Precertification Information Request Form and the Hair Removal Authorization Form (if applicable) to the Aetna® Precertification Department
• Requirements for chemical regimen:
  • Preauthorization approval was completed prior to January 1, 2026
  • The approved chemical regimen was filled prior to January 1, 2026
  • The exception form is completed and submitted to the Clinical Team for review.  You may mail or email the exception request to:
    • Clinical FFS Team  P.O. Box 14079 Lexington, KY 40512-4079
    • ScottsdaleClinical@Aetna.com

The continuation of care exception process is available only through December 31, 2026. Effective January 1, 2027, no new, renewed, or extended exceptions will be granted. Any previously approved exceptions will end on December 31, 2026 (if not already terminated), and no coverage or benefits will be available pursuant to any such exception for care received on or after January 1, 2027.

Our Gender Affirming Surgery Clinical Policy Bulletin outlines the procedures that are considered medically necessary.

Individuals under age 19 are not eligible for exceptions related to services for ongoing surgical or hormonal treatment for gender dysphoria.

If you disagree with the decision on your exception, please see Section 8 of the Plan brochure for the FEHB Appeals and Disputed Claims Process.