Gender affirming care

In accordance with the U.S. Office of Personnel Management guidance, for 2026, chemical and surgical modification of an individual's sex traits through medical interventions (including gender transition services) will no longer be covered under the FEHB Program.

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

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

If you are mid-treatment under our Plan, you could be eligible for our continuation of care exception process by meeting all the requirements below.

• Surgical services if:
• Preauthorization approval was completed prior to January 1, 2026;
• Treatment or services, under approved treatment plan, began before January 1, 2026;
• You are enrolled in the same Aetna plan that you were enrolled in 2025; and
• Your attending physician completes and submits the Precertification Information Request Form and the Hair Removal Authorization Form (if applicable) to the Aetna® Precertification Department
• Chemical regimen if:
• Preauthorization approval was completed prior to January 1, 2026;
• Prescription for approved chemical regimen had an initial fill prior to January 1, 2026; and
• The exception form for review and approval is completed. (Please Note: Exception form will be available by 12/1/2025.)

Individuals under age 19 are not eligible for exceptions related to services for ongoing surgical or hormonal treatment for gender dysphoria per the Executive Order issued on January 28, 2025.

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

Our Transgender and Gender Diverse Personal Navigators can be a single point of contact to get answers quickly and conveniently. They can also explain benefits, provide resources and review/assist with claim questions. You can access a Transgender and Gender-Diverse Personal Navigator by calling the number on your member ID card or sending an email to MyPersonalNavigator@Aetna.com. Please be sure to include the following in your email message:

• Name (legal and current/preferred name)
• ID number
• Question
• Best contact number

The Personal Navigators are available Monday to Friday from 8AM to 6PM EST and respond to emails within 1 business day.