Sex-Trait Modification Services

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 PSHB 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.

• You remain covered under the same Aetna plan as your enrollment for the 2025 plan year or
• You enrolled in an Aetna plan for 2026 due to your previous 2025 plan no longer being available.
• Requirements to be met 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 completes and submits the Precertification Information Request Form and the Hair Removal Authorization Form (if applicable) to the Aetna® Precertification Department
• Requirements to be met for chemical regimen:
• 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.

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 PSHB 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.