FEHB 2027: What OPM's Call Letter Means for Your Health Plan

Last Updated: April 8, 2026 Reading Time: 9 min

Every year, OPM sends insurance carriers a document called the call letter. It tells carriers what they must cover, what they should prioritize, and where they need to cut costs. Enrollees usually never see it. But it shapes every plan choice you make in November.

OPM released the Plan Year 2027 call letter on March 31, 2026. The headline theme is "well care," which OPM defines as "expanding our vision for benefits with a stronger emphasis on the physical and mental wellness of the whole person." Underneath that framing are some concrete changes that will affect your coverage starting January 1, 2027.

Here is what you need to know before Open Season.

Key Takeaways

• OPM now requires all FEHB plans to cover at least one GLP-1 anti-obesity medication, plus at least two oral alternatives. Intensive behavioral therapy is required before and during medication use.
• Gender-affirming care coverage ends completely in 2027, including for enrollees currently mid-treatment. Mental health counseling remains covered.
• OPM is pushing carriers toward "well care": preventive screening, non-pharmaceutical treatments, digital health tools, and patient autonomy.
• Fertility support is expanded, with required outreach and IVF discount programs strongly encouraged.
• Vaccine incentive programs are being removed to preserve "member independence" on vaccination decisions.
• Official 2027 premium rates won't be announced until fall 2026. Open Season runs November-December 2026.

What the Call Letter Does and Why It Matters

The call letter is not optional guidance. OPM uses it to set binding requirements for every carrier that wants to participate in FEHB or PSHB. Carriers that don't comply risk their contract with OPM.

Think of it this way: every FEHB plan you can pick during Open Season has already been filtered through OPM's call letter requirements. If OPM mandates GLP-1 coverage, every plan must offer it. If OPM prohibits gender-affirming care, no plan can cover it.

The 2027 call letter was released on March 31, 2026, giving carriers several months to redesign benefits and submit rates before OPM announces final plan offerings in fall 2026.

The same call letter applies to both FEHB (covering most federal civilian employees and retirees) and PSHB (covering U.S. Postal Service employees and retirees who moved to that program starting in 2025).

GLP-1 Coverage Mandate: What Changes in 2027

OPM is requiring all FEHB and PSHB carriers to include anti-obesity medications on their formularies, with specific minimums:

• At least one GLP-1 anti-obesity medication (for example, semaglutide, the active ingredient in Ozempic and Wegovy)
• At least two additional oral anti-obesity medication options beyond the GLP-1

The GLP-1 class of drugs has changed obesity treatment. Semaglutide, tirzepatide (Mounjaro, Zepbound), and similar drugs produce 15-20% body weight reduction in clinical trials, far beyond what older medications achieved. Demand has exploded, and so have costs: a monthly supply can run $800-$1,300 without coverage.

Before this call letter, coverage varied by plan. Some FEHB plans had already added GLP-1 coverage. Many had not, or restricted access through strict prior authorization. The 2027 mandate standardizes the floor.

There is a catch, though: coverage requires intensive behavioral therapy.

OPM is not handing out prescriptions. Carriers must require enrollees to complete intensive behavioral therapy (IBT) before they can receive drug coverage, and to continue it while on the medication. IBT is a clinician-supervised program: regular check-ins, tracked lifestyle changes, documented progress. Not a phone call with a doctor. A structured program.

The IBT requirement does two things. It aligns with evidence that the drugs work better alongside behavioral support. And it limits runaway utilization by filtering out enrollees who aren't committed to a broader treatment plan.

If you are interested in GLP-1 coverage through FEHB starting in 2027, the IBT requirement means you will need to engage with a qualifying program before your plan pays for the medication. Get familiar with what your plan considers IBT and what documentation you will need.

Fertility Coverage Expansion

The 2027 call letter expands OPM's expectations around reproductive health and fertility support, though the approach here is more nudge than mandate.

OPM is directing carriers to:

• Conduct outreach to women interested in becoming pregnant, with specific focus on preconception health screening
• Provide access to treatments for conditions that impair fertility, including obesity, prediabetes, hypertension, and male factor infertility
• Strongly encourage carriers to offer discounted rates for assisted reproductive technology (ART) procedures, including in vitro fertilization (IVF), even for plans that do not cover ART outright

OPM is not requiring plans to cover IVF. But it is pushing carriers to negotiate discounted rates, so enrollees who pursue IVF pay less out of pocket even when the procedure isn't covered outright. If your plan doesn't cover IVF now, check whether it lists preferred-rate partner clinics starting in 2027.

The fertility provisions connect to OPM's broader obesity treatment focus. Obesity is one of the leading causes of fertility challenges in both men and women, and OPM's call letter explicitly links GLP-1 access, IBT, and fertility support as connected pieces of the same preventive health strategy.

For more on existing FEHB fertility coverage, see our guide to FEHB fertility coverage in 2026.

Gender-Affirming Care: Full Phase-Out in 2027

OPM's position on gender-affirming care has now been codified in the 2027 call letter. Starting January 1, 2027, FEHB and PSHB carriers must end coverage for all gender-affirming care procedures and treatments.

This is an extension of the direction OPM signaled in 2025, when it required carriers to eliminate gender-affirming care coverage for Plan Year 2026. The 2027 call letter closes the transition for any enrollees who were mid-treatment.

What the call letter specifically allows:

• Mental health counseling with licensed mental health providers remains covered
• OPM explicitly notes that counseling "consistent with members' personal values," including faith-based counseling, is permitted

What is no longer covered in 2027:

• Gender-affirming surgical procedures
• Hormone therapy for gender transition purposes
• Other medical treatments categorized as gender-affirming care

If you or a family member has been receiving gender-affirming care through an FEHB plan, your coverage for those treatments ends at the start of the 2027 plan year. Mental health support through licensed counselors continues to be a covered benefit.

The "Well Care" Initiative: What It Means in Practice

The "well care" label is new but many of the ideas behind it aren't. OPM has been pushing preventive care for years. What's different in 2027 is the specificity of the language and a few provisions that stand out.

OPM is asking carriers to expand digital therapeutics and non-drug alternatives. More plans may cover behavioral coaching apps, remote monitoring programs, and other tools that don't involve a prescription. Paired with the IBT requirement for GLP-1s, this signals OPM wants behavioral change to lead, with drugs as a support.

On cost control: carriers are being pushed to steer members toward lower-cost care settings. Urgent care over emergency room. Telehealth for routine visits. Outpatient surgery when inpatient isn't required. OPM also wants carriers to reduce "low-value services," which in practice means things like routine imaging that wouldn't change a treatment decision. These are premium management moves dressed in wellness language.

The precision medicine angle is worth watching. OPM is encouraging plans to match treatments to individual patient profiles rather than applying one-size-fits-all protocols. In 2027 that's mostly aspiration. But it points toward how OPM envisions the program evolving.

The most unusual provision: vaccine cash incentives are out. OPM is telling carriers to drop any existing monetary rewards for enrollees who get pediatric and prenatal vaccinations, citing "member independence" on vaccination decisions. Vaccine coverage itself doesn't change. Plans must still cover all CDC-recommended vaccines. But the cash-reward programs go away.

What This Means for Your Premiums

The honest answer: we don't know yet.

Official 2027 premium rates will not be announced until fall 2026, before Open Season begins. The call letter tells carriers what they must cover, but carriers then submit their rate proposals to OPM, which negotiates and approves final rates.

OPM's letter does tell carriers to "offset the cost of benefit increases through efficiency improvements" rather than premium increases. That is a signal that OPM will push back on rate hikes. Whether that pressure holds depends on how expensive the new mandates turn out to be, particularly GLP-1 coverage, which is costly when demand is high.

For context: the 2026 plan year saw average enrollee shares rise 12.3% for FEHB and 11.3% for PSHB. The GLP-1 mandate, if heavily utilized, could add pressure in 2027.

A few things that could go either way:

Factor	Potential Premium Effect
GLP-1 mandate (if high utilization)	Upward pressure
IBT requirement limiting GLP-1 access	Moderating effect
Gender-affirming care elimination	Minimal savings (small affected population)
Site-of-care optimization	Modest downward pressure over time
Fertility outreach and ART discounts	Negligible premium effect

Plan-level changes matter more than the averages. Some plans will be affected more than others depending on their current formularies and enrollee demographics. The full picture won't be clear until OPM publishes the 2027 plan brochures and rate tables.

PSHB vs. FEHB: Are There Differences?

The 2027 call letter applies to both programs with the same requirements. Postal Service employees and retirees enrolled in PSHB will face the same GLP-1 mandates, gender-affirming care phase-out, fertility guidance, and well care expectations as FEHB enrollees.

PSHB enrollees who are Medicare-eligible must also be enrolled in Medicare Part B to maintain PSHB coverage. That coordination continues under the 2027 rules. See our guide on FEHB and Medicare Part B coordination for more on how the two programs work together.

Open Season 2026: Your Planning Timeline

You have until November to act on any of this. Here is how to use the time between now and Open Season.

Now through September:

• If GLP-1 coverage matters to you, research the IBT requirement. Ask your doctor what programs qualify. Some employers and plans have existing IBT vendors you can access now.
• If you are using fertility treatments or assisted reproductive technology, check your current plan's coverage and note what changes in 2027.
• If gender-affirming care coverage applies to your family, plan ahead. Coverage ends January 1, 2027. Talk to your provider about treatment timelines.

October:

• OPM will announce 2027 plan offerings and rate tables. Compare your current plan's costs against alternatives.
• Watch for your current plan's brochure updates: new GLP-1 formulary details, IBT partners, and ART discount programs.

November-December 2026:

• Open Season runs in November and December 2026 (specific dates pending OPM announcement).
• Use the FEHB Calculator to compare premium costs across enrollment types before you decide.
• Read your plan's 2027 brochure summary of benefits carefully, especially the drug formulary and the obesity management section.

Outside of Open Season, you can only change your plan through a qualifying life event. See our guide on FEHB qualifying life events for the full list.

Compare Your FEHB Options Before Open Season

The 2027 changes are worth factoring into your plan choice now. Use our free FEHB Calculator to compare premium costs across plans and enrollment types and get a head start on your November decision.

Compare FEHB Plan Costs

Frequently Asked Questions

What is the OPM FEHB call letter?

The call letter is the annual guidance OPM sends to FEHB and PSHB insurance carriers. It sets coverage requirements, policy priorities, and benefit expectations that carriers must incorporate into their plan offerings for the upcoming plan year. OPM released the Plan Year 2027 call letter on March 31, 2026.

Will all FEHB plans cover GLP-1 weight loss drugs in 2027?

Yes. OPM's 2027 call letter requires all FEHB and PSHB carriers to cover at least one GLP-1 anti-obesity medication (such as semaglutide) plus at least two oral anti-obesity medication alternatives. However, coverage requires enrollment in intensive behavioral therapy (IBT) before and during medication use.

What happens to gender-affirming care coverage in 2027?

OPM's 2027 call letter requires carriers to end all coverage for gender-affirming care procedures and treatments, including for enrollees currently mid-treatment. Mental health counseling with licensed providers, including faith-based counselors, remains covered.

Will my FEHB premiums go up because of the 2027 changes?

OPM has instructed carriers to offset the cost of new benefit expansions through efficiency improvements rather than premium increases. However, official 2027 premium rates won't be announced until fall 2026, ahead of the November-December 2026 Open Season. The 2026 plan year saw average enrollee shares rise 12.3% for FEHB and 11.3% for PSHB.

Does the 2027 call letter apply to PSHB plans for postal workers?

Yes. The call letter covers both FEHB (for most federal civilian employees and retirees) and PSHB (for U.S. Postal Service employees and retirees). Both programs received the same policy guidance for Plan Year 2027.

When is the 2027 FEHB open season?

Open Season for Plan Year 2027 coverage will run in November and December 2026. Specific dates have not yet been announced by OPM. Outside of Open Season, you can only change your FEHB plan if you experience a qualifying life event.

Related Resources

• FEHB Calculator: Compare premium costs across plans and enrollment types
• FEHB Plan Evaluation Guide: How to choose and compare FEHB plans
• FEHB Value in Retirement: The full dollar value of keeping FEHB after you retire
• FEHB Fertility Coverage 2026: What FEHB plans currently cover for IVF and fertility treatments
• FEHB and Medicare Part B Guide: How FEHB and Medicare coordinate for retirees
• OPM.gov: FEHB Carrier Resources: Official OPM carrier guidance and call letters