Federal

Federal Health Insurance Benefits NALC Health Benefit Plan

Unfortunately, the NALC Health Benefit Plan (High Option and CDHP), will not participate in the Federal Employees Health Benefits (FEHB) Program for the 2026 contract year and will not be offered to FEHB enrollees in 2026. Please see below for 2025 FEHB benefit information.

NALC FEHB Member Portal

Quickly manage your NALC HBP services through the Plan's Member Portal

NALC Member Portal

Knowing your 2025 FEHB NALC Health Benefits

Clear, straightforward 2025 benefit information for FEHB members.

Download the official 2025 FEHB Plan Brochure
Download the 2025 FEHB High Option Summary of Benefits
Download the 2025 FEHB CDHP Summary of Benefits
Download the 2025 Formulary Drug List
Download the 2025 SilverScript Formulary Drug List
Download the 2025 Specialty Drug List
Download the 2025 Drugs only available through CVS Specialty
Download the 2025 Controlled Drugs with Dispensing Limits
Download the 2025 Advanced Control Specialty Formulary

Patient Safety as a member of the NALC Health Benefit Plan

The institute of Medicine estimates that around 98,000 Americans die every year from medical mistakes in hospitals. Providing information you can use to protect yourself and your family is a top priority of the Plan.

  • Proven reliability with over 70 years of specialized federal employee healthcare expertise.

  • Request the results of any test or procedure you receive, and always keep a list of all the medicines you take.

  • Make sure you understand the process and what will happen if you need surgery.

  • For more information on patient safety, High Option members can contact our 24-hour nurse line at 855-244-6252 for medical concerns, or 800-865-9379 for mental health and substance use concerns. CDHP members can contact our 24-hour nurse line at 800-594-6252 for medical, mental health or substance use concerns.

Benefits as a member of the NALC Health Benefit Plan

Contraceptives

The NALC Health Benefit Plan covers Contraceptives at no cost to you when you see an in-network provider or pharmacy!

Under the Affordable Care Act, your plan covers contraceptive medications and medical devices approved by the U.S. Food and Drug Administration. The Plan covers a full range of contraceptive medications at a zero dollar member cost share.

  • For detailed coverage information see the Family Planning or Preventive care medications section of the Plan's brochure.

  • To learn about your reproductive right and reproductive health, visit the U.S. Department of Health and Human Services at https://www.hhs.gov/

  • If individuals have concerns about the plan's compliance, the requirements mentioned or other OPM guidance, you can contact OPM directly at contraception@opm.gov

  • You can find additional information concerning Contraceptive coverage on the OPM website.

Infertility

The Plan covers the diagnosing and treatment of infertility as well as treatment needed to conceive, including covered artificial insemination procedures. Infertility may also be established through an evaluation based on medical history and diagnostic testing.

Artificial means of conception includes any means of attempting pregnancy that does not involve coitus. The Plan considers artificial insemination (intra-cervical insemination, intra-uterine insemination, or intra-vaginal insemination) to be medically necessary for the treatment of infertility for any of the following:

  • Infertile couples with mild male-factor fertility problem

  • Unexplained infertility problems

  • Minimal refractory erectile dysfunction or vaginismus preventing intercourse

  • Couples where the man is HIV positive and undergoing sperm washing

  • Couples undergoing menotropin ovarian stimulation or clomiphene-citrate-stimulated artificial insemination (intra-cervical insemination or IUI) medically necessary for infertile women with WHO Group II ovulation disorders such as polycystic ovarian syndrome who ovulate with clomiphene citrate but have not become pregnant after ovulation induction with clomiphene.

Prior to the initiation of Artificial Insemination, the member must complete an evaluation of the:

  • Ovulatory disorders

  • Tubal abnormalities

  • Cervical abnormalities

  • Immunologic factors

Gender affirming care

This plan recognizes that transgender, non-binary, and other gender diverse members require health care delivered by healthcare providers experienced in gender affirming health. 
This page will help members navigate our gender affirmation surgical benefits.

Gender affirming chest, genital, and facial feminization/masculinization surgeries are covered when medically necessary and meet the following criteria:

  • Note: Your provider must submit a treatment plan including all surgeries planned and the estimated date each will be performed. A new prior approval must be obtained if the treatment plan is approved and your provider later modifies the plan.

  • Note: We only cover procedures outlined in Table 1 of Cigna's Medical Coverage Policy for Gender Dysphoria Treatment.

Gender affirmation surgery on an inpatient or outpatient basis is subject to the pre-surgical requirements listed below. 

The patient must meet all requirements.

  • Prior approval is obtained (Call Cigna at 877-220-NALC (6252) for prior approval)

  • Patient must be at least 18 years of age at the time prior approval is requested and the treatment plan is submitted

  • Diagnosis of gender dysphoria by a qualified healthcare professional

  • Reversal of a gender affirmation surgery is covered only when determined to be medically necessary or a complication occurs.

Frequently asked Questions

FAQ representative
Please contact our Customer Service Department at 877-814-6252.
This decision was not made lightly; we simply were no longer able to meet our mission for federal employees.
You will need to enroll in another plan during Open Season. If you are a Federal employee, tribal employee, former spouse under Spouse Equity, Temporary Continuation of Coverage (TCC) enrollee or an enrollee receiving Office of Workers’ Compensation Programs (OWCP), you should change to another plan by December 8, 2025. If you do not change your enrollment by December 8, 2025, you will be automatically enrolled into the lowest-cost nationwide plan option as determined by OPM.
If you are a Federal employee, use your agency’s online self-service system such as Employee Express, MyPay, Employee Personal Page, EBIS, etc. If you need additional help, contact your HR office. If you are a Tribal employee, contact your Tribal Employer. If you are a Civil Service Retirement System (CSRS) or Federal Employees Retirement System (FERS) retiree, call Open Season Express at 800.332.9798 or access OPM’s Open Season website.
As a Federal employee, annuitant, or Tribal employee, if you do not change your enrollment, you will be automatically enrolled into the lowest-cost nationwide plan option as determined by OPM.
Any unused PCA credits will be forfeited once the new plan you’ve elected becomes effective.
Your current plan or option will continue to provide benefits until the effective date of the new plan or option you’ve elected during Open. There will be no gap in coverage. The effective date of coverage for the health plan you elect will generally be the first day of the first full pay period beginning on or after January 1, 2026.
Under the Patients’ Bill of Rights, enrollees who are in any trimester of a pregnancy or who are seeing a specialist for a chronic or disabling condition have a right to continued treatment through the end of post-partum care or treatment for up to 90 days of care, as applicable, following notice that a health plan is leaving the FEHB Program.
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