Blue Cross Blue Shield Association

Coordinates: 41°53′11″N 87°37′26″W / 41.8864516°N 87.6239771°W / 41.8864516; -87.6239771
From Wikipedia, the free encyclopedia

Blue Cross Blue Shield Association
Founded1929; 95 years ago (1929)
Legal status501(c)(4) public welfare organization[1]
Coordinates41°53′11″N 87°37′26″W / 41.8864516°N 87.6239771°W / 41.8864516; -87.6239771
ProductsHealth insurance PPOs and HMOs
Kim Keck[1]
SubsidiariesHealth Services Foundation
BC and BS Foundation on Health Care
BCBSA Services Inc[1]
Revenue (2014)
Expenses (2014)$449,635,361[1]
Employees (2014)
1,253[1] Edit this at Wikidata

Blue Cross Blue Shield Association, also known as BCBS, BCBSA, or The Blues, is a United States-based federation with 34 independent and locally-operated BCBSA companies that provide health insurance in the United States to more than 115 million people as of 2022.[2][3]

It was formed in 1982 from the merger of its two namesake organizations: Blue Cross was founded in 1929 and became the Blue Cross Association in 1960, and Blue Shield emerged in 1939 and the Blue Shield Association was created in 1948. Its headquarters are at 300 E. Randolph Street in Chicago, Illinois.[4]

BCBSA claims to control access to the Blue Cross and Blue Shield trademarks and names across the United States and in more than 170 other countries, which it then licenses to the affiliated companies for specific, exclusive geographic service areas.[5] It has affiliated plans in all 50 states, Washington, D.C., and Puerto Rico, and licensees offering plans in several foreign countries; it also participates in the nationwide health insurance program for employees of the United States federal government.[6]

BCBSA manages communications between its members and the operating policies required to be a licensee of the trademarks. This permits each BCBSA company to offer nationwide insurance coverage through it's BlueCard provider network and claims reimbursement program even though it operates only in its designated service area.[5]


Blue Cross and Blue Shield developed separately, with Blue Cross providing coverage for hospital services and Blue Shield covering physicians' services.[7]

Blue Cross is a name used by an association of health insurance plans throughout the United States. Its predecessor was developed by Justin Ford Kimball in 1929, while he was vice president of Baylor University's health care facilities in Dallas, Texas.[8] The first plan guaranteed teachers 21 days of hospital care for $6 a year, and was later extended to other employee groups in Dallas, and then nationally.[8] The American Hospital Association (AHA) adopted the Blue Cross symbol in 1939 as the emblem for plans meeting certain standards. In 1960, the AHA commission was superseded by the Blue Cross Association. Blue Cross severed its ties with the AHA in 1972.

Blue Shield was developed by employers in lumber and mining camps of the Pacific Northwest to provide medical care by paying monthly fees to medical service bureaus composed of groups of physicians.[9][10] In 1939, the first official Blue Shield plan was founded in California. In 1948, the symbol was informally adopted by nine plans called the Associated Medical Care Plan, and was later renamed the National Association of Blue Shield Plans.

In the 1960s, the U.S. government chose to partner with Blue Cross and Blue Shield companies to administer Medicare.[10]

In 1982, Blue Shield merged with The Blue Cross Association to form the Blue Cross and Blue Shield Association (BCBS).[11]

Prior to 1986, organizations administering BCBS were tax exempt under 501(c)(4) as social welfare plans. The Tax Reform Act of 1986 revoked the exemption, however, because the plans sold commercial-type insurance. They became 501(m) organizations, subject to federal taxation, but entitled to "special tax benefits"[12] under IRC 833.[13]

In 1994, BCBS changed to allow its licensees to be for-profit corporations.[7] During 2010, Health Care Service Corporation, the parent company of BCBS in Texas, Oklahoma, New Mexico, Montana and Illinois, nearly doubled its income to $1.09 billion in 2010, and began four years of billion-dollar profits.[14] In the final spending bill for FY 2015 after much lobbying since 2010, nonprofit Blue Cross and Blue Shield plans continue to have special tax breaks that were understood to be threatened by the Affordable Care Act of 2010.[15]

Current organization[edit]

Blue Cross and Blue Shield insurance companies are licensees, independent of the association and traditionally of each other,[16] offering insurance plans within defined regions under one or both of the association's brands. Blue Cross Blue Shield insurers offer some form of health insurance coverage in every U.S. state. They also act as administrators [17][16] of Medicare in many states or regions of the U.S.

The Blue Cross Blue Shield Federal Employee Program (FEP) is a nationwide option under the Federal Employees Health Benefits Program (FEHB) for U.S. federal government employees and retirees, and has been part of FEHB since FEHB's inception in 1960.[18] FEP enrolls over half of the federal workforce, with over 5 million members, making it the largest insurer of federal employees and the largest single health plan group in the world.[5][18][19][20]

The association is headquartered in the Michigan Plaza complex in the Chicago Loop area of Chicago, Illinois.[21]

Member affiliated companies[edit]

Blue Cross Blue Shield of Wyoming in Gillette, Wyoming

Regional member organizations[edit]

Single-state and regional member include the following organizations.


Blue Cross Blue Shield of Arizona (BCBSAZ) is a non-profit healthcare organization founded in 1939.[24] BCBSAZ partners with non-profit "Discovery Triangle Development Corporation" to launch a Farm Express mobile market (formerly Fresh Express).[25]


Founded in 1948,[26] Arkansas Blue Cross Blue Shield (ABCBS)[27] is an independent licensee of the Blue Cross Blue Shield Association, and the largest healthcare provider in the state.[28] It donated $1.98 million to The Walton College of Business toward founding its Robert L. Shoptaw Master of Healthcare Business Analytics Program.[29] In August 2022, more than 12,000 members of Arkansas Blue Cross were affected by a ransomware attack on a former affiliate, North Highland Company, LLC.[30]


Highmark Blue Cross Blue Shield is the state organization for Delaware. [31]


Blue Cross of Idaho and Regence BlueShield Idaho[32] are separate companies and compete throughout the state. In 2019, Regence Blue Shield Idaho announced a strategic alliance (not a merger) with Blue Cross North Carolina.[33]


Blue Cross and Blue Shield of Kansas (BCBSKS) was founded in 1942 by Sam Bartham,[34] later becoming an independent licensee of the Blue Cross Blue Shield Association.[35]


Blue Cross Blue Shield of Louisiana is a tax-paying non-profit that was founded in 1934 in New Orleans. An independent licensee of the BCBSA, it is a privately held mutual company without shareholders, which is wholly owned by its policyholders.[36]


Blue Cross Blue Shield of Minnesota (BCBSMN) was founded in 1933, with 3,500 employees reported in 2022.[37]


Blue Cross Blue Shield of Mississippi (BCBSMS) was formed as a privately held company in 1954. In 1948, it was converted to a non-profit. In 1973, its name was changed from Mississippi Hospital and Medical Service to Blue Cross & Blue Shield of Mississippi, Inc., which, in 1996, was converted from a non-profit membership corporation to a mutual insurance company, with the name again changed, to Blue Cross & Blue Shield of Mississippi, A Mutual Insurance Company.[38] During 2022, BCBS and University of Mississippi Medical Center (UMMC) network entered conflict over who is to blame for an increasing lack of covered care in the state.[39] Media reported that UMMC had paid close to $279,000 for digital advertising, commercials, and billboards to attack BCBS, which, in subsequent months, sued the hospital for defamation.[40]


Blue Cross Blue Shield of Nebraska was founded in 1939.[41] On July 1, 2018, BCBS Nebraska formed GoodLife Partners Inc., a mutual holding company, to conduct its noninsurance businesses. The company retained the Blue Cross brand, converting from mutual ownership to a stock company wholly owned by GoodLife.[42]

New York[edit]

Excellus BlueCross BlueShield (Excellus BCBS, or Excellus) is a non-profit health insurance company headquartered in Rochester, New York. It is part of the Blue Cross Blue Shield Association. BCBS is Upstate New York's largest nonprofit health plan.[43]

In 2001, Excellus merged with Univera Healthcare, (formerly North AmeriCare), based in Buffalo, New York. Univera retained its name and is separate from Excellus BCBS.[44][45][46] Excellus was the target of a cyberattack in 2015, in which 10.5 million records were hacked, and cost the company 17.5 million dollars.[47] The company's Blue Cross Blue Shield subsidiaries have been known as:[48]

  • BlueCross BlueShield of Central New York
  • BlueCross BlueShield of the Rochester Area
  • BlueCross BlueShield of Utica-Watertown

North Carolina[edit]

By September 2010, BCBS licensee Blue Cross and Blue Shield of North Carolina announced that it would refund $156 million to their policyholders[49] following documented charges: they had been sued and fined for denying due medical treatments to their customers and for underpaying doctors.[50][51] As of 2019 they were overseeing well over half of all payments for medical services in their state.[52] BCBSNC invests in chronic and underlying condition research,[53] telehealth[54] and artificial intelligence (AI) for digital healthcare.[55]

In 2019, Blue Cross and Blue Shield of North Carolina agreed to enter into a partnership with Cambia Health, but cancelled the agreement later that year.[56] Dr. Patrick H. Conway, who had served as CEO from 2017, was scheduled to become CEO of the merged company, replacing retiring Cambia CEO Mark Ganz, but resigned after a DWI arrest in June 2019, putting the merger on hold.[57]


Though historically "Blue Cross" was used for hospital coverage while "Blue Shield" was used for medical coverage,[58] today that split only exists for traditional health insurance plans in Pennsylvania. Two independent companies operate in central Pennsylvania, Highmark Blue Shield in Pittsburgh and Capital Blue Cross in Central Pennsylvania. In southeastern Pennsylvania, Independence Blue Cross in Philadelphia has a joint marketing agreement with Highmark Blue Shield in Pittsburgh for their separate hospital and medical plans. However, Independence Blue Cross, like most of its sister Blue Cross Blue Shield companies, cover most of their customers under managed care plans such as HMOs and PPOs which provide hospital and medical care in one policy.

Rhode Island[edit]

Blue Cross & Blue Shield of Rhode Island was founded in 1939.[59] The insurer is headquartered in Providence, Rhode Island.

U.S. Virgin Islands[edit]

BlueCross BlueShield of the U.S. Virgin Islands is administered by BlueCross BlueShield of Puerto Rico.[60]


Blue Cross Blue Shield of Vermont was founded in 1980.[61] In 2022, BCBS Vermont sued Teva Pharmaceuticals over its "years-long scheme to reap excessive profits" from sales of its multiple sclerosis (MS) drug, Copaxone.[62]


Blue Cross Blue Shield of Wyoming (BCBSWY) is a non-profit founded in 1945.[63] In 2022, BCBSWY penned opposition to the Pharmacy benefit managers act enhancements (Wyoming Senate File 0036).[64]

Nonprofit status debate[edit]

While only some members retain nonprofit status, the ones that do have been criticized for holding excessive amounts of cash or excessive executive compensation. For instance, the CEO of BCBS Michigan, Daniel Loepp, earned over 19 million USD in 2018, more than the CEO of Ford or Fiat Chrysler during the same year.[65]

In 2014, BC/BS of Illinois (Health Care Service Corporation) was sued over its nonprofit status. The lawsuit was dismissed, with prejudice, and the dismissal ruling was upheld on appeal.[66] Similar suits occurred with similar results in other states such as Oregon.[67]

For-profit conversions[edit]

Conversions into for-profit corporations typically results in distribution of some of the assets into a charitable foundation. When Blue Cross of California was converted, it initially had no distribution, but subsequently The California Endowment and California Health Care Foundation were endowed with $3.2 billion.[68] Proceeds ranged from $3.2 billion (California) to $1.5 million (Nevada).[69]: 63 

An exceptional case occurred in the Empire Blue Cross conversion, where the proceeds went to fund wage increases for union workers.[70]

Antitrust settlement[edit]

In 2022, the group of 34 companies that make up the BCBS Association settled an antitrust investigation by allowing competition among member companies under non-Blue names while retaining regional exclusivity for regional licenses.[71]

Claim denial controversies[edit]

In 2018 Robert Salim was diagnosed with stage 4 throat cancer, however the proton therapy ordered by his doctor was denied by Blue Cross Blue Shield. Salim sued.[72] In July 2022 the United States District Court, Western District of Louisiana ruled that "Because Salim showed that PBT was a nationally accepted standard of care for advanced head and neck cancer in 2018, BCBSLA abused its discretion in finding Salim's PBT treatment was not medically necessary."[73] A Propublica investigation found that Blue Cross and Blue Shield of Louisiana used guidelines from an outside company called AIM Specialty Health to reject appeals for denial, and that this practice was widespread.[72]

See also[edit]


  1. ^ a b c d e f g "Form 990: Return of Organization Exempt from Income Tax". Blue Cross and Blue Shield Association. Guidestar. December 31, 2014.
  2. ^ "Blue Facts Sheet 2022" Blue Cross Blue Shield Association,
  3. ^ "Blue Cross Blue Shield Association - Supporting the 36 Independent, Locally Operated Blue Cross and Blue Shield Companies -". Archived from the original on November 5, 2011. Retrieved November 2, 2011.
  4. ^ The Blues: History of the Blue Cross and Blue Shield System by Robert Cunningham III and Robert M. Cunningham Jr. 1997; page 3. ISBN 9780875802244
  5. ^ a b c "The Blue Cross Blue Shield System | Blue Cross Blue Shield". Retrieved December 11, 2019.
  6. ^ "BCBS® Companies and Licensees | Blue Cross Blue Shield". Retrieved December 11, 2019.
  7. ^ a b Coordinated Issue Paper – Blue Cross Blue Shield/Health Insurance; Life Insurance: Conversion of nonprofit corporations. 4 June 2008) Archived 6 May 2009 at the Wayback Machine
  8. ^ a b Justin Ford Kimball from the Handbook of Texas Online. Retrieved August 31, 2009. [dead link]
  9. ^ "Health Care Service Corporation (HCSC) – Who We Are". Archived from the original on November 8, 2016. Retrieved January 6, 2017.
  10. ^ a b Marc Lichtenstein (n.d.). "Health Insurance From Invention to Innovation: A History of the Blue Cross and Blue Shield Companies". Blue Cross and Blue Shield Association. Archived from the original on May 23, 2014. Retrieved May 23, 2014.
  11. ^ "History of Blue Cross and Blue Shield Association – 1980s". Blue Cross and Blue Shield Association. Archived from the original on September 26, 2009.
  12. ^ "Nonprofit Health Inc.: Overview of issues in the protection of nonprofit assets - Blue Cross: 501(m)". Consumers Union. January 1, 2008. Retrieved December 18, 2014. As of January 1, 1987, the federal government removed the full tax-exempt status of BCBS plans and instead created a special tax class for BCBS organizations, Internal Revenue Code ("I.R.C.") 5833. That I.R.C. category subjected BCBS plans to federal taxation but recognized the unique role BCBS plans play, unlike commercial for-profit insurers, and entitled it to special tax benefits.
  13. ^ 26 USC § 833 – Treatment of Blue Cross and Blue Shield organizations, etc. | Title 26 – Internal Revenue Code | U.S. Code | LII / Legal Information Institute Retrieved on 2013-09-05.
  14. ^ "Blue Cross parent boosts profit in second quarter". Crain's Chicago Business. Crain Communication, Inc. September 3, 2013. Retrieved December 18, 2014.
  15. ^ Pear, Robert (December 14, 2014). "In Final Spending Bill, Salty Food and Belching Cows Are Winners". The New York Times. Retrieved December 18, 2014.
  16. ^ a b Martin Gottlieb (August 2, 1993). "For Nation's Blue Cross Plans, Echoes of the Troubles at Empire". The New York Times. Retrieved September 4, 2022.
  17. ^ NYT quote: Now you have non-medical people, business promoters, coming in and running Blue Crosses.
  18. ^ a b "Blue Cross and Blue Shield's Federal Employee Plan". FEP Blue. Retrieved December 11, 2019.
  19. ^ "Feds Are Flocking to the Same Few Health Care Plans Despite Choices". Government Executive. November 7, 2017. Retrieved December 11, 2019. GAO said since 2000, Blue Cross Blue Shield has become a behemoth in the federal employee insurance market. The company was the largest carrier in 93 percent of counties in 2000, and that proportion grew to 98 percent in 2015. Over that same time period, Blue Cross Blue Shield grew its median county market share from 58 percent to 72 percent.
  20. ^ FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM: Enrollment Remains Concentrated Despite More Plan Offerings, and Effects of Adding Plan Types Are Uncertain. United States Government Accountability Office. 2017. p. 35. BCBSA's large program market share—66 percent of total program enrollment in 2015
  21. ^ "Contact Us". Blue Cross and Blue Shield Association. Archived from the original on January 10, 2007. Retrieved December 23, 2009.
  22. ^ "Florida Blue – New Name of Blue Cross and Blue Shield of Florida" (Press release). PRNewswire. April 2, 2012. Retrieved April 27, 2012.
  23. ^ a b c d "Contact Us". Retrieved September 6, 2016.
  24. ^ "Blue Cross Blue Shield of Arizona Welcomes Marcus Montoya as VP, Network Management" Fierce Healthcare; March 14, 2011.
  25. ^ "BCBSAZ and Farm Express launch mobile produce market" AZBIGMEDIA; April 19, 2018.
  26. ^ "OUTSTANDING HEALTH CARE PROFESSIONALS" Arkansas Money & Politics; December 26, 2018.
  27. ^ "Pharmacists Get Creative Overcoming Barriers to Care by Going the Extra Virtual Mile" by Jill Murphy; Pharmacy Times; May 13, 2021.
  28. ^ "Healthcare Business Analytics Graduate Program Honors Robert L. Shoptaw" University of Arkansas; September 28, 2022.
  29. ^ "ARKANSAS BLUE CROSS BLUE SHIELD DONATES $1.98M TO U OF A" Arkansas Money & Politics; October 13, 2022.
  30. ^ "Vendor provides protection to Arkansas Blue Cross members affected by ransomware attack" THV11; August 24, 20222.
  31. ^ Highmark official website.
  32. ^ "Regence BlueShield of Idaho Inc - Company Profile and News". Bloomberg News.
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  34. ^ "Barham took BCBS to the top" by Karen Ridder; The Topeka-Capitol Journal; March 4, 2009.
  35. ^ "COMMUNITY HEALTH & VIBRANCY PILOT COMPETITION" by Loretta George; FortScottBiz; February 11, 2022.
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  37. ^ "Blue Cross Blue Shield of Minnesota" Forbes. Accessed November 8, 2022.
  38. ^ "Report of Examination" Mississippi Insurance Department; March 6, 2014, page 3.
  39. ^ "Nearly four months in, still no developments in mediation between UMMC and Blue Cross" by Will Stribling; Mississippi Today; September 20, 2022.
  40. ^ "Conflict between Mississippi’s largest hospital, insurer a breaking point for some residents" by Shalina Chatlani; WWNO New Orleans Public Radio; November 7, 2022.
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  44. ^ "Stories". October 23, 2000. Retrieved June 5, 2019.
  45. ^ "Stories". October 1, 2001. Retrieved June 5, 2019.
  46. ^ "Approval rate". Retrieved June 5, 2019.
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  49. ^ Reed Abelson (June 7, 2011). "California Insurer Says It Will Cap Earnings". The New York Times. Retrieved September 4, 2022.
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  52. ^ Steve Lohr (August 26, 2019). "Inside North Carolina's Big Effort to Transform Health Care". The New York Times. Retrieved September 4, 2022.
  53. ^ How 6 payers are addressing food insecurity" by Rylee Wilson; Becker's Payer; October 21, 2022.
  54. ^ "Blue Cross NC Widens Teladoc Collab, Bolstering Telehealth Services" by Anuja Vaidya; mHealthIntelligence; November 11, 2021.
  55. ^ "Former Aetna exec launches consumer health IT platform" by Andrea Park; Becker's Hospital Review; November 20, 2019.
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  59. ^ "" Bloomberg. Accessed November 9, 2022.
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  61. ^ "100 Best Medium Workplaces" Fortune; 2022.
  62. ^ "Blue Cross Vermont sues pharmaceutical giant Teva over MS drug" Vermont Business; August 24, 2022.
  63. ^ "Cheyenne business chamber luncheon will feature panel on health care" Wyoming Business Report; August 31, 2022.
  64. ^ "Letter to the Editor: Please Ask the House to Vote No on SF0036" by Diane Gore; Cowboy State Daily; March 22, 2022.
  65. ^ "Blue Cross CEO earned $11.5M cash in 2020 during COVID-19, a moderate dip from 2019". March 1, 2021. Retrieved August 19, 2022.
  66. ^ Holland, Scott. "Appeals panel upholds dismissal of class action challenge of how Blue Cross parent corp uses profits". Retrieved June 15, 2019.
  67. ^ "Judge Dismisses Attempted Class-Action Suit Against Regence BlueCross BlueShield of Oregon | The Lund Report". September 17, 2014. Retrieved June 15, 2019.
  68. ^ "Conversion and Preservation of Charitable Assets of Blue Cross and Blue Shield Plans: How States Have Protected or Failed to Protect the Public Interest" (PDF). Community Catalyst. Archived (PDF) from the original on December 9, 2016.
  69. ^ "Blue Cross and Blue Shield A Historical Compilation" (PDF). Archived (PDF) from the original on April 12, 2019.
  70. ^ Robinson, James C. (July 1, 2003). "The Curious Conversion Of Empire Blue Cross". Health Affairs. 22 (4): 100–118. doi:10.1377/hlthaff.22.4.100. ISSN 0278-2715. PMID 12889758.
  71. ^ Mathews, Anna Wilde (August 9, 2022). "Judge Approves Blue Cross's $2.67 Billion Antitrust Settlement". Wall Street Journal.
  72. ^ a b Miller, T. Christian (November 7, 2023). "Big Insurance Met Its Match When It Turned Down a Top Trial Lawyer's Request for Cancer Treatment". ProPublica. Retrieved November 9, 2023.
  73. ^ "Salim v. La. Health Serv. & Indem. Co, CIVIL 1:19-CV-00442 | Casetext Search + Citator". Retrieved November 9, 2023.

External links[edit]