100 things to know about Blue Cross Blue Shield

One in 3 Americans receives health coverage through one of 34 independent Blue Cross Blue Shield companies. 

Here are 100 things to know about BCBS' corporate structure, history and more. 

Structure 

1. The Blue Cross Blue Shield Association is made up of 34 independent BCBS companies. BCBS affiliates are locally owned and operated. 

2. BCBS affiliates operate in all 50 states, Washington, D.C., and Puerto Rico. 

3. As of September 2022, BCBS companies had 114 million members, accounting for 1 in 3 Americans. 

4. BCBS companies use different operating models. Some are nonprofits, or mutual companies owned by their members. Others operate as for-profit. 

5. Elevance Health, which operates 14 BCBS affiliates, is publicly traded.

6. Kim Keck became president and CEO of the BCBS Association in 2021. Prior to leading the association, she was president of BCBS Rhode Island. 

7. The BCBSA is headquartered in Chicago, with offices in Washington, D.C. 

8. The BCBSA has around 1,000 employees. 

9. BCBS affiliates employ more than 150,000 people nationwide, one of the top 20 employers in the United States. 

History 

10. The first hospital prepayment plan was founded in 1929 by Justin Ford Kimball, a vice president at Baylor School of Medicine. Mr. Kimball created a system for Dallas public school teachers to pay 50 cents a month for up to 21 days of hospitalization. 

11. The Baylor prepaid plan evolved into the first Blue Cross plan, and the model was picked up by other hospitals. 

12. The first Blue Cross plan to include a network of multiple hospitals was created in New Jersey in 1931. 

13. BlueCross BlueShield of Minnesota, founded in 1933, claims to be the first to use the Blue Cross name. 

14. Blue Shield plans started separately from Blue Cross plans, which only dealt with hospital services. 

15. The first Blue Shield plans evolved from employer-organized plans to treat loggers and miners in the Pacific Northwest. 

16. Blue Cross and Blue Shield plans grew through the 1930s and '40s, and the two companies began to merge. 

17. The Blue Cross Association and the Blue Shield Association began administering the Federal Health Employee Benefit contract in 1959. It is the largest single health plan group in the world. 

18. The Blue Cross Association and Blue Shield Association merged in 1982, creating the current BCBSA. 

19. All affiliates were required to operate as nonprofits until 1994, when the association allowed members to convert to for-profit status. 

Membership by the numbers

20. According to the BCBSA, as of 2022, BCBS companies had network agreements with 1.7 million physicians and hospitals across the country. 

21. BCBS companies pay more than $510 billion in claims annually. 

22. BCBS companies contract with 79 of the Fortune 100 companies. 

23. In addition to group commercial plans, BCBS companies offer Medicare Advantage, Medicaid managed care, Medigap, Medicare Part D and individual exchange plans. 

24. In 2022, the BCBS companies had 5.8 million members in the Federal Employees Health Benefits Program,

25. 18 million members through labor unions, 

26. 6.9 million members through small business plans,

27. 6.9 million individual market members,

28. 11.9 million Medicaid members,

29. 4.3 million Medicare Advantage members,

30. 1.2 million Medicare Part D members, and

31. 4 million Medicare supplement, or Medigap, members. 

32. More than 67 million BCBS members have access to value-based care from 580,000 providers, as of 2022. 

33. Nonprofit Blue Cross Blue Shield plans accounted for 10.5 percent of the total Medicare Advantage market in 2023, according to a report from Chartis. 

BCBS companies to know 

34. Each state BCBS affiliate has its own CEO: Here are the leaders in every state. 

35. Health Care Service Corporation owns BCBS affiliates in Illinois, Texas, New Mexico, Oklahoma and Montana. It is the largest member-owned insurer in the United States and covered nearly 17 million members in 2021. 

36. Elevance Health operates 14 state BCBS affiliates under the Anthem Blue Cross Blue Shield brand. Anthem offers plans in Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, Ohio, Virginia, Wisconsin, California and New York. Elevance Health had 31.4 million commercial members in 2022. 

37. Highmark operates BCBS affiliates in Pennsylvania, Delaware, New York and West Virginia. Highmark Health Plan is part of parent organization Highmark Health, which also owns Pennsylvania-based Allegheny Health Network. Highmark Health Plan has around 7 million members. 

38. CareFirst Blue Cross Blue Shield offers health plans in Maryland, Washington, D.C., and parts of Virginia. The payer has 3.5 million members. 

39. Premera BlueCross offers plans in Washington state, Oregon and Alaska. Premera has over 2 million members. 

40. Cambia Health Solutions operates Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueShield of Washington and Regence BlueShield of Utah. As of 2022, Cambia affiliates had 3.4 million members. 

41. Wellmark Blue Cross Blue Shield offers plans in Iowa and South Dakota. The company has more than 2 million members. 

42. Blue Cross Blue Shield of Alabama serves 2.8 million members across the state. 

43. Blue Shield of California, a nonprofit payer, has 4.7 million members in the Golden State. 

44. Florida Blue serves more than 5 million healthcare members. 

45. Blue Cross Blue Shield of Massachusetts, headquartered in Boston, has 3 million members. 

46. Blue Cross Blue Shield of Kansas City has nearly 1 million members in 30 northwest Missouri counties and two Kansas counties. 

47. Blue Cross Blue Shield of Michigan has 3.9 million members in Michigan and 1.3 million members in other states. 

48. Blue Cross Blue Shield of North Dakota has 310,000 members. 

49. Blue Cross Blue Shield of South Carolina is the largest commercial insurer in the state. 

50. BlueCross BlueShield of Tennessee has more than 3.5 million members. The company has received several "Best Place to Work" awards. 

51. Capital BlueCross serves 21 counties in Central Pennsylvania. It is the largest commercial insurer in the state. 

52. The Hawaii Medical Services Association serves more than half of the state's population. 

53. Horizon Blue Cross Blue Shield of New Jersey has more than 3.8 million members. 

54. Independence Blue Cross operates in the Philadelphia region, serving 8 million people nationwide through its affiliates. 

55. Blue Cross Blue Shield of Arizona has more than 1.9 million customers. 

56. Blue Cross and Blue Shield of Arkansas is the second largest commercial insurer in the state. 

57. Blue Cross of Idaho has over 600,000 members. It is separate from Regence BlueShield of Idaho. 

58. Blue Cross Blue and Shield of Kansas serves 925,000 members. 

59. Blue Cross and Blue Shield of Louisiana serves 1.9 million members. The company is set to be acquired by Elevance Health. 

60. Blue Cross Blue Shield of Minnesota has 2.5 million members.

61. Blue Cross Blue Shield of Mississippi is the second-largest commercial insurer in the state.  

62. Blue Cross and Blue Shield of Nebraska is the second-largest commercial insurer in the state and the second largest Medicare Advantage provider. 

63. Excellus BlueCross BlueShield has 1.5 million members in upstate New York. 

64. Blue Cross and Blue Shield of North Carolina has 4.5 million members. 

65. Blue Cross and Blue Shield of Vermont has 250,000 members. 

66. Blue Cross Blue Shield of Wyoming had over 138,000 members as of 2020. 

Prime Therapeutics and prescription drugs

67. Nineteen Blue Cross Blue Shield plans own Prime Therapeutics, a pharmaceutical benefit manager. 
    
    
68. BCBS Nebraska and BCBS Minnesota created the PBM in 1998, and more plans joined as co-owners. Health Care Service Corporation joined as an equity owner in 2004. 

69. In December 2022, Prime Therapeutics acquired MagellanRx from Centene in a $1.5 billion deal. 

70. In January, the BCBSA and several Blues companies formed Synergie Medication Collective, a contracting organization aimed at bringing down the price of specialty drugs. 

Workforce

71. Several BCBS companies are embracing remote and hybrid work models and cutting back on office space. 

72. BCBS Minnesota is vacating its 443,000 square-foot headquarters in Eagan, Minn. 

73. Anthem BCBS Connecticut's headquarters will be up for auction in April 2023. 

74. BlueCross BlueShield of Tennessee committed to permanent remote work for most of its 6,300 employees in September 2022. 

75. Several BCBS companies were named among Forbes' top midsize and large employers, including BCBS Tennessee, BCBS Michigan, Health Care Service Corporation, BCBS South Carolina, Highmark Health, Excellus BCBS, BCBS North Carolina, Arkansas BCBS, BCBS Alabama, BCBS Louisiana, Horizon BCBS, BCBS Massachusetts, Premera Blue Cross, Wellmark BCBS, BCBS Nebraska, BCBS Minnesota and BCBS Kansas. 

76. Elevance Health, Health Care Service Corporation and BlueCross BlueShield of Michigan were named among Fortune's most innovative companies. 

77. Many BCBS companies are investing in workforce development programs, particularly in cybersecurity and information technology. 

78. The BCBSA is partnering with Cyversity, an organization that works to increase the number of women and underrepresented minorities in cybersecurity, to create a mentorship and training program for future cybersecurity professionals. 

79.  BlueCross BlueShield of Tennessee's BlueSky Institute, a college degree and training program aimed at fostering IT talent for the payer, has achieved a 100 percent retention rate in its first year. 

80. Blue Cross and Blue Shield of Nebraska plans to grow its new program that trains students to take on IT roles at the company. 

81. Blue Cross Blue Shield of North Carolina is sponsoring an insurance pre-licensing academy as part of the payer's efforts to create a more diverse workforce in the insurance industry. 

Antitrust actions

82. The BCBSA and individual BCBS companies have faced legal challenges alleging the companies limit competition. 

83. In August 2022, a federal judge approved a final $2.67 billion settlement agreement with BCBS companies after a decadelong court battle. 

84. As part of the settlement, insurers must drop a BCBS Association rule that requires two-thirds of national net revenues from health plans and related services to come from Blue-branded products. 

85. The settlement also struck down a rule requiring large employers to work with the Blue insurer that offers coverage where the employer is located so that BCBS companies could avoid competing with one another for large contracts.

86. The settlement is being appealed on behalf of six objectors, including Home Depot. 

87. In December 2022, a federal judge dismissed a lawsuit against BCBS Michigan from the Anesthesia Associates of Ann Arbor over an alleged decadeslong scheme to control the state's anesthesia market.

Recent news to note

Here are some of the notable BCBS company developments Becker's has reported in the last year. 

88. Blue Cross and Blue Shield of North Carolina is backing bills in the North Carolina Legislature to allow the payer to move some of its assets to a nonprofit holding company. The bill would allow the insurer to operate some of its business with fewer state regulations. 

89. North Carolina awarded Aetna its $17.5 billion state employee health plan contract, previously held by BCBS North Carolina for nearly 40 years. BCBS North Carolina is challenging the contract decision in court.

90. Elevance Health is set to acquire BCBS Louisiana in a $2.5 billion deal. It is the first local BCBS affiliate Elevance has acquired in over 15 years. Elevance expects to add 1.6 million members and $4.5 billion in revenue from the purchase.  

91. Blue Cross and Blue Shield of Minnesota is bringing on 300 employees to manage back-office work for its Medicaid programs, ending its contract with Amerigroup to manage these services. 

92. Site-neutral payment policies under Medicare could save $471 billion over 10 years for the federal government and in premiums and out-of-pocket costs, according to a report from the BCBSA. 

93. The report is part of a set of policy proposals the BCBSA says would save the U.S. healthcare system $767 billion over 10 years. The association proposes site-neutral payments, a move away from fee-for-service care and more access to cheaper prescription drugs. 

94. New Jersey extended its $136 million employee benefits contract with Horizon BCBS despite state officials and media reports alleging that previous contract terms have not been upheld by the payer. 

95. California awarded more payers, including Blue Shield of California, contracts to manage its Medicaid program, reversing course on contract awards that could have forced 2 million Medi-Cal members to switch insurance. 

96. A federal judge in Washington state ruled that Blue Cross Blue Shield of Illinois discriminated against transgender individuals by denying coverage for medically necessary gender-affirming care in its administration of employer-provided ERISA health plans, a decision that presents industrywide implications.

97.  Blue Cross Blue Shield of Massachusetts created a financial payment model that rewards health systems and physicians for eliminating racial and ethnic inequalities to care. Four of the state's health systems have signed the value-based payment contracts as of December 2022. 

98. Horizon Blue Cross Blue Shield of New Jersey is in the process converting from a nonprofit health services corporation to a nonprofit mutual holding company, which will allow it to create for-profit subsidiaries through the acquisition of providers or pharmacy benefit managers.

99. Anthem launched a new telehealth platform to offer digital care to women for pregnancy, menopause and other women's health issues through a partnership with New York City-based Happify Health.

100. The company formerly known as Anthem officially rebranded as Elevance Health in June 2022.