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The Blue Cross Blue Shield Association (BCBSA) is an American federation of 39 independent, community-based and locally operated Blue Cross and Blue Shield health insurance companies, in total covering over 100 million Americans.

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In 1929, Justin Ford Kimball became vice president of Baylor University in Waco, Texas. An experienced administrator, he headed the Baylor College of Medicine, School of Nursing, College of Dentistry, and the university hospital. Soon after taking the job, he developed a health plan that guaranteed teachers 21 days of hospital care for $6 a year. The plan was extended to other employee groups in Dallas, and similar plans began to spread nationally.

The cross symbol was first used in a 1934 advertisement for the Hospital Service Association, today known as Blue Cross Blue Shield of Minnesota. Company secretary E.A. van Steenwyk had Viennese artist Joseph Binder create a poster that included a blue Greek cross. Van Steenwyk continued to use the symbol to identify his company's health plans, and the Blue Cross began to be used in other parts of the country.

In 1939, the Chicago-based American Hospital Association began using the Blue Cross symbol to signify that health plans across the country met certain standards. The AHA continued to administrate the use of the symbol until the Blue Cross Association was founded in 1960. The two organizations remained affiliated until 1972.

Another health plan gained popularity in the lumber and mining camps of the Pacific Northwest around the same time that Kimball created his plan. These would provide medical care by paying monthly fees to medical service bureaus composed of groups of physicians. The first of these, Pierce County Medical Bureau (now known as Regence BlueShield) in Tacoma, Washington, was founded in 1917 and is now a part of The Regence Group. The shield symbol was created in Buffalo, New York by Carl Metzger in 1939, and the first official Blue Shield plan was founded in California that same year. In 1948 the symbol was informally adopted by nine plans called the Associated Medical Care Plans, and was later renamed the National Association of Blue Shield Plans.

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Blue Cross and/or Blue Shield insurance companies are franchisees, independent of the association (and traditionally each other), 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 US state. They also act as administrators of Medicare in many states or regions of the U.S., and regularly can be found providing group coverage to state government employees, as well as the U.S. Federal government under a nationwide option of the Federal Employees Health Benefit Plan (FEHBP) established by the association on their behalf. Thus a strong bond exists between the Blue Cross Blue Shield system and health insurance policy-making bodies at the highest levels of government in the United States.

Though historically "Blue Cross" was used for hospital coverage while "Blue Shield" was used for medical coverage, today that split only exists for traditional health insurance plans in eastern Pennsylvania, where Independence Blue Cross (Philadelphia) and Blue Cross of Northeastern Pennsylvania each have joint marketing agreements with Highmark Blue Shield (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. In most of the country (including western Pennsylvania), one insurer operates under both brands; in the remaining places (including California and central Pennsylvania), the Blue Cross and Blue Shield brands belong to competing insurers. Blue Cross of Idaho even displays the Blue Shield logo alongside the Blue Cross logo, in direct competition with Regence BlueShield of Idaho. Both brand names are used in both CamelCase and traditional forms by both the association and its member insurers, though some members prefer one form or the other.

Some of the state plans have been merged to achieve economies of scale. Many plans are administered by not-for-profit organizations, while others are for-profit companies. (Though all Blue Cross Blue Shield plans must pay Federal income tax under the Tax Reform Act of 1986, some plans are still considered not-for-profit at the state level.) The 14-state WellPoint is the largest Blue Cross Blue Shield member, and is a publicly traded company. Other multi-state organizations include CareFirst in the Mid-Atlantic and The Regence Group in the Pacific Northwest. The largest non-investor owned member is Health Care Service Corporation (HCSC), which operates four Blue Cross and Blue Shield Plans in the Midwest and Southwest.

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PUBLICLY TRADED COMPANIES


MULTI-STATE PRIVATE COMPANIES


SINGLE-STATE OR REGIONAL COMPANIES


PUERTO RICO

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The Canadian Association of Blue Cross Plans is independent of the U.S. association. Its members specialize in travel insurance and individual health plans to supplement the health plans of the various provincial governments.


LIST OF CANADIAN ASSOCIATION OF BLUE CROSS PLANS MEMBERS

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