Blue cross blue shield what type of insurance

When reviewing your 2023 health plan options, you may come across a few common types of health insurance, like Individual and Family, Group, Medicare or Medicaid.

If you are looking for maternity coverage, dental services or prescription drug coverage, check out the plan details for different types of health insurance and specific plans to make sure you get the coverage you need.

Individual Health Insurance For You and Your Family

Individual and family health plans are a type of health insurance coverage available for you and your family.

These plans cover a wide range of services and:

  • Last a year
  • Can usually be renewed
  • Meet the essential requirements set by the Affordable Care Act

Affordable Care Act requirements include:

  • Emergency services, hospitalization, and preventive care
  • Maternity, newborn and pediatric care
  • Mental health care & substance abuse treatment
  • Lab services, prescription drugs, and disease management
  • Rehabilitative services and devices

If you enroll in an Individual and Family health plan, you may be able to get help lowering your monthly bill with a premium tax credit, also known as a subsidy.

If you qualify for a premium tax credit, you can enroll in an on-Exchange plan through beWellnm from November 1, 2022 - January 15, 2023. If you don't qualify for a premium tax credit, you can also enroll directly with a health insurance provider, or off-Exchange, from November 1 - December 15, 2022.

Learn more about getting financial help to lower your monthly bill.

Employer Insurance Plan

If you get your health plan through your job, this is called an employer insurance pan. It's also known as a group insurance plan or group coverage.

Medicare

Medicare  is a type of health insurance coverage for people age 65 or older or people under 65 with certain disabilities or illnesses.

You can add to your Original Medicare Part A (hospital) and Part B (medical) to help strengthen your health insurance safety net:

  • Part C – Medicare Advantage Plans can be seen as all-in-one coverage, some with built-in prescription drug coverage
  • Part D – Prescription drug coverage that pays for approved drugs
  • Medicare Supplement Insurance Plans – May help pay for health care costs not covered by Original Medicare

Medicaid and Children's Health Insurance Program (CHIP)

Medicaid and CHIP are types of low- or no-cost health insurance through the government. Your eligibility is based on your household size and income and determined by the government. You can apply any time of year.

Send us a question or request more information.  Our team is here to help you get a 2023 health plan for yourself or family.

Choosing a health care plan can be overwhelming. You have to decide between an HMO and a PPO, and if you want an HSA. It helps to know how you like to manage your care and if you want a plan that helps you save on taxes. Our health plan advisors can help you decide. Watch this video or read the transcript below to get started.

Blue Cross Blue Shield Association (BCBS, BCBSA) is a federation, or supraorganization, of, in 2022, 34 independent and locally operated BCBSA companies that provide health insurance in the United States to more than 106 million people.[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, while Blue Shield emerged in 1939 and the Blue Shield Association was created in 1948.

Commonly called "The Blues" within the healthcare insurance industry,[4] the organization has two offices, one in Chicago and one in Washington, D.C. The main office is in Chicago in the Illinois Center at 225 North Michigan Avenue. The 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, the District of Columbia, and Puerto Rico, as well as 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] The 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 even though it operates only in its designated service area.[5]

History[edit]

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. However, the Tax Reform Act of 1986 revoked the exemption, 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.

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]

Multi-state private companies

  • CareFirst
    • District of Columbia
    • Maryland
    • Parts of Virginia
  • Health Care Service Corporation
    • BlueCross BlueShield of Illinois
    • BlueCross BlueShield of Montana
    • BlueCross BlueShield of New Mexico
    • BlueCross BlueShield of Oklahoma
    • BlueCross BlueShield of Texas
  • Highmark
    • Highmark BlueCross BlueShield (Western and Northeastern Pennsylvania)
    • Highmark BlueShield (Eastern & Central Pennsylvania)
    • Highmark Blue Cross Blue Shield Delaware (Delaware)
    • Highmark BlueShield of Northeastern New York (New York)
    • Highmark BlueCross BlueShield West Virginia (formerly Mountain State Blue Cross Blue Shield) (West Virginia)
    • Highmark BlueCross BlueShield of Western New York (New York)
  • Premera
    • Premera BlueCross BlueShield of Alaska
    • Premera BlueCross (Washington)
  • Cambia Health Solutions
  • Wellmark Blue Cross Blue Shield

Publicly traded companies

  • Anthem
    • Anthem BlueCross and BlueShield[22]
      • Colorado
      • Connecticut
      • Georgia
      • Indiana
      • Kentucky
      • Maine
      • Missouri (excluding 30 counties in the Kansas City area)
      • Nevada
      • New Hampshire
      • Ohio
      • Virginia (excluding the Northern Virginia suburbs of Washington, D.C.)
      • Wisconsin
    • Anthem Blue Cross (California)[22]
    • Blue Cross Blue Shield of Georgia[22]
    • Empire BlueCross BlueShield (New York)[22]
  • Triple-S Management Corporation (BlueCross & BlueShield Puerto Rico)

Companies outside of the United States

  • BlueCross BlueShield of Costa Rica
  • BlueCross BlueShield of Panama
  • BlueCross BlueShield of Uruguay
  • BlueCross of Canada

Regional member organizations[edit]

Single-state and regional member include the following organizations.

Arizona[edit]

BlueCross BlueShield 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]

Arkansas[edit]

Founded in 1948,[26] Arkansas BlueCross BlueShield (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]

Blue Cross of Idaho and Regence BlueShield Idaho[31] are separate companies and compete throughout the state. In 2019, Regence BlueShield Idaho announced a strategic alliance (not a merger) with Blue Cross North Carolina.[32]

Blue Cross and Blue Shield of Kansas (BCBSKS) was founded in 1942 by Sam Bartham,[33] later becoming an independent licensee of the Blue Cross Blue Shield Association.[34]

Louisiana[edit]

BlueCross BlueShield 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.[35]

Minnesota[edit]

Blue Cross Blue Shield of Minnesota (BCBSMN) was founded in 1933, with 3,500 employees reported in 2022.[36]

Mississippi[edit]

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.[37] 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.[38] 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.[39]

Nebraska[edit]

Blue Cross Blue Shield of Nebraska was founded in 1939.[40] 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.[41]

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. Excellus BCBS is Upstate New York's largest nonprofit health plan.[42]

In 2001, Excellus merged with Univera Healthcare, (formerly North AmeriCare), based in Buffalo. Univera retained its name and is separate from Excellus BCBS.[43][44][45] 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.[46] The company's BlueCross BlueShield subsidiaries have been known as:[47]

  • 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[48] following documented charges: they had been sued and fined for denying due medical treatments to their customers and for underpaying doctors.[49][50] As of 2019 they were overseeing well over half of all payments for medical services in their state.[51] BCBSNC invests in chronic and underlying condition research,[52] telehealth[53] and artificial intelligence (AI) for digital healthcare.[54]

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.[55] 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.[56]

Pennsylvania[edit]

Though historically "Blue Cross" was used for hospital coverage while "Blue Shield" was used for medical coverage,[57] today that split only exists for traditional health insurance plans in Pennsylvania. Two independent companies operate in central Pennsylvania, Highmark Blue Shield (Pittsburgh) and Capital Blue Cross (Central Pennsylvania). In southeastern Pennsylvania, Independence Blue Cross (Philadelphia) has a joint marketing agreement 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.

Rhode Island[edit]

Blue Cross & Blue Shield of Rhode Island was founded in 1939.[58] The insurer is headquartered in Providence, at the 13-storey, $114 million Smith Hill office tower that it had built during 2008 to 2009: Blue Cross & Blue Shield of Rhode Island Headquarters.[59]

U.S. Virgin Islands[edit]

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

Vermont[edit]

BlueCross BlueShield 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]

Wyoming[edit]

BlueCross BlueShield 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]

What type of insurance is Blue Cross Blue Shield of Illinois?

Blue Cross and Blue Shield of Illinois (BCBSIL) is a customer-owned health insurance company serving Illinois residents. The company offers individuals and families healthcare and prescription drug coverage through its Blue Choice Preferred PPO, Blue Precision HMO, and BlueCare Direct HMO plans.

What are the 2 most common health insurance plans?

Here are the three most common types of health insurance plans along with what to consider for each..
HEALTH MAINTENANCE ORGANIZATION (HMO) ... .
PREFERRED PROVIDER ORGANIZATION (PPO) ... .
HIGH-DEDUCTIBLE HEALTH PLAN (HDHP) WITH A HEALTH SAVINGS ACCOUNT (HSA).