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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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review by . February 07, 2009
Disclaimers:   I've just acquired insurance with them and have yet to actually visit a doctor, so I cannot comment on claims processing, finding a doctor, or the countless other aspects of health insurance. This is my first time getting independent health insurance outside of a job or a family plan. I bought Blue Shield based almost entirely on price. I'm a fairly healthy 24-year-old with no previous medical conditions besides the occasional allergy, so I figured I'd just get the stop-gap …
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