This permits each BCBSA company to offer nationwide insurance coverage through its BlueCard provider network and claims reimbursement program even though it operates only in its designated service area.

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.

[11] Prior to 1986, organizations administering BCBS were tax exempt under 501(c)(4) as social welfare plans.

They became 501(m) organizations, subject to federal taxation, but entitled to "special tax benefits"[12] under IRC 833.

[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.

[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.

An independent licensee of the BCBSA, it is a privately held mutual company without shareholders, which is wholly owned by its policyholders.

[36] 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.

[37] 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] On July 1, 2018, BCBS Nebraska formed GoodLife Partners Inc., a mutual holding company, to conduct its noninsurance businesses.

[51] BCBSNC invests in chronic and underlying condition research,[52] telehealth[53] and artificial intelligence (AI) for digital healthcare.

[60] In 2022, BCBSWY penned opposition to the Pharmacy benefit managers act enhancements (Wyoming Senate File 0036).

[66]: 63 An exceptional case occurred in the Empire Blue Cross conversion, where the proceeds went to fund wage increases for union workers.

[69] 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.

[69] In August 2024, BCBS of Illinois, Texas, New Mexico, Montana, and Oklahoma ceased paying for surgical anesthesia given to patients with complex health conditions, a move which the company said would streamline costs, but which the medical community was strongly against.

[74] The American Society of Anesthesiologists decried this move, calling it a “money grab” and “commercial health insurers looking to drive their profits up at the expense of patients”.