Blue Cross and Blue Shield of Florida (doing business as Florida Blue) is the state's largest and oldest health insurance provider. It provides health insurance products and services to 4 million Floridians and serves 15.5 million people in 16 states through affiliates. Its health plans include group and individual HMO, PPO, indemnity, and supplemental Medicare policies. Florida Blue also provides accident and dismemberment, long-term care, dental, disability, life, and workers' compensation insurance. Other services include the administration of pharmacy programs and health savings accounts. The not-for-profit mutual insurance firm is owned by its policyholders. It is an independent Blue Cross and Blue Shield Association licensee.
Change in Company Type
Florida Blue gained approval from state officials to restructure itself into a not-for-profit mutual holding company structure in 2013; the transition from a mutual company to a mutual holding company would give Florida Blue more flexibility to expand into new markets outside of the insurance industry. Keeping policyholders' interest in mind, the Florida office of insurance regulation stipulated that the company cannot demutualize or sell stock directly to external investors (the firm would have to transfer assets to a for-profit entity to do so). The proposal must gain approval from policyholders before Florida Blue can carry out the transformation.
Florida Blue operates in one of the most competitive health care markets in the nation primarily due to the state's population growth. The company's HMO products are offered through subsidiary Health Options, while workers' compensation policies are issued by subsidiary Comp Options (dba OptaComp). Some of its supplemental insurance products, such as its life and disability insurance offerings, are provided through Life and Specialty Ventures, a joint venture with several other Blue Cross and Blue Shield licensees; the group of Blue providers also collaborate through their Prime Therapeutics pharmacy benefits management (PBM) venture.
Florida Blue also has operations outside of the insurance arena, such as human resources consulting and staffing services provided by its Incepture subsidiary. Another unit, Availity, is an electronic medical records administration joint venture with Humana, HCSC, and other health insurers.
The company's strategy for keeping its competitors at bay consists of using the specialty insurance product offerings of its various subsidiaries to complement its core health plans, thus providing a one-stop employee benefits shop. It also regularly introduces new products, especially products targeting low-income customers such as health plan discount cards and specialized plans for at-risk communities.
Florida Blue moved to expand into the Medicaid market in 2012 by forming a joint venture with the AmeriHealth Mercy Family of Companies, a Medicaid provider operating in several states that is affiliated with Pennsylvania-based Independence Blue Cross. The new joint venture, named Florida True Health, will provide Medicaid managed care services to Florida residents. That year it also has signed a Medicare Advantage PPO network agreement with Baptist Health Care in Escambia County and signed a network agreement with Ascension- Sacred Heart Health System in Escambia, Gulf, and Walton counties for all health product lines of business, including the Medicare Advantage PPO plan.
That year Florida Blue signed an agreement to buy Diagnostic Clinic Medical Group in Largo, Florida.
In late 2011 the company's Medicare claims management and administrative services unit, Diversified Service Options (DSO), expanded through the acquisition of Highmark's similar subsidiary, Highmark Medicare Services. The purchase widened DSO's Medicare Administrative Contractor (MAC) contract area to include five states (Delaware, Florida, Maryland, New Jersey, and Pennsylvania) as well as Puerto Rico, the Virgin Islands, and Washington, DC.
Florida Blue was founded in 1944. The not-for-profit mutual insurance company, an independent Blue Cross and Blue Shield Association licensee, is owned by its policyholders.