Highmark has staked its claim as the largest health insurer in the Keystone state. A licensee of the Blue Cross and Blue Shield Association, the not-for-profit firm covers some 4.9 million people in its core service areas in central and western Pennsylvania and the Lehigh Valley. It serves additional customers in West Virginia, Delaware, and other areas of Pennsylvania through its subsidiaries and affiliates, and it provides administrative and network-access services nationally. In addition, Highmark sells Medicare Advantage and prescription drug plans to seniors. Other subsidiaries (not operating under a BCBS license) provide dental insurance, vision care, and other products and services nationwide.
The company's core Pennsylvania service areas are served through wholly owned subsidiaries Highmark Blue Cross Blue Shield and Highmark Blue Shield. It reaches nearby states through its Highmark Blue Cross Blue Shield West Virginia and Highmark Blue Cross Blue Shield Delaware subsidiaries.
Highmark Blue Shield serves approximately 1 million members through the company's health care benefits business. Its health, dental, vision, and supplemental health products businesses serve 34.4 million customers nationwide
Highmark also operates more than 600 optical retail stores (Visionworks) and four US-based eyewear manufacturing facilities. In the optical arena, subsidiaries include managed vision care organization Davis Vision (with 55 million members), and eyewear manufacturer Viva Optique. .
Another unit, HM Insurance Group, offers employer health risk solutions such as stop-loss insurance and a limited benefit medical plan, while United Concordia Companies provides dental coverage to around 8 million members across the US.
The company maintains multiple collaborative agreements with neighboring Blues Independence Blue Cross and Hospital Service Association of Northeastern Pennsylvania. Another affiliate, Gateway Health Plan, is a partnership with Mercy Health System that provides Medicaid HMO coverage in Pennsylvania.
Highmark processes about 85 million health care claims a year.
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Highmark's customers include Celtic Healthcare, dck worldwide, Excela Health, and MARC USA.
The company has been working to expand its core health insurance operations through a number of measures, including introducing new programs and increasing involvement in government health programs such as Medicare and strengthening partnerships with other insurance companies.
In 2012 Highmark introduced Simply Blue PPO, a new individual insurance plan that offers simple health insurance coverage with a low premium, low deductible, and predictable copayment structure. That year the company opened a Highmark Direct retail health insurance store in Erie, its ninth location in Pennsylvania. It is also constructing a medical mall in Wexford for better delivery of health care in Western Pennsylvania.
In 2011 Highmark broadened its operations geographically by forming an affiliation with Blue Cross Blue Shield of Delaware, which noted the shift by changing its name to Highmark Blue Cross Blue Shield Delaware. Through the affiliation agreement, BCBSD operates as part of the Highmark network, benefiting from access to Highmark's administrative, claims management, and wellness program technologies, though it remains an independent legal entity headquartered in Delaware.
Highmark provides an impressive array of specialty services through its non-Blue subsidiaries, and the company is experiencing strong growth in its dental and vision care businesses.
In addition, to further its efforts to improve quality of care, lower costs, and increase communications and collaboration between clinicians and patients, Highmark and fellow Blues companies Independence Blue Cross and Horizon Blue Cross Blue Shield of New Jersey partnered with health information technology provider Lumeris in 2012 and acquired NaviNet, which provides a real-time communication network for physicians, hospitals, and health insurers. NaviNet connects 75% of doctors in the US and in 70,000 physicians and hospitals throughout the Blues' service areas.
To focus on its core health plan and provider strategies, in late 2011 Highmark decided to divest its Highmark Medicare Services unit, which provided Medicare claims processing and administration services for Medicare Part A and Part B plans in several states. The unit was acquired by the Diversified Services Options unit of Blue Cross and Blue Shield of Florida.