What are “Blue Cross Plans” and what services and benefits do they provide?

The most widely held form of medical care insurance is that which assists toward the payment of hospital charges. Service organizations are generally established under special legislation which exempts them from most state and local taxes and from insurance laws. They are, however, under some supervision by the state insurance department concerned.

A hospitalization service plan contracts with a hospital or group of hospitals to supply, at a pre-fixed cost, enumerated services to the plan’s subscribers. This arrangement might be made with a single hospital, all those in a city, or those in an entire state.

The preponderance of these plans have placed themselves under the guidance of the American Hospital Association and are known as Blue Cross plans. The subscriber to the hospital care service plan simply presents a membership card upon admission to the hospital. He or she is entitled to services to the extent of the hospital’s contract with the plan. Additional services are billed to the subscriber personally.

To summarize the benefits is almost impossible. The local variations are too many. Most often though, all non-compensation disabilities are covered. Diagnostic hospital stays are usually excluded. The most common room facility offered is semi-private, with subscribers who select more expensive arrangements being credited a specific amount.

Premiums vary depending upon the locality concerned and services contracted for, and also vary with the class of the subscribership; that is, whether an individual subscribes for himself or his wife and family as well. Employee groups, paid for through payroll deduction arrangements with employers, are numerous and usually receive a more attractive premium rate.

What are the major differences between Blue Cross and “Blue Shield” Plans?

Blue Cross plans are community-sponsored, non-profit organizations, organized under special state-enabling legislative acts that exempt them from many of the insurance laws. The impetus for Blue Cross plans has usually been from the hospitals. Blue Shield plans, on the other hand, are primarily sponsored by physicians through medical societies and formed in a similar manner.