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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 3.9 million people in central and western Pennsylvania, as well as the Lehigh Valley. It serves another 800,000 customers in West Virginia and other areas of Pennsylvania through affiliations and partnerships with other insurers, and it provides administrative and network-access services nationally. In addition, Highmark sells Medicare Advantage and prescription drug plans to seniors in both states. Other subsidiaries (not operating under the BCBS license) provide dental insurance, vision care, and other products and services nationwide.

Horizon NJ Health, a subsidiary of Horizon Blue Cross Blue Shield of New Jersey, is a managed health care organization, providing health coverage to some 350,000 publicly insured residents of the Garden State. Its members are beneficiaries of state programs such as Medicaid and NJ FamilyCare, a state-funded children's insurance program. The company's health plans cover routine office visits, prenatal care, vision and dental care, and medications. It also provides transportation and case management services. Horizon NJ Health was formed in 1993.

Independence Blue Cross (IBC) provides health insurance and related services to some 3.3 million members in Philadelphia and surrounding areas. The company's plans include Personal Choice (PPO), Keystone Health Plan East (HMO and POS), and traditional indemnity options for groups, families, and individuals. It also offers supplemental Medicare, dental, vision, life, and disability insurance. Through subsidiary AmeriHealth Administrators, IBC provides third-party administration (TPA) services. IBC, which was founded as the Associated Hospital Service of Philadelphia in 1938, is an independent licensee of the Blue Cross and Blue Shield Association.

Independent Care (better known as Independent Care Health Plan or simply iCare) offers health insurance to individuals ages 19 years and older with special needs (physical, developmental, and emotional) who already receive Medicaid and SSI benefits. iCare provides medical, dental, behavioral health, and vision benefits, as well as prescription drugs and social services for clients. The organization was founded as a joint venture between Humana Wisconsin and the Milwaukee Center for Independence in 1994.

Independent Health (IH) is a not-for-profit organization that provides a range of health insurance and related products to some 375,000 members primarily in western New York (it's licensed in 35 states). IH's plans include HMO, PPO, indemnity, and Medicare Advantage plans. It also provides dental and vision coverage, as well as coverage for Medicaid recipients. The firm offers a variety of community-based health and fitness programs including it Encompass 65 and SilverSneakers wellness programs for seniors. The company's Healthy Options program helps local restaurants design healthy menus. IH was formed in 1980 from a State University of New York at Buffalo graduate-school research project.

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