Excellus BlueCross BlueShield
Excellus BlueCross BlueShield is a not-for-profit, independent BCBS licensee providing individual, Medicare, Medicaid, and employer group health insurance across 39 counties in New York State, generating revenue through recurring monthly premiums.
- Company typePrivate
- Founded1932
- HeadquartersRochester, United States
- Headcount1,001–5,000
- GTM typeB2B and B2C
- OfferingServices
What Excellus BlueCross BlueShield does
Excellus BlueCross BlueShield is a not-for-profit, independent licensee of the Blue Cross Blue Shield Association that provides health insurance and related care services across 39 counties in New York State, headquartered at 333 Butternut Drive, Syracuse. Its product portfolio spans individual and family plans, Medicare Advantage, Essential Plan, Medicaid Managed Care, Health and Recovery Plan (HARP), Child Health Plus, Dual Special Needs Plan (D-SNP), and small, medium, and large employer group plans, supported by digital channels including a member web portal, an iOS/Android mobile app, virtual care, a provider directory, and a medical cost estimation tool.
The technology stack centers on interoperability: a HAPI FHIR Server (v8.6.0) exposes Patient Access APIs (OAuth 2.0 / SMART-on-FHIR) covering resources including Patient, Coverage, ExplanationOfBenefit, and Immunization, alongside Public Access APIs for provider and pharmacy directory data. Approximately 2.5 TB of CMS-mandated Transparency in Coverage machine-readable JSON files (~400 in-network rate files, ~220 out-of-network allowed-amount files) are published via a HealthSparq portal. Social Care Network integrations with Care Compass, Healthy Alliance, and FLIPA connect Medicaid, HARP, and D-SNP members to social services addressing housing, food, nutrition, and transportation.
The revenue model is subscription-based, collecting recurring monthly premiums from individuals, families, employers, and government payers (Medicare, Medicaid, NY State of Health). Distribution is hybrid: direct-to-consumer through the website, call centers, and a member mobile app; broker partnerships; NY State of Health marketplace enrollment; and a direct employer group sales team. In 2025, the insurer processed nearly $7 billion in medical and prescription drug claims, recorded a $108 million operating loss driven by a 16% YoY claims cost surge, and finished the year with $1.7 billion in reserves and a 2% net margin enabled by investment gains.
Excellus BlueCross BlueShield firmographics
Firmographics- Name
- Excellus BlueCross BlueShield
- Legal name
- Excellus BlueCross BlueShield
- Website
- https://excellusbcbs.com
- Company type
- Private
- Founded year
- 1932
- Operating status
- Operating
- Headcount range
- 1,001–5,000 employees
- Short description
- Excellus BlueCross BlueShield is a not-for-profit, independent BCBS licensee providing individual, Medicare, Medicaid, and employer group health insurance across 39 counties in New York State, generating revenue through recurring monthly premiums.
- Ownership category
- akta.pro rank
Excellus BlueCross BlueShield industry classification
Industry- Product category
- Health Insurance
- NAICS
- Health and Welfare Funds (525120), Health Care and Social Assistance (62)
- SIC
- Accident & Health Insurance (6321), Hospital & Medical Service Plans (6324)
- akta.pro primary industry
- Large Group Health Insurance (Mid-Market & National Accounts) (FSAIAFAE)
- akta.pro secondary industries
- Healthcare-Linked Social Benefits Administration (e.g., Medicaid/Means-Tested Health Coverage) (BPAIAKAH), Substance Use Disorder (SUD) Benefit Management (HLAEAHAF), Public Health & Health Equity Organizations (BPAGACAL)
Keywords
Where Excellus BlueCross BlueShield is headquartered
LocationHeadquarters
- HQ city
- Rochester
- HQ country
- United States
- HQ region
- North America
Offices2 records
Markets served
Excellus BlueCross BlueShield business model
Business model- GTM type
- B2B and B2C
- Offering type
- Services
- Cost components
- Operations, Personnel, Technology or R&D, Marketing or Sales, Infrastructure
Revenue model
- Health Insurance Premiums: Excellus BlueCross BlueShield generates revenue primarily through premium payments collected from individuals, families, employers, and government programs (Medicare Advantage, Medicaid, Essential Plan, Child Health Plus, HARP, D-SNP) in exchange for health insurance coverage. Premiums are scaled based on plan type, coverage level, and eligibility.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Subscription | Monthly | Individual & Family Plans - Various plan tiers including $0 and low-cost options |
| Subscription | Monthly | Medicare Advantage Plans - Medicare Advantage coverage for Medicare-eligible individuals |
| Subscription | Monthly | Medicaid Managed Care Plans - Coverage for Medicaid-eligible individuals |
| Subscription | Monthly | Essential Plan - Income-based affordable coverage |
| Subscription | Monthly | Small Business Health Plans - Group coverage for small employers |
| Subscription | Monthly | Medium & Large Business Health Plans - Group coverage for larger employers |
Go-to-market motion2 records
Distribution channels4 records
Marketing channels5 records
Excellus BlueCross BlueShield product offering
Product offeringCore offering
Excellus BlueCross BlueShield is a not-for-profit health insurance company that finances and delivers health care coverage to individuals, families, Medicare beneficiaries, Medicaid recipients, and employer groups across 39 counties in upstate New York. It offers individual and family plans, Medicare Advantage, Essential Plan, Medicaid Managed Care, HARP, Child Health Plus, D-SNP, and small/medium/large group employer plans, supplemented by member digital tools, virtual care, wellness programs, and Social Care Network services.
Product overview
Excellus BlueCross BlueShield is a health insurance provider offering a comprehensive portfolio of health insurance products across multiple channels. The core offerings include Individual & Family Plans, Medicare Advantage, Essential Plan, Medicaid, Health and Recovery Plan (HARP), Child Health Plus, and Dual Special Needs Plan (D-SNP), along with employer group plans for small, medium, and large businesses. The company provides member-facing digital services including a mobile app, virtual care capabilities, provider search tools, and cost estimation features. For developers, Excellus offers FHIR APIs for interoperability enabling third-party application access to member healthcare data. The product ecosystem also includes wellness programs, Social Care Networks for community support, and transparency in coverage data files for regulatory compliance.
Differentiator
Problem solved
Functional benefit
Products and services
- Individual & Family Plans Health insurance plans available for purchase by individuals and families in New York State, including various coverage levels and premium options for preventive care, prescription drugs, and network access.
- Medicare Advantage Medicare Advantage plans for Medicare-eligible individuals offering managed healthcare coverage with additional benefits beyond Original Medicare, including prescription drug coverage and supplemental benefits.
- Essential Plan New York State-sponsored affordable health insurance plan for individuals meeting income eligibility requirements, with low or no monthly premiums.
- Medicaid Managed Care State and federal health insurance program for low-income individuals and families providing comprehensive medical coverage, with eligibility determined by government program criteria.
- Health and Recovery Plan (HARP) Managed care plan for individuals with serious mental health and/or substance use disorders providing integrated physical and behavioral health services.
- Child Health Plus New York State-sponsored health insurance program for children under 19 who do not qualify for Medicaid and may not otherwise afford coverage.
- Dual Special Needs Plan (D-SNP) Special needs plan for individuals eligible for both Medicare and Medicaid providing coordinated coverage and additional support services.
- Small Business Health Plans Group health insurance coverage options designed for small businesses with employees, including employer-sponsored plans for SMB customers.
- Medium & Large Business Health Plans Health insurance plans tailored for medium and large employer groups with customizable benefits packages for employee coverage.
- Medicare Plans for Business Medicare-related health coverage options for employers to offer to their workforce, including group Medicare Advantage and Medicare supplement plans for retirees.
- Excellus BCBS Member Mobile App Mobile application for iOS and Android that allows members to access their health insurance benefits, view claims, find providers, manage coverage, and connect with care services.
- FHIR APIs for Interoperability Developer-facing APIs enabling authorized third-party applications to access member Protected Health Information (PHI), provider directories, and pharmacy directories following FHIR R4 standards, including Patient Access APIs and Public Access APIs.
Quantifiable outcome
- #1 in Customer Satisfaction among Medicare Advantage Plans in New York for the third consecutive year
- +2 more outcomes
Companies that use Excellus BlueCross BlueShield
Customer profileSegments5 records
Ideal customer profiles5 records
Excellus BlueCross BlueShield technology and API
TechnologyTechnology focussed No
API detail
- Has API
- Yes
- API docs
- API detail
Core technology
AI maturity
App detail
Integration1 record
Feature4 records
Excellus BlueCross BlueShield partnerships and signals
Strategic signalPartnerships
Five partnerships are on record, tiered core.
- New York State of HealthcoreExcellus BlueCross BlueShield collaborated with New York State of Health to develop the Health Equity Affordability Reform Act (HEARA), which would allow any New Yorker to buy into the Essential Plan regardless of income. The partnership involves working with state government on healthcare policy initiatives to expand affordable coverage access.
- Care CompasscoreCare Compass is a Social Care Network partner serving Broome and Otsego Counties. They provide screening for Excellus BCBS Medicaid Managed Care, HARP, and D-SNP members to determine eligibility for services addressing health-related social needs including housing, food, nutrition, and transportation.
- Healthy AlliancecoreHealthy Alliance is a Social Care Network partner serving Herkimer, Oneida, and Onondaga Counties. They provide screening and coordination services for Excellus BCBS Medicaid Managed Care, HARP, and D-SNP members to address health-related social needs.
- Forward Leading Independent Provider Association (FLIPA)coreFLIPA is a Social Care Network partner serving Livingston, Monroe, Ontario, Seneca, Wayne, and Yates Counties. They provide screening services for Excellus BCBS Medicaid Managed Care, HARP, and D-SNP members to address health-related social needs.
- Univera HealthcarecoreUnivera Healthcare is an affiliate of Excellus BlueCross BlueShield, sharing the same corporate parent and website infrastructure for language assistance and accessibility services. Both entities operate under the Excellus BCBS parent organization.
Scale indicators6 records
Recent moves6 records
Expansion highlights5 records
Excellus BlueCross BlueShield competitors and assessment
Company assessmentDirect peers
- Highmark Inc. Highmark is a nonprofit Blue Cross Blue Shield licensee operating across Pennsylvania, West Virginia, Delaware, and New York (including a Buffalo-region plan). Like Excellus, it is a regional BCBS licensee offering commercial, Medicare, Medicaid, and specialty products under a similar nonprofit structure with multi-state scale.
- BlueCross BlueShield of North Carolina: A nonprofit BCBS licensee with comparable scale (~5,000+ employees), serving individuals, families, Medicare, and large employer groups in a single state — the closest structural analog to Excellus in New York.
- BlueCross BlueShield of Michigan: Largest nonprofit BCBS licensee serving Michigan with multi-line commercial, Medicare Advantage, and Medicaid products. Larger scale but analogous nonprofit regional BCBS business model.
- Empire BlueCross BlueShield (Anthem/Elevance): Empire is the Anthem/Elevance Health-owned BCBS licensee competing head-to-head with Excellus in New York across commercial, Medicare, and individual market segments.
- BlueShield of Northeastern New York (BSNENY): BSNENY is a regional BCBS licensee operating in overlapping upstate New York counties, competing directly for employer group and Medicare Advantage members in the Capital District and Adirondacks.
- MVP Health Care: MVP is a regional nonprofit health plan operating in New York and Vermont with employer group, Medicare Advantage, and individual product overlap with Excellus.
- CDPHP: CDPHP is a Capital Region-based nonprofit health plan serving Albany-area employers, individuals, Medicare, and Medicaid members — direct competitor in central/upstate New York.
Broad incumbents
- Health Care Service Corporation (HCSC): HCSC is the largest customer-owned BCBS licensee operating across multiple states with broad commercial, Medicare, and Medicaid lines — a structurally analogous nonprofit BCBS at meaningfully larger scale.
- Humana: Humana is the largest US Medicare Advantage carrier with significant NY MA membership; competing for the same senior population where Excellus holds the J.D. Power #1 in NY distinction.
Regional players
- Independent Health: Independent Health is a Buffalo-based regional health plan serving Western New York with commercial, Medicare, and Medicaid products, overlapping Excellus's Rochester/Western NY service area.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat5 records
Key risks5 records
Key highlights6 records
Customer concentration
Excellus BlueCross BlueShield social profiles
Digital presenceExcellus BlueCross BlueShield compliance and trust
Trust signalCompliance4 records
Excellus BlueCross BlueShield financial estimates
Financial estimateRevenue estimate
Valuation estimate
Excellus BlueCross BlueShield leadership team
Management profileNumber of profiles
Profiles5 records
Excellus BlueCross BlueShield funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Excellus BlueCross BlueShield M&A and investment
M&A and investmentM&A
Investments24 records
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Excellus BlueCross BlueShield
What does Excellus BlueCross BlueShield do?
Excellus BlueCross BlueShield is a not-for-profit health insurance company that finances and delivers health care coverage to individuals, families, Medicare beneficiaries, Medicaid recipients, and employer groups across 39 counties in upstate New York. It offers individual and family plans, Medicare Advantage, Essential Plan, Medicaid Managed Care, HARP, Child Health Plus, D-SNP, and small/medium/large group employer plans, supplemented by member digital tools, virtual care, wellness programs, and Social Care Network services.
Is Excellus BlueCross BlueShield a public or private company?
Excellus BlueCross BlueShield is a private company. It is classified as nonprofit foundation owned and is currently operating.
When was Excellus BlueCross BlueShield founded?
Excellus BlueCross BlueShield was founded in 1932. It employs 1,001 to 5,000 people.
Where is Excellus BlueCross BlueShield based?
Excellus BlueCross BlueShield is headquartered in Rochester, United States, in the North America region.
How does Excellus BlueCross BlueShield make money?
One revenue line is on record: health Insurance Premiums.
Who are Excellus BlueCross BlueShield's main competitors?
Direct peers on record are Highmark Inc., BlueCross BlueShield of North Carolina, BlueCross BlueShield of Michigan, Empire BlueCross BlueShield (Anthem/Elevance), BlueShield of Northeastern New York (BSNENY), MVP Health Care and CDPHP. Broad incumbents are Health Care Service Corporation (HCSC) and Humana. Independent Health is listed as a regional player.
Does Excellus BlueCross BlueShield have an API?
Yes. Excellus BlueCross BlueShield FHIR APIs for Interoperability enable health plan members to access their healthcare information through authorized third-party applications. The APIs also allow access to public non-member specific information such as Provider and Pharmacy Directories. Two API categories are offered: Patient Access APIs (require OAuth 2.0 authentication via SMART App Launch Framework, end-user consent, and client application registration) and Public Access APIs (no authentication required). Supported FHIR profiles include CARIN Consumer Directed Payer Data Exchange IG, HL7 US Core IG, and HL7 FHIR Da Vinci PDex Plan Net IG. Base URL: https://fhir.excellusbcbs.com/fhir/api. OAuth endpoints: authorization at https://fedprd.excellusbcbs.com/sso/oauth2/FHIR_EXCELLUS/authorize, token at https://fhir.excellusbcbs.com/fhir/auth/token, and registration at https://fhir.excellusbcbs.com/fhir/auth/register. Developer documentation is at news.excellusbcbs.com/developer-info/interoperability-apis.
What industry is Excellus BlueCross BlueShield in?
Excellus BlueCross BlueShield's product category is Health Insurance. Its primary akta.pro industry code is FSAIAFAE, Large Group Health Insurance (Mid-Market & National Accounts), with a secondary code of BPAIAKAH, Healthcare-Linked Social Benefits Administration (e.g., Medicaid/Means-Tested Health Coverage). Its NAICS code is 525120 and its SIC code is 6321.