BlueChoice HealthPlan

What BlueChoice HealthPlan does

BlueChoice HealthPlan of South Carolina is a private health maintenance organization and independent licensee of the Blue Cross and Blue Shield Association, headquartered in Columbia, South Carolina, and operating as a wholly-owned subsidiary of BlueCross BlueShield of South Carolina. The company offers a multi-line health insurance portfolio spanning individual plans (Blue Option on the ACA marketplace), small and large employer group plans (Choice Complete, Choice Select, BusinessADVANTAGE, BA Primary Choice), the Engagement Plus high-deductible plan with Patient-Centered Medical Home incentives, and the BlueChoice HealthPlan Medicaid managed care product for South Carolina Healthy Connections beneficiaries. Member-facing services include the My Health Toolkit digital portal and mobile app for claims, ID cards, and benefits access; Blue CareOnDemand telehealth powered by American Well; the FOCUSfwd wellness incentive program with Apple Watch integration; and the Blue365 discount and BlueCard national network programs.

The business model is subscription-based premium revenue, with monthly billing across individual, group, and Medicaid lines, and ancillary revenue from managed care administration. Distribution is multi-channel: three company-owned SC BLUE retail stores (Columbia, Greenville, Mount Pleasant), an independent agent network, a State Farm alliance providing access to 330 South Carolina offices, direct online enrollment, toll-free phone sales, and two mobile RV units that tour the state during ACA open enrollment. The company holds NCQA Accredited status for both commercial and Medicaid lines, an A.M. Best A+ financial strength rating, HIPAA compliance with an active Notice of Privacy Practices, and federal Surprise Billing compliance.

Technology infrastructure centers on the My Health Toolkit member platform and a Patient Access API that enables members to authorize third-party apps to retrieve health plan data dating back to January 2016. The company participates in the CMS Oncology Care Model and complies with federal interoperability mandates, but no proprietary AI/ML models or in-house data science capabilities are disclosed. Operations are confined to South Carolina with no documented geographic expansion plans.

Name

BlueChoice HealthPlan

Legal name

BlueChoice HealthPlan of South Carolina

Website

https://bluechoicesc.com

Company type

Private

Founded year

1946

Operating status

Operating

Headcount range

101–250 employees

Short description

BlueChoice HealthPlan is a South Carolina-based Blue Cross Blue Shield licensee offering individual, employer group, and Medicaid health insurance plans to state residents, supported by digital member tools, telehealth, and a multi-channel distribution network including retail stores and the State Farm alliance.

Ownership category

akta.pro rank

Product category

Health Insurance

NAICS

Direct Health and Medical Insurance Carriers (524114)

SIC

Accident & Health Insurance (6321)

akta.pro primary industry

Employer Wellness & Population Health Programs (HLAEAAAH)

akta.pro secondary industries

Integrated Physical-Behavioral-Social Care (Whole-Person) Medicaid Plans (HLAEAEAI), Small Group Health Insurance (2–50/100) (FSAIAFAD)

Keywords

• Health insurance plans
• Managed care services
• Medicaid coverage
• Telehealth services
• Wellness programs

Headquarters

HQ city

Columbia

HQ country

United States

HQ region

North America

Offices4 records

Markets served

GTM type

B2B and B2C

Offering type

Services

Cost components

Operations, Personnel, Technology or R&D, Marketing or Sales, Others

Revenue model

1. Health Insurance Premiums: BlueChoice HealthPlan generates revenue through premium payments from individual and group health insurance plans. Members pay recurring premiums (monthly or annually) in exchange for coverage of medical services through the provider network.
2. Medicaid Managed Care: Revenue from administering South Carolina Healthy Connections Medicaid program, coordinating care for Medicaid beneficiaries through a managed care model.

Pricing tiers

Go-to-market motion2 records

Distribution channels6 records

Marketing channels7 records

Core offering

BlueChoice HealthPlan of South Carolina is an independent licensee of the Blue Cross Blue Shield Association that sells health insurance products to individuals, employer groups (2-50 and 51+ employees), and South Carolina Medicaid beneficiaries. Its core offerings include group plans (Choice Complete, Choice Select, BusinessADVANTAGE, BA Primary Choice, Engagement Plus), individual ACA marketplace plans (Blue Option), and the BlueChoice HealthPlan Medicaid managed care plan, complemented by member-facing programs such as Blue CareOnDemand telehealth, FOCUSfwd wellness incentives, BlueCard national network access, Blue365 discounts, and the My Health Toolkit member portal.

Product overview

BlueChoice HealthPlan of South Carolina is an independent licensee of the Blue Cross Blue Shield Association offering a comprehensive portfolio of health insurance products and wellness services. The company provides individual and group health plans (including Choice Complete, Choice Select, Blue Option, BusinessADVANTAGE, and BA Primary Choice), Medicaid coverage through BlueChoice HealthPlan Medicaid, and consumer-facing wellness programs. Key member services include Blue CareOnDemand (telehealth), My Health Toolkit (digital portal), FOCUSfwd (wellness incentive program), BlueCard (national network access), and Blue365 (discount program). The product architecture combines core insurance offerings with integrated wellness and digital health tools to support member health outcomes.

Differentiator

Problem solved

Functional benefit

Brands

• My Health Toolkit: Digital member portal and mobile app for accessing ID cards, claims status, plan details, and benefits
• Blue CareOnDemand
• FOCUSfwd
• BlueCard
• Blue365

Products and services

• Choice Complete and Choice Select Group Plans

Quantifiable outcome

• Members report positive health outcomes through wellness programs, with testimonials of weight loss and diabetes management through FOCUSfwd program

Named customers2 records

Segments4 records

Ideal customer profiles4 records

Technology focussed No

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration1 record

Feature4 records

Partnerships

Six partnerships are on record, tiered core, major and minor.

• Medical University of South Carolina (MUSC)coreStrategic or Co-development Partner · 1 October 2016Network coverage agreement for MUSC facilities and providers to participate in BlueCross and BlueChoice individual exchange plans (BlueEssentials, Blue Option) and BlueChoice Medicaid network. Includes all MUSC specialty services not available elsewhere in the state. Effective October 1, 2016.
• American WellcoreTechnology or Integration · 1 January 2016Telehealth technology provider powering Blue CareOnDemand platform, enabling 24/7 video consultations with licensed physicians. American Well is headquartered in Boston and administers telehealth services on behalf of BlueCross and BlueChoice.
• State FarmmajorChannel Partner/ Reseller/ Distributor · 6 August 2015State Farm agents in South Carolina (330 offices, 1,500 employees) market BlueCross and BlueChoice individual health insurance policies as part of national BCBS-State Farm alliance expanding access to consumers during Open Enrollment under ACA.
• Patient-Centered Medical Home AlliancecoreStrategic or Co-development Partner · 15 September 2014Public-private collaboration including BlueCross, BlueChoice, SC Department of Health and Human Services, SC DHEC, SC Medical Association, SC Primary Health Care Association, and SC Office of Rural Health to promote PCMH model statewide.
• Engagement Plus Employer Wellness PartnersminorStrategic or Co-development Partner · 23 June 2014BlueChoice offers Engagement Plus plan with employer-managed wellness incentive programs where employees earn points for healthy activities redeemable for gift cards and merchandise.
• Centering Healthcare InstituteminorStrategic or Co-development Partner · 4 June 2014Partnership for CenteringPregnancy group prenatal care program at approved sites including Greenville Health System, MUSC, and others. Includes incentive payments to providers for patient participation.

Scale indicators3 records

Recent moves6 records

Expansion highlights5 records

Emerging players

• Clover Health: Medicare Advantage-led payer using software-driven care management; adjacent to BlueChoice's chronic-condition and Stars-oriented initiatives.
• Bright Health Group: Tech-enabled payer focused on individual and Medicare Advantage markets with value-based provider partnerships, comparable to BlueChoice's PCMH/wellness model.
• Oscar Health: Tech-first individual ACA insurer with a member-app experience overlapping BlueChoice's My Health Toolkit and Blue CareOnDemand digital stack.

Direct peers

• Cigna Group: Major commercial health insurer with group and individual products in South Carolina; directly competes for employer-sponsored and exchange customers.
• Humana: Operates commercial, Medicare Advantage, and group plans in South Carolina, overlapping with BlueChoice especially in employer-sponsored and senior segments.
• Centene Corporation: Largest U.S. Medicaid managed care operator and ACA marketplace leader; competes with BlueChoice in South Carolina Medicaid and exchange markets.
• UnitedHealthcare (Optum): Largest U.S. health insurer offering individual, group, and Medicaid plans in South Carolina. Directly competes with BlueChoice across commercial and government product lines.
• Aetna (CVS Health): National carrier selling individual ACA, employer group, and Medicare plans in South Carolina, head-to-head with BlueChoice on small group and exchange products.
• Molina Healthcare: Government-program focused payer with Medicaid managed care contracts in South Carolina; directly competes with BlueChoice HealthPlan Medicaid for state contract members.

Broad incumbents

• Anthem (Elevance Health): Largest Blue Cross Blue Shield licensee operating across multiple states; comparable product portfolio (individual, group, Medicaid) outside South Carolina.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks5 records

Key highlights7 records

Customer concentration

• Xtwitter.com/BCBSSC
• YouTubeyoutube.com/BCBSofSouthCarolina
• Facebookfacebook.com/BCBSSC
• LinkedInlinkedin.com/company/BlueCross-BlueShield-of-SC

Compliance5 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles2 records

Subsidiaries1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about BlueChoice HealthPlan