Blue Cross Blue Shield employer health plans in Pennsylvania
Who Blue Cross Blue Shield insures among Pennsylvania employers and what those plans pay in premium and broker compensation, and what the Blue Cross Blue Shield network pays physicians and hospitals.
Blue Cross Blue Shield employer health plans in Pennsylvania at a glance
What the data shows
Blue Cross Blue Shield is the largest insurer of employer health plans in Pennsylvania: 800 plans held a Blue Cross Blue Shield major-medical contract in form year 2024, 54% of the state's 1,491 insured large plans, ahead of Cigna with 207.
The Blue Cross Blue Shield book in Pennsylvania has held steady since 2020 (813 plans then).
Most of these plans cover 100–499 people (491 plans); 56 cover 1,000 or more.
Median premium per person covered was $7,441, 5% above the Pennsylvania all-carrier median of $7,075. Benefit design and group mix differ, so this is not a price comparison.
73% of these plans reported broker or agent pay on their Blue Cross Blue Shield contracts; where paid, the median was 3.3% of premium (middle half 2.5%–4.8%).
In BCBS: Capital BlueCross, 23 of the 50 Employer 50 services have a Pennsylvania benchmark, at a median of 148% of Medicare across those services.
At Pennsylvania hospitals, Blue Cross Blue Shield's commercial rates run higher than other carriers' at the same hospital for 4 of 17 services; a hip or knee replacement stay has a median rate of $27,220 across 74 hospitals.
Blue Cross Blue Shield plans in Pennsylvania, 2020–2024
| Form year | Plans | Persons covered | Share of state | Median premium / person |
|---|---|---|---|---|
| 2020 | 813 | 420,322 | 46% | $6,512 |
| 2021 | 813 | 495,712 | 48% | $6,572 |
| 2022 | 828 | 526,152 | 51% | $6,999 |
| 2023 | 848 | 793,813 | 53% | $7,309 |
| 2024 | 800 | 717,998 | 54% | $7,441 |
| 2025 (partial) | 545 | 390,730 | 56% | $7,869 |
Plan size
| Persons covered | Plans | Share |
|---|---|---|
| Under 100 | 162 | 20% |
| 100–499 | 491 | 61% |
| 500–999 | 90 | 11% |
| 1,000–4,999 | 49 | 6% |
| 5,000 or more | 7 | 1% |
Premiums and broker pay
| Measure | Blue Cross Blue Shield | All carriers, Pennsylvania |
|---|---|---|
| Median premium per person covered | $7,441 | $7,075 |
| Premium per person, middle half | $5,669–$9,977 | $4,536–$9,457 |
| Plans reporting broker or agent pay | 73% | 69% |
| Median broker pay, % of premium | 3.3% | 3.7% |
| Broker pay, middle half | 2.5%–4.8% | 2.5%–5.3% |
| Median broker pay per person covered | $268 | $256 |
Industries
Blue Cross Blue Shield's Pennsylvania employer clients are concentrated in manufacturing (183 plans) and health care and social assistance (127), followed by professional and technical services (106).
| Industry | Plans | Share |
|---|---|---|
| Manufacturing | 183 | 23% |
| Health care and social assistance | 127 | 16% |
| Professional and technical services | 106 | 13% |
| Finance and insurance | 52 | 6% |
| Educational services | 49 | 6% |
| Retail trade | 46 | 6% |
Blue Cross Blue Shield employer clients in Pennsylvania
776 employers in Pennsylvania have a Blue Cross Blue Shield major-medical contract, 56 of them covering 1,000 or more people. For each one Medlyze has the plan year, the broker on each contract and what that broker was paid, and compiles the list for a state, an industry or a single employer on request.
| Employer | Persons covered | Plan year ends | Broker | Broker pay, % of premium |
|---|---|---|---|---|
| Employer name | Locked | Locked | Locked | Locked |
| Employer name | Locked | Locked | Locked | Locked |
| Employer name | Locked | Locked | Locked | Locked |
Brokers: request the Blue Cross Blue Shield Prospect List for Pennsylvania →
What the Blue Cross Blue Shield network pays physicians in Pennsylvania
| Service | Code | Median | Middle half | % of Medicare | Other networks, median | Provider groups |
|---|---|---|---|---|---|---|
| Echocardiogram, transthoracic complete with Doppler | 93306 | $209 | $165–$254 | 162% | $208 | 21 |
| Electrocardiogram (EKG), complete | 93000 | $27 | $24–$31 | 177% | $23 | 19 |
| Nuclear stress test (SPECT myocardial perfusion) | 78452 | $130 | $124–$144 | 175% | $90 | 21 |
| Treadmill stress test, complete | 93015 | $126 | $114–$137 | 172% | $108 | 21 |
| Skin biopsy, single lesion (tangential) | 11102 | $108 | $99–$160 | 113% | $100 | 40 |
| Abdominal ultrasound, complete | 76700 | $60 | $42–$68 | 160% | $54 | 36 |
| Bone density scan (DXA), axial | 77080 | $11 | $10–$15 | 119% | $14 | 36 |
| CT abdomen and pelvis with contrast | 74177 | $331 | $210–$352 | 153% | $325 | 36 |
| CT chest without contrast | 71250 | $73 | $51–$95 | 148% | $72 | 36 |
| Chest X-ray, 2 views | 71046 | $16 | $10–$17 | 155% | $15 | 36 |
| MRI brain without and with contrast | 70553 | $170 | $139–$194 | 161% | $147 | 36 |
| MRI cervical spine without contrast | 72141 | $109 | $83–$126 | 160% | $111 | 36 |
| MRI knee (lower-extremity joint) without contrast | 73721 | $100 | $82–$114 | 159% | $101 | 36 |
| MRI lumbar spine without contrast | 72148 | $110 | $90–$125 | 160% | $110 | 36 |
| MRI shoulder (upper-extremity joint) without contrast | 73221 | $102 | $82–$114 | 161% | $102 | 36 |
Professional fee only: facility, implant and anesthesia charges are not included. Limited: rates come from a sample of providers, and groups are counted only in specialties that perform the service.
What the Blue Cross Blue Shield network pays hospitals in Pennsylvania
Blue Cross Blue Shield commercial rates are on record at 82 Pennsylvania hospitals (the hospitals covered so far, not every hospital). Compared at the same hospitals, Blue Cross Blue Shield's rate is higher than the other carriers' median for 4 of 17 services and lower for 10. For Emergency visit, level 4, the rate runs from $153 to $1,649 across 23 hospitals.
This page shows 3 of the 17 services in full. The other rates, the size of each gap and every hospital's prices are in the Plan Cost Benchmark.
| Service | Hospitals | Median rate | Range (P10–P90) | vs other carriers, same hospitals | Cash price, median |
|---|---|---|---|---|---|
| Hip or knee replacement (hospital stay) | 74 | $27,220 | $16,057–$42,273 | Lower | $34,462 |
| C-section delivery (hospital stay) | 71 | Locked | Locked | About the same | Locked |
| Vaginal delivery (hospital stay) | 71 | Locked | Locked | Lower | Locked |
| MRI, lower back | 36 | $722 | $212–$1,696 | Higher | $513 |
| MRI, knee | 35 | Locked | Locked | Higher | Locked |
| CT, head | 37 | Locked | Locked | Higher | Locked |
| CT, abdomen and pelvis | 36 | Locked | Locked | About the same | Locked |
| Screening mammogram | 34 | Locked | Locked | Lower | Locked |
| Colonoscopy, diagnostic | 18 | Locked | Locked | Lower | Locked |
| Upper GI endoscopy with biopsy | 18 | Locked | Locked | Lower | Locked |
| Knee arthroscopy | 17 | Locked | Locked | Lower | Locked |
| Cataract surgery | 16 | Locked | Locked | Lower | Locked |
| Gallbladder removal, laparoscopic | 25 | Locked | Locked | Lower | Locked |
| Knee replacement, outpatient | 25 | Locked | Locked | Lower | Locked |
| Emergency visit, level 4 | 23 | $540 | $153–$1,649 | Lower | $1,797 |
| Comprehensive metabolic panel | 28 | Locked | Locked | About the same | Locked |
| Complete blood count | 28 | Locked | Locked | Higher | Locked |
Hospitals with the most published Blue Cross Blue Shield rates
| Hospital | Joint replacement | MRI lower back | CT abdomen | Colonoscopy | ER level 4 | Vaginal delivery |
|---|---|---|---|---|---|---|
| Ahn Allegheny General Hospital | $26,899 | Locked | Locked | Locked | Locked | Locked |
| Ahn Allegheny Valley Hospital | $20,702 | Locked | Locked | Locked | Locked | Locked |
| Ahn Canonsburg General Hospital | $19,205 | Locked | Locked | Locked | Locked | Locked |
| Ahn Forbes Hospital | $20,191 | Locked | Locked | Locked | Locked | Locked |
| Ahn Grove City Medical Center | $12,506 | Locked | Locked | Locked | Locked | Locked |
| Ahn Saint Vincent Hospital | $25,592 | Locked | Locked | Locked | Locked | Locked |
| Ahn Wexford Hospital | $20,436 | Locked | Locked | Locked | Locked | Locked |
| Bryn Mawr Hospital | $34,623 | Locked | Locked | Locked | Locked | Locked |
| Holy Redeemer Hospital | $24,808 | Locked | Locked | Locked | Locked | Locked |
| Jefferson Lansdale Hospital | $20,539 | Locked | Locked | Locked | Locked | Locked |
How the contracts are written: case rates 4%, fee schedules 94%, per diem 0%, percent of billed charges 0%, other 1% of Blue Cross Blue Shield's published commercial rates for these services in Pennsylvania.
Employers: see all 17 services and every hospital near your people in a Plan Cost Benchmark →
Hospital facility rate only: physician, anesthesia and implant charges are separate. Rates are what hospitals publish, not claims paid, and are not weighted by use.
Carriers in Pennsylvania
| Carrier | Plans | Share | Median premium / person | Median broker % |
|---|---|---|---|---|
| Blue Cross Blue Shield | 800 | 54% | $7,441 | 3.3% |
| Other insurers (regional and local plans) | 423 | 28% | $7,243 | 3.4% |
| Cigna | 207 | 14% | $3,936 | 6.1% |
| Aetna | 158 | 11% | $5,612 | 3.1% |
| UnitedHealthcare | 122 | 8% | $5,192 | 4.4% |
| Kaiser Permanente | 97 | 7% | $9,455 | 3.0% |
| Anthem (Elevance Health) | 7 | 0% | $8,992 | 2.0% |
| Humana | 5 | 0% | $2,657 | – |
Blue Cross Blue Shield in other states
FAQ
How many Pennsylvania employers have Blue Cross Blue Shield health insurance?
800 employer health plans in Pennsylvania reported a Blue Cross Blue Shield major-medical contract in their 2024 filings, covering 717,998 persons. Self-funded plans that Blue Cross Blue Shield only administers are not counted.
What is Blue Cross Blue Shield's share of the Pennsylvania insured employer market?
54% of insured large employer health plans, 1st of 8 carrier groups by plan count.
How much do brokers earn on Blue Cross Blue Shield plans in Pennsylvania?
Where broker or agent pay was reported, the median was 3.3% of premium (3.7% across all carriers in Pennsylvania).
Can I see the figures for a specific employer?
Yes. Brokers can request an Employer Account Brief on one employer, or a Prospect List for this market. Employers can request a Plan Cost Benchmark for their own plan. Use the request form on this page.
About these numbers
- Plans counted: the 800 Pennsylvania employer health plans with a Blue Cross Blue Shield major-medical contract in their 2024 filings. Self-funded plans that Blue Cross Blue Shield only administers are not counted here.
- Premium and broker figures: 741 contracts with 20+ persons covered and a reported premium; broker percentages use the 582 contracts that reported broker or agent pay.
- Network rates: BCBS: Capital BlueCross, professional fees only, from a sample of providers.
- Hospital prices: Blue Cross Blue Shield commercial rates at Pennsylvania hospitals; stay and facility prices only.
- Full method and limits: how the employer health plan data is built.