Blue Cross and Blue Shield Association

The cross symbol was first used in a 1934 advertisement for the Hospital Service Association, today known as Blue Cross Blue Shield of Minnesota. Company secretary E.A. van Steenwyk had Viennese artist Joseph Binder create a poster that included a blue Greek cross. Van Steenwyk continued to use the symbol to identify his company's health plans, and the Blue Cross began to be used in other parts of the country.

In 1939, the Chicago-based American Hospital Association began using the Blue Cross symbol to signify that health plans across the country met certain standards. The AHA continued to administrate the use of the symbol until the Blue Cross Association was founded in 1960. The two organizations remained affiliated until 1972.

Another health plan gained popularity in the lumber and mining camps of the Pacific Northwest around the same time that Kimball created his plan. These would provide medical care by paying monthly fees to medical service bureaus composed of groups of physicians. The first of these, Pierce County Medical Bureau (now known as Regence BlueShield) in Tacoma, Washington, was founded in 1917 and is now a part of The Regence Group. The shield symbol was created in Buffalo, New York by Carl Metzger in 1939, and the first official Blue Shield plan was founded in California that same year. In 1948 the symbol was informally adopted by nine plans called the Associated Medical Care Plans, and was later renamed the National Association of Blue Shield Plans.