The Blue Shield concept was developed at the beginning of the twentieth century by employers in lumber and mining camps of the Pacific Northwest to provide medical care by paying monthly fees to medical service bureaus composed of groups of physicians. The first official Blue Shield Plan was founded in California in 1939. In 1948 the symbol was informally adopted by nine plans called the Associated Medical Care Plan, and was later renamed the National Association of Blue Shield Plans. In 1982 Blue Shield merged with The Blue Cross Association to form the Blue Cross and Blue Shield Association.

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