Triple-S Management Corporation is the largest managed care company in Puerto Rico in terms of membership, providing health, life, and property and casualty insurance. A subsidiary of GuideWell (parent of Florida Blue), Triple-S operates as an independent licensee of the Blue Cross Blue Shield Association for Puerto Rico and the U.S.

Anthem, Inc. (now operating as Elevance Health) is one of the largest health benefits companies in the United States, serving members through affiliated Blue Cross and Blue Shield health plans across multiple states including California, New York, Virginia, Georgia, and others.