Blue Cross and Blue Shield of Texas (BCBSTX), the state's sole statewide, customer-owned health insurer, is the state's biggest supplier of health benefits, partnering with approximately 80,000 physicians and 500 hospitals to serve 5 million members throughout all 254 counties. In addition, BCBSTX is the largest private employer in Texas with more than 400 employees working at offices across the state. They provide coverage for medical services, hospital care, prescription drugs, mental health and substance abuse treatment, and dental services. Members can select from a variety of plans that range from simple savings programs to comprehensive coverage that includes extensive coverage for vision care, too. Premiums are based on age, gender, current health status, location of residence, and other factors such as smoking history and family income. A small copayment is required when services are used so patients don't feel the burden of unreasonable cost sharing. In fact, since its inception in 1946, Blue Cross has made it a policy not to charge new members for services they may need later in life. Instead, they keep costs down by offering substantial discounts to people who have no chronic illnesses or injuries that would lead others to expect higher premiums. The company also creates financial assistance programs for those with low incomes or who suffer from certain medical conditions. Texas was one of the first states to adopt the Blue Cross brand of insurance.