A+ HEALTH CARE SERVICE CORPORATION, A MUTUAL LEGAL

A+
RATING RATIONALE
Ultimate Parent:
Health Care Svc Corp Mut Legal Reserve
HEALTH CARE SERVICE
CORPORATION, A MUTUAL LEGAL
RESERVE COMPANY
300 East Randolph Street
Chicago, IL 60601-5099
Web: www.hcsc.net
Tel: 312-653-6000
AMB#: 009193
Ultimate Parent#: 009193
Fax: 312-540-0544
NAIC#: 70670
FEIN#: 36-1236610
BEST’S CREDIT RATING
Best’s Financial Strength Rating: A+
Outlook: Stable
Best’s Financial Size Category: XV
© 2015 A.M. Best Company, Oldwick, NJ 08858
The following text is derived from A.M. Best’s Credit Report on
Health Care Service Corporation Group (AMB# 069154).
Rating Rationale: The ratings of Health Care Service Corporation
(HCSC) and its subsidiaries reflect the company’s leading market
presence and brand strength in its primary health insurance markets,
enrollment and premium growth, strong risk-adjusted capital, as well
as its diverse product portfolio. These strengths are partially offset by
recent underwriting and net losses, the impact of the Affordable Care
Act (ACA) provisions and exchange business on the company’s balance sheet and financial results, the impact of regulation on its primary
business line, competitive market pressure and earnings concentration.
The health insurance operations of HCSC (which operates as Blue
Cross Blue Shield of Illinois/Texas/New Mexico/Oklahoma/Mon-
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tana), as well as its HMO subsidiaries and lines of business, have a
well-established market presence in their respective markets and benefit considerably from its brand strength in these markets. The company
has leading overall market shares in each of the five states in which
it operates. Additionally, the company has achieved leading shares in
healthcare exchange enrollment in these markets. These enrollment
gains have contributed to continued organic premium growth for the organization. HCSC has a strong level of capital in support of its business
and investment risks. HCSC has a history of capital growth through retained earnings. The company’s risk-adjusted capital was on an upward
growth trend in preparation for enrollment gains with the introduction
of health insurance exchanges. Due to the significant enrollment growth
and recent statutory losses, risk-adjusted capital has declined; however,
it remains strong, and the company has very favorable capital adequacy
on a risk-adjusted basis. HCSC offers a diverse product portfolio designed to meet the ever-changing needs of individuals and large, medium and small employer groups that also meet regulatory required
benefits and benefit levels. This comprehensive portfolio offers a continuum of products designed to enhance member retention and to offer
employers cost-effective employee benefits solutions. Also, HCSC has
a strong complementary portfolio of life and ancillary health product
offerings written by its subsidiaries, which are licensed in all 50 states
and the District of Columbia.
HCSC has recently reported underwriting and net losses mostly driven
by the impact of provisions of ACA and new exchange enrollment.
The company’s operating performance was negatively affected by the
grandfathering of individual commercial plans as this provision was not
included in the company’s pricing assumptions for this segment. Additionally, the high degree of uncertainty around risk corridor payments
resulted in the company accounting for a considerably smaller portion
of the risk corridor receivable than originally anticipated. HCSC’s
operating cash flow was also impacted by the company’s reinsurance
receivable for exchange enrollment. To a much lesser degree, underwriting and net income was also impacted by the company’s expansion
into Medicare and Medicaid as the company invested significantly in
these operations. HCSC’s primary line of business is health insurance,
which is a highly regulated industry both on a state and federal level.
The health insurance industry has been heavily impacted by ACA in
recent years. As the company expands its government-funded business,
it will see an increased level of regulatory requirements in this business
line. External economic and market conditions in each of the operating
markets pose a challenge for HCSC to continue to grow its commercial
© 2015 A.M. Best Company, Oldwick, NJ 08858
group businesses organically as the majority of HCSC’s enrollment
remains employer-based. The commercial employer market has been
very competitive with many national and regional carriers vying for
business. Moreover, HCSC’s earnings continue to be geographically
concentrated in the markets of Illinois and Texas, with employerbased business driving the majority of the results. Although earnings
have historically been strong, A.M. Best expects a certain degree of
volatility around earnings which could continue to be impacted by
provisions of ACA over the next few years.
A.M. Best believes a positive rating action on HCSC is unlikely in
the near to medium term. A negative rating action could occur if the
organization is unable to sustain operating profitability, reports a considerable deterioration in risk-adjusted capital or experiences a significant decline in premium revenue and/or enrollment.
KEY FINANCIAL INDICATORS ($000)
Total
Net
Capital &
Premiums
Total
Net
Year
Assets
Surplus
Written
Revenues
Income
2010 12,718,574
7,793,536
19,722,014
19,667,777 1,092,641
2011 14,603,800
8,909,829
20,182,710
19,958,096 1,203,879
2012 15,517,614
9,553,748
20,685,942
20,714,282 1,007,066
2013 16,713,554 10,271,633
22,446,494
22,804,588
684,267
2014 17,829,421
9,942,246
27,604,396
27,838,260
-281,884
(*) Data reflected within all tables of this report has been compiled from the companyfiled statutory statement.
CORPORATE OVERVIEW
Health Care Service Corporation (HCSC) is a Mutual Legal Reserve
Company that conducts business as Blue Cross and Blue Shield of
Illinois/Texas/New Mexico/Oklahoma/Montana where it provides
health insurance coverage to over 14 million members. HCSC is a
leading provider of health insurance products and services to individuals and employer groups in each of its five core states. HCSC’s
life subsidiary, Dearborn National Life Insurance Company, and its
insurance subsidiaries, Dearborn National Life Insurance Company
of New York and Colorado Bankers Life Insurance Company, offer
individual and group life insurance and ancillary products in 50 states
and the District of Columbia. With the products available through
Dearborn National, HCSC can provide a complete array of health and
life insurance products to both individuals and employer groups.
HCSC’s complementary group life product offerings are marketed
through the distribution systems of HCSC as well as other Blue Cross
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and Blue Shield plans in numerous states. The life companies fulfill
the product diversity goals of HCSC. Dearborn National has laid out
an operating strategy that is designed to utilize the parent company’s
marketing position by leveraging its relationships within the Blue Cross
Blue Shield system while maintaining selective distribution outside the
“Blues” network. Dearborn National aligns its core complimentary
group product offerings as well as its voluntary product base with its
parent’s medical products in its home states.
BUSINESS PROFILE
The following text is derived from A.M. Best’s Credit Report on
Health Care Service Corporation Group (AMB# 069154).
Health Care Service Corporation (HCSC) (d/b/a Blue Cross Blue
Shield of Illinois/Texas/New Mexico/Oklahoma/Montana) offers Blue
branded indemnity, preferred provider option (PPO) and Consumer
Driven Health Plan (CDHP) products. In addition the organization offers health maintenance organization (HMO), point-of-service (POS),
Medicare and Medicaid products through several subsidiaries and
lines of business. For large multi-state employer groups, HCSC also
provides access to the national Blue Cross and Blue Shield network
through its BlueCard program participation. Health subsidiaries include
GHS Health Maintenance Organization (OK), HCSC Insurance Services Company, GHS Managed Health Plans, Inc and GHS Insurance
Company. Lines of business are the HCSC - Illinois HMO Line of Business and HCSC - Texas HMO Line of Business. The company’s HMOs
are focused on serving commercial individuals and employer groups
of various sizes. The company also offers Blue Cross and Blue Shield
branded Medicare Supplemental, Medicare Advantage and Medicare
Part D prescription drug coverage directly or through its subsidiary,
HCSC Insurance Services Company.
Scope of Operations: The company’s health operations are defined by
three market segments: Group, Government and Retail.
The Group market segment includes Small Group, Large Group and
National Accounts. Small Group represents employer groups with 150
or less employees in Illinois, 100 or less in New Mexico and Texas and
50 or less employees in Montana. In all states, groups of 50 employees
and under are more regulated by the state Department of Insurance than
other market segments. Product offerings for this segment are standard© 2015 A.M. Best Company, Oldwick, NJ 08858
ized and include PPO, HMO, POS and indemnity, and are available
only on a fully insured basis. Policyholders in this market are more
price sensitive than other markets and may change carriers frequently
due to price. Small Group employers have the new option of utilizing
Small Business Health Options Program (SHOP) in order to provide
benefits for its employees. Large Group represents employer groups
with 151 - 1,999 employees in Illinois, 101 - 1,999 employees in
Texas and Oklahoma, 101 or more employees in New Mexico and
51 or more employees in Montana. HCSC serves this segment with a
cross section of products from PPO and HMO plans to multiple option
product offerings (including dual and triple option plans). Self-funding is available to groups of 100 employees or more. Within the Large
Group market segment, HCSC manages multiple group accounts that
do not fall in to the traditional group segment definition such as the
Federal Employee Health Benefits Program (FEP), Illinois Labor Accounts and Illinois Municipal Accounts. National Accounts primarily represents employer groups with over 1,000 employees as well as
the processing of BlueCard claims for members covered under other
Blue Cross and Blue Shield plans. HCSC offers a variety of healthcare
plans to national account customers, including PPO, POS, HMO and
indemnity products. The majority of the national accounts covered by
HCSC are self-funded.
The Government Market segment is comprised of different government plans in each state. HCSC currently participates in Medicaid
programs in New Mexico and Texas, and in Medicare Part D in all
five core states. The over age 65 sub-segment offers Medicare Supplemental plans which are administered by HCSC; as well as Medicare
Advantage and Medicare Part D prescription drug coverage offered
by its wholly owned subsidiary, HCSC Insurance Services Company
(HISC) and GHS Managed Health Plans.
The Retail Markets segment is divided into two sub-segments: the
under age 65 group and student health. In the under age 65 sub-segment, the company offers a variety of individual and family plans,
ranging from comprehensive plans to high-deductible catastrophic
coverage. These products are offered in all five core states both on
healthcare exchanges and off. HCSC has seen significant growth in
its individual enrollment through the first open enrollment period in
late 2013/early 2014 and has realized leading market shares of this
enrollment base. HCSC provides student health coverage through its
subsidiary Academic Health Plans, which it acquired in 2009.
Health insurance products are sold through several distribution channels. They include general agents, brokers and consultants. In Illinois
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and Texas, the company utilizes general agents to sell to the individual
market and small group employers markets. Brokers mainly market to
employer groups of more than 50 lives in all states. Direct sales accounts for a good portion of individual under and over 65 sales in all
states. In all states, consultants market to the national accounts.
HCSC recognizes the competitive advantages and operating efficiencies that can be achieved through maintaining state-of-the-art technology infrastructure and systems. The company utilizes several systems
for functions such as paying claims, identifying fraudulent claims and
maintaining membership. These systems allow the company to better
manage its resources and evaluate data. Blue Chip is the company’s
claim adjudication system that processes all health claims for Illinois,
New Mexico, Texas and Oklahoma. The Blue Chip system works with
other systems within the organization to generate specific utilization
and cost information reports. In addition, the company scans all incoming claim documents, which allows a digitized image of the document
to be immediately available in any claims office. Scanning of the claim
documents also allows for a more effectively controlled claim inventory process.
The company also recognizes the importance of using the Internet to
communicate information about its products and services. Members
can access information about pending health claims, receive an electronic explanation of benefits, search for providers and view the drug
formulary. Group administrators can view information about HCSC
products online and self-funded accounts can utilize online billing. Brokers can complete an application online as well as monitor the status of
submitted cases. Key small group producers are able to obtain an online
proposal and quote.
Territory: The company is licensed in the District of Columbia, AK,
AZ, AR, CO, CT, DE, FL, GA, ID, IL, IN, KY, ME, MD, MA, MI,
MN, MO, MT, NE, NJ, NM, OH, OK, OR, PA, SC, TX, UT, VA, WV
and WI.
Business Trends: HCSC’s strategy for growth relies equally on organic
growth as well as on business combinations. The December 1998 merger with Blue Cross and Blue Shield of Texas was the first major step in
HCSC’s strategic expansion. This transaction provided the combined
entity with a significant market presence in the Texas market, while
adding needed scale to the overall healthcare operation. In July 2001,
HCSC acquired the assets of Blue Cross and Blue Shield of New Mexico, which provided further access to expand into new markets. The
company has maintained a strong local presence in sales, marketing,
provider relations and contracting offices. Administrative functions are
© 2015 A.M. Best Company, Oldwick, NJ 08858
centrally integrated. In November 2005, HCSC and Blue Cross and
Blue Shield of Oklahoma completed the merger with Group Health
Service of Oklahoma, d.b.a. Blue Cross and Blue Shield of Oklahoma.
In 2007, HCSC merged its line of business, HCSC HMO-New Mexico, into Blue Cross Blue Shield of New Mexico. On October 28, 2009,
HCSC announced a membership transition agreement with WellPoint,
Inc., and its UniCare subsidiaries commercial membership from the
Illinois and Texas markets. Under the agreement, HCSC offered
guaranteed replacement coverage for individual and group members
in those states. Through this agreement HCSC achieved membership
transfers of over 200,000 in 2010. In September 2013, HCSC completed an affiliation with Blue Cross and Blue Shield of Montana; this
transaction added approximately 239,000 members to the HCSC organization as well as further diversified its business geographically. In
May 2014, HCSC acquired Lovelace Health Plan, a provider owned
health plan in New Mexico adding approximately 110,000 commercial and government program members.
In addition to acquisitions of health insurance companies, HCSC has
acquired supplemental business as well. On August 15, 2008, HCSC
acquired MEDecision, a provider of healthcare information technology for case, disease and utilization management, and has developed
secure health information access and exchange capabilities. Additionally, on October 31, 2008, HCSC acquired TMG Health, a leading
provider of business provider outsourcing for Medicare, Medicaid,
and group retiree health plans. This follows investments in prior years
in Prime Therapeutics, a pharmacy benefit management company,
and a joint venture between HCSC’s subsidiary, THIN, an electronic
claims and information network, which, effective June 2009, was
merged into Availity, LLC, an advanced Internet-based e-health exchange. HCSC along with WellPoint, Inc. and Blue Cross Blue Shield
of Michigan made equal investments in Bloom Health. This joint effort enables the offering of a nationwide private exchange and defined
contribution platform for employers to manage their employee health
benefit offerings.
Market Share/Market Presence: HCSC is a market leader in all five
Blue branded states. The Illinois division has 7.9 million members,
who comprise a little more than one half of HCSC’s total enrollment.
The Texas division has nearly 5.2 million members and primarily
serves the large local market segment. The New Mexico division has
over 500,000 members, the Oklahoma division has approximately
840,000 members, and the Montana division covers nearly 243,000
members. The vast majority of membership is enrolled in a managed
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care plan (PPO/POS/HMO). Group business accounts for over fourfifths of HCSC’s business. HCSC group accounts include over one
half of Fortune 500 employers in HCSC home states. HCSC also participates with the Blue Cross Blue Shield Association National BlueCard program which accounts for approximately 2.6 million additional
members. Although individual business makes up a smaller portion of
HCSC’s overall enrollment, HCSC enrollment grew by 79% to reach
about 1.7 million individual members. HCSC continues to have one of
the largest individual membership bases in the country.
ally, A.M. Best expects the low interest rate environment to continue
to affect investment income returns.
OPERATING PERFORMANCE
Capitalization: HCSC reported a decline in risk-adjusted capital due
mostly to increased business risk associated with the strong premium
growth the company reported in 2014 but also in part due to a decline in capital related to net losses reported for the year. Although
it declined the company still maintains a strong level of risk-adjusted
capital in support of its business and financial risks.
Additionally, HCSC has a history of using its capital strength to support its subsidiaries. Capital infusions were made to Dearborn National Life Insurance Company $23 million in 2010 as well as $5.0 million
to GHS Insurance Company in 2010 and $10 million in 2012. Contributions of $1.5 million in 2011 and $10 million in 2012 were made to
Colorado Bankers Life Insurance Company. In 2013 and 2014, HCSC
contributed $200 million to HCSC Insurance Services Company and
$15 million to GHS HMO in 2013 in support of premium growth.
Subsequent to the Texas HMO purchases from NYLCare, the company issued a $400 million debt offering in June 2001, which paid
down $267 million of commercial bank debt. In January 2011, HCSC
issued $500 million of senior unsecured notes which mature January
2021. The January 2011 issuance proceeds were primarily used to repay the $400 million senior notes that matured on June 15, 2011 and
the remainder used for general corporate purposes. HCSC’s debt-tocapital ratio as of year-end 2014, was less than 4%, and is well below
the industry norm and is expected to remain stable in the near term.
The following text is derived from A.M. Best’s Credit Report on
Health Care Service Corporation Group (AMB# 069154).
Operating Results: HCSC reported strong premium growth in 2014
driven by strong enrollment growth in all segments but it is most pronounced in individual, Medicaid and Medicare business. Operating
results turned negative in 2014 for the first time in the last five years.
The negative results are primarily being driven by higher than anticipated utilization for the company’s individual enrollment, as well as
the uncertainty around the ACA risk corridor payments for exchange
enrollment. Based on these factors, HCSC conservatively established
a premium deficiency reserve and set up a receivable for only a small
portion of the risk corridor payment from the government. Additionally, the company had increased administrative expenses incurred for the
company’s growing business segments. Increased operational expenses
were incurred due to healthcare exchanges; as well as investments in its
Medicare Advantage and Medicaid business lines.
The organization’s strong results through 2012 has mainly been due
to favorable underwriting results as net investment income remains significantly lower than historic levels due to the low interest rate environment; as well as due in part to write downs taken on affiliated subsidiaries. Operating margins showed compressed in 2013 mainly due to the
increased medical loss ratio in the company’s commercial business due
to minimum loss ratios under healthcare reform legislature and competitive pricing pressure.
A.M. Best believes that HCSC should return to profitability in the
medium term but margins most likely will remain suppressed based on
continued economic pressure on employer groups, strategic operational
investments and healthcare exchange product performance. Addition© 2015 A.M. Best Company, Oldwick, NJ 08858
BALANCE SHEET STRENGTH
The following text is derived from A.M. Best’s Credit Report on
Health Care Service Corporation Group (AMB# 069154).
The following text is derived from A.M. Best’s Credit Report on
Health Care Service Corporation Group (AMB# 069154).
Liquidity: HCSC maintains a very liquid, high quality and well-diversified portfolio with cash and cash equivalents comprising almost onethird of invested assets. HCSC’s investment strategy is to match shortterm maturities with its ongoing obligations. The company utilizes a
13 week rolling cash flow model to ensure all cash requirements are
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Page 5 of 8
met normal operating and investment cash flows. The company manages its portfolio in two allocations; Working Capital and Capital and
Surplus. The long-term perspective for the Working Capital is to maintain a highly liquid, low risk short-term balance sheet while Capital and
Surplus emphasizes preservation of capital. Some investment management functions are performed internally. The company also engages the
services of external advisers and consultants in the management of the
company’s invested assets.
The investment portfolio is conservatively managed and provides adequate liquidity. A majority of assets held are fixed income securities
and the vast majority is investment grade with an average duration of
about three years. HCSC has a fairly limited exposure to the public equity markets and diversifies the portfolio across numerous funds.
On October 25, 2011, HCSC closed on a five year credit facility for
$400 million. There were no balances outstanding against the facility
at year end 2014.
MANAGEMENT
Officers: President and Chief Executive Officer, Patricia A. Hemingway
Hall; Presidents, Michael E. Frank (Montana Division), Ted Haynes
(Oklahoma Division), Bert E. Marshall (Texas Division), Mark Owen
(Government Markets), Kurt B. Shipley (New Mexico Division), Maurice S. Smith (Illinois Division), Jeffrey R. Tikkanen (Retail Markets);
Executive Vice President and Chief Administrative Officer, John Cannon III; Executive Vice President and Chief Officer, Paula A. Steiner
(Strategy, Public and Gov’t Relations and Emerging Markets); Executive Vice Presidents, Karen M. Atwood (Service and Technology),
Colleen F. Reitan (President Plan Operations); Senior Vice President
and Chief Financial Officer, Kenneth S. Avner; Senior Vice President
and Chief Information Officer, Steven Betts; Senior Vice President and
Chief Marketing Officer, J. Darren Rogers; Senior Vice President and
Chief Actuary, Janice Knight; Senior Vice President and Controller,
James Kedela; Senior Vice President and Chief Legal Officer, Ken
O’Rourke (Interim); Senior Vice President and Chief Medical Officer,
Stephen Ondra; Senior Vice Presidents, Kevin Cassidy (Enterprise
Sales & Account Management Illinois Markets), Carolyn Dawson
(Health Care Management), Steve Hamman (Provider Engagement and
Enterprise Network Solutions), Thomas C. Lubben (Compliance and
Audit), Nazneen Razi (H/R).
Directors: Dianne Brewer Gasbarra, M.D., Timothy L. Burke, Milton
Carroll, Robert T. Clarke, Waneta Coester Tuttle, Michelle L. Collins,
James R. Corrigan, Tieman H. Dippel, Jr., Dennis J. Gannon, Patricia
© 2015 A.M. Best Company, Oldwick, NJ 08858
A. Hemingway Hall, Chase T. Hibbard, Thomas R. Hix, Elaine M.
Mendoza, M. Ray Perryman.
Balance Sheet
Assets ($000)
12/31/2014
Total bonds . . . . . . . . . . . . . . . . . . . . . . . . . $ 6,382,633
Total common stocks. . . . . . . . . . . . . . . . . . 1,622,729
Real estate . . . . . . . . . . . . . . . . . . . . . . . . . .
934,917
Cash & short-term invest . . . . . . . . . . . . . . .
954,235
Health care recvble . . . . . . . . . . . . . . . . . . .
602,675
Amounts recov reins . . . . . . . . . . . . . . . . . .
792,422
Net deferred tax asset . . . . . . . . . . . . . . . . .
534,555
Prems and consids due . . . . . . . . . . . . . . . . 1,943,592
Accrued invest income. . . . . . . . . . . . . . . . .
37,423
Uninsured A&H plans . . . . . . . . . . . . . . . . . . 3,018,925
Other assets . . . . . . . . . . . . . . . . . . . . . . . . . 1,005,314
Assets . . . . . . . . . . . . . . . . . . . . . . . . . . . $17,829,421
Liabilities ($000)
Claims payable. . . . . . . . . . . . . . . . . . . . . . . $ 2,327,285
Unpaid claims adj. . . . . . . . . . . . . . . . . . . . .
112,894
Accrued med incent pool . . . . . . . . . . . . . . .
182,380
Advance premiums . . . . . . . . . . . . . . . . . . .
353,664
Comm taxes expenses. . . . . . . . . . . . . . . . . 1,982,565
Unallocated items. . . . . . . . . . . . . . . . . . . . .
428,312
Borrowed money . . . . . . . . . . . . . . . . . . . . .
509,930
Health policy reserves . . . . . . . . . . . . . . . . . 1,738,834
Other liabilities . . . . . . . . . . . . . . . . . . . . . . .
251,311
Total Liabilities . . . . . . . . . . . . . . . . . . . . $ 7,887,174
Unassigned surplus . . . . . . . . . . . . . . . . . . . 9,456,234
Other surplus . . . . . . . . . . . . . . . . . . . . . . . .
486,013
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . $17,829,421
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HEALTH CARE SERVICE
CORPORATION, A MUTUAL LEGAL
RESERVE COMPANY
Total Admitted Assets
20.0
18.0
16.0
14.0
12.0
10.0
8.0
6.0
4.0
2.0
0.0
2010
2011
2012
2013
2014
Years
in billions
of dollars
FINANCIAL SUMMARY ($000) as of 12/31/2014
Capital & Surplus . . . . . . . . . . . . . . . . . . . . . . . .
Net Premiums Written . . . . . . . . . . . . . . . . . . . .
Assets. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total Life Insurance Issued. . . . . . . . . . . . . . . . .
Total Life Insurance In Force . . . . . . . . . . . . . . .
© 2015 A.M. Best Company, Oldwick, NJ 08858
$ 9,942,246
$ 27,604,396
$ 17,829,421
$
…
$
…
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Why is this Best’s® Rating Report important to you?
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as well as its relative credit risk.
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to, an insurer’s claims-payment policies or procedures; the ability of
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the policy or contract holder. The rating is not a recommendation
© 2015 A.M. Best Company, Oldwick, NJ 08858
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