Well-recognized Blue Cross Blue Shield (BCBS) brand and leading market share in North Dakota Solid capitalization per our risk-based capital (RBC) model 80% of sales through captive agents Geographically constrained due to single-state operations Deteriorated operating performance after a couple very profitable years in 2015-2017 Operations in highly regulated U.S. health insurance sector and "prior approval" state Blue Cross Blue Shield of North Dakota (BCBSND; formerly Noridian Mutual Insurance Co.) is the largest health insurer in North Dakota and an independent not-for-profit licensee of the Blue Cross Blue Shield Assn. S&P Global Ratings' ratings balance BCBSND's capital strength with earnings deterioration and its limited geographic and product scope. BCBSND holds a leading, albeit somewhat diminished, market share in its core
