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 North Dakota market. But in the past couple years, its very strong performance has been bolstered by its overall balance sheet strength, which we believe should be able to withstand a few years of diminished earnings. Major weaknesses are its concentration in a highly regulated and relatively small U.S. state and its limited product portfolio profile, which