Blue Cross Blue Shield companies saw their share of hardships in 2009. According to A.M. Best, the companies experienced a decline in underwriting earnings from upticks in the health care expense and the sales, general & administrative (SG&A) expense ratios as well as by lower premiums due to the recession. Investment income also declined due to continuously low interest rates.

However, there were a few good results. The turnaround in the financial markets resulted in realized and unrealized gains in 2009, compared with losses the prior year. Overall, net income improved mostly due to realized gains rather than investment or underwriting income. Total capital & surplus (C&S) also grew largely due to unrealized gains on investments.

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