AM Best has removed from under review with developing implications and affirmed the Financial Strength Rating of C (Weak) and the Long-Term Issuer Credit Rating of “ccc” (Weak) of Health Insurance Plan of Greater New York, EmblemHealth Insurance Company and EmblemHealth Plan, Inc., collectively referred to as Emblem. All companies are subsidiaries of EmblemHealth, Inc. and are domiciled in New York (NY). The outlook assigned to these Credit Ratings (ratings) is stable.

The ratings reflect Emblem’s balance sheet strength, which AM Best assesses as very weak, as well as its marginal operating performance, neutral business profile and marginal enterprise risk management (ERM).

AM Best assesses Emblem’s balance sheet strength as very weak, with risk-adjusted capitalization, as measured by Best's Capital Adequacy Ratio (BCAR), also assessed as very weak. Absolute capital and surplus improved slightly in 2024, driven by unrealized capital gains that offset net losses. In the first quarter of 2025, Emblem reported further improvement in its capital and surplus as well as gains from the sale of ConnectiCare operations in the first quarter of 2025, which resulted in more than a $60 million improvement in the capital and surplus at Health Insurance Plan of Greater New York, the lead entity. Emblem’s investment portfolio is conservative, with cash and short-term comprising over half of the investment portfolio at year-end 2024. Although capital and surplus improved in 2024 and through first-quarter 2025, Health Insurance Plan of Greater New York, the lead operating entity, remains under a capital restoration plan with the New York State Department of Financial Services. The company is forecasting to restore capital by the end of 2025 and conclude the capital restoration plan.

Emblem has a long-term trend of net losses and underwriting losses. However, AM Best acknowledges that results improved through year-end 2024, which continued into the first quarter of 2025. In the first quarter of 2025, Emblem reported a significant reduction in underwriting losses year over year and reported a slight net income for the quarter, which keeps a trend of three consecutive quarters of net income.

The neutral business profile reflects Emblem’s solid market position in the greater New York City market with a long-standing presence. Additionally, the organization derives a large portion of its membership from union and labor accounts, anchored by the City of New York account.

Emblem’s ERM is assessed as marginal. While the company has a fully developed ERM program, the organization faced challenges over the years (specifically during Covid periods) in meeting projections and the restoration plan with the New York State Department of Financial Services. Emblem has exceeded the restoration plan projections for the last two years.

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