While the leverage may fluctuate depending on timing of new debt issuances and maturities pay downs, management has repeatedly indicated that it remains committed to managing the financial leverage at approximately 40%. Cigna's debt service is supported by its strong earnings and dividends from the group's insurance entities, as well as solid non-regulated earnings from its Evernorth segment. Insurance earnings have been supported by market-leading positions in the self-funded and stop-loss segments. Cigna's insurance operations are less exposed to government programs compared with peers resulting in higher margins, and the organization has demonstrated profitable growth in the commercial segment over the past several years. The ratings of HealthSpring reflect its balance sheet strength, which AM Best assesses as adequate, as well as its adequate operating performance, neutral business profile and appropriate ERM.