A.M. Best has affirmed the financial strength ratings (FSR) of A- (Excellent) and issuer credit ratings (ICR) of “a-” for the majority of the insurance subsidiaries of Humana Inc. (Humana) (Louisville, KY) [NYSE: HUM]. A.M. Best also has affirmed the ICR of “bbb-” and the existing debt ratings of Humana. The outlook for these ratings is stable. Additionally, A.M. Best has revised the outlook of the ICR to stable from negative and affirmed the FSR of B++ (Good) and ICR of “bbb+” of Kanawha Insurance Company (Kanawha) (Lancaster, SC). The outlook for the FSR is stable. Concurrently, A.M. Best has affirmed the FSR of B++ (Good) and ICRs of “bbb+” for the following subsidiaries of Humana: Humana Insurance of Puerto Rico, Inc. and Humana Health Plans of Puerto Rico, Inc. (both domiciled in Puerto Rico). The outlook for these ratings is stable. (See link below for a detailed listing of all companies and ratings.) The rating affirmations for Humana’s key U.S. subsidiaries reflect the enterprise’s strong earnings in 2013, mainly as a result of improved revenue development, cost containment strategies and favorable overall operating performance. Humana again reported considerable membership gains in 2013, which represents the outcome of merger and acquisition activity, increased access to available Medicare Advantage and Medicare Part D members and some organic growth. As a result of changes in the scope of its ongoing business operations and in preparation for the structural shifts inherent in The Patient Protection and Affordable Care Act, Humana revamped its organizational structure to make seamless the implementation of new operating requirements impacting employer groups, retail members, health care services and other business operations. Additionally, Humana chose an integrative care delivery approach that lowers the number of provider touch points to patients in lieu of a more comprehensive service environment that has the potential to cut redundancies and meaningfully reduce costs.