AM Best has affirmed the financial strength rating of "A+" (Superior) and the long-term issuer credit rating of “aa-” (Superior) of Berkley Life and Health Insurance, a medical group captive. The agency also revised the outlook to ‘positive’ from ‘stable’. The ratings of Berkley Life and Health reflect its balance sheet strength, which AM Best assesses as ‘strongest’, as well as its adequate operating performance, neutral business profile and appropriate enterprise risk management (ERM). According to AM Best, the company has strengthened its risk-adjusted capitalisation annually in each of the last five years while also maintaining conservative, high-quality investments and favourable liquidity metrics. Berkley Life and Health continues to grow premium, driven by new and renewal sales of its group captive and medical stop-loss products. The company has reported increasing pre-tax net operating gains in recent years, primarily due to favourable underwriting experience. In addition, the captive has maintained a market niche in the small group medical stop-loss space. The company receives support from its parent, W. R. Berkley, and is fully integrated into the parent organisation’s operations, strategic plans and ERM programme.