FHLC vs XHS: Grades, Fees and Holdings Compared

Fidelity MSCI Health Care Index ETF

FHLCANYSE Arca

State Street SPDR S&P Health Care Services ETF

XHSANYSE Arca

Overlap

12.6%by weight

Expense ratio

FHLC −0.27pt a year

FHLC0.08%XHS0.35%

Avg volume · 30D

FHLC 7.7×the volume

FHLC246KXHS31.9K

10Y return · a year

FHLC +0.9pt

FHLC+12.4%XHS+11.5%

FHLC vs XHS Performance

Oct 29, 2021 – Oct 30, 2026

+42.8%FHLC+36.6%XHS

Expense ratio: FHLC 0.08%, better; XHS 0.35%
Fund size: FHLC $3.54B; XHS $234M
1Y total return: FHLC +28.9%; XHS +39.7%, better
Yield (12M): FHLC 1.15%, better; XHS 0.15%
Holdings: FHLC 345; XHS 63
Avg volume (30D): FHLC 246K sh, better; XHS 31.9K sh
NAV per share: FHLC $88.53; XHS $144.25
52W range

ETF.net Grade

Pillar letters and Scores for FHLC, XHS, with each pillar’s weight
Pillar	FHLC	XHS
Cost30% weight	A98Higher	A81
Mission25% weight	A81	Not scored
Risk15% weight	A79Higher	A78
Tradability15% weight	A82Higher	C54
Holdings10% weight	C54	A87Higher
Durability5% weight	A77Higher	B64

Rank among Health Care (Broad) funds

How we build Categories ›

Same Category. FHLC and XHS are both graded against the same 25 Health Care (Broad) funds, so their Grades compare head to head.

Health Care (Broad)⁠

Category · 25 funds

See all 25 ›

FHLC ranks 2nd and XHS 4th of 25 funds in the Health Care (Broad) Category.

Rank 1AXLVState Street Health Care Select Sector SPDR ETFScore 85
Rank 2AFHLCFidelity MSCI Health Care Index ETFScore 83
Rank 3AVHTVanguard Health Care ETFScore 77
Rank 4AXHSState Street SPDR S&P Health Care Services ETFScore 74
Rank 5AIYHiShares U.S. Healthcare ETFScore 71

Our read on each fund

ETF.net Research

FHLCAFidelity MSCI Health Care Index ETF

XHSAState Street SPDR S&P Health Care Services ETF

In short

FHLC Health care, whole market. FHLC tracks an MSCI index that runs from mega-cap pharma down to small-cap biotech and device makers, roughly 400 names, for 0.08% a year.

XHS Most health care ETFs are pharma funds in disguise. XHS buys the delivery system instead: insurers, hospitals, distributors and clinics, roughly equal weighted so one giant insurer does not run the show.

Stated mandate

FHLC The fund seeks to track the performance of the MSCI USA IMI Health Care Index before fees and expenses.

XHS The fund seeks to track the total return of the S&P Health Care Services Select Industry Index before fees and expenses, providing targeted exposure to health care services companies.

Why people hold it

FHLC Charges 0.08% a year against a 0.50% median for broad health care ETFs. Only XLV matches that sticker; VHT sits a hair above.
The IMI index it follows reaches for about 99% of US free-float market value, so smaller biotech and device names ride along with the pharma giants.msci.com
Mirrors its benchmark closely, one of the tighter tracking jobs among broad health care funds. Distributions come quarterly.
Fidelity has run it since 2013, and it has grown into a multi-billion-dollar fund with a plain vanilla index mandate.fidelity.com

XHS No drugmakers, no device makers. The index tracks four slices of care delivery: distributors, facilities, health care services and managed care.ssga.com
Modified equal weighting spreads about 60 names across large, mid and small caps, so the portfolio is not a bet on two or three mega caps.ssga.com
0.35% a year sits below the 0.50% median for broad health care ETFs, on a fund that has been running since 2011.
Ranks in the top quartile of the broad health care ETFs we grade.

Worth knowing

FHLC One sector, one country. Drug-pricing politics, patent cliffs and FDA rulings move the whole portfolio at once.
Free-float cap weighting means a handful of mega-cap insurers and drugmakers carry most of the weight; that long tail of small names counts for less than it looks.msci.com
Moderately traded rather than the category's volume leader, so spreads matter more on large or hurried orders.

XHS Cheap against the median, not against the giants: XLV, VHT and FHLC charge under a tenth of a percent for cap weighted whole sector exposure.
Thinly traded next to the big sector funds, so spreads and limit orders matter more here.
Leaving out pharma and biotech means it moves differently from a whole sector fund, and insurers and hospitals sit close to reimbursement policy.ssga.com

Full FHLC profile⁠

Full XHS profile⁠

FHLC vs XHS Holdings

How FHLC and XHS differ

Overlap by weight

12.6%

Shared holdings make up 91.6% of XHS and 15.7% of FHLC.

Level by level

Holdings54 in both12.6%
Sector2 Sectors98.1%
Asset classEquity100%
Countryby domicile99.6%

Sector

Sector weights in FHLC and XHS, widest gap first
Sector	More in FHLCMore in XHS	FHLC	XHS
Health Care	FHLC +1.9 points	100.0%	98.1%
Financials	XHS +1.9 points	0.0%	1.9%

Country, concentration and asset class

Country by domicile

Country weights in FHLC and XHS, widest gap first
Country	More in FHLCMore in XHS	FHLC	XHS
United States	XHS +0.4 points	99.6%	100.0%
United Kingdom	FHLC +0.3 points	0.3%	0.0%
Switzerland	FHLC +0.1 points	0.1%	0.0%
Canada	Same weight	0.0%	0.0%
Netherlands	Same weight	0.0%	0.0%

Concentration

Weight in the 10 largest Holdings

FHLC52.6%
XHS20.7%

Securities held

FHLC343
XHS61

Asset class

FHLC: Equity
XHS: Equity

Holdings

Only in FHLC289
In both54
Only in XHS7

Only in FHLC

289 securities, 85.1% of FHLC by weight

Eli Lilly & Co14.17%
Johnson & Johnson8.54%
AbbVie Inc6.62%
Merck & Co Inc New4.66%
Thermo Fisher Scientific Inc3.40%
Amgen Inc3.20%
Gilead Sciences Inc2.65%
Abbott Laboratories2.35%
Pfizer Inc2.20%
Intuitive Surgical Inc2.05%
Danaher Corp1.95%
Vertex Pharmaceuticals Inc1.77%
Bristol-Myers Squibb Co1.62%
Medtronic PLC1.60%
Stryker Corp1.39%
Elevance Health Inc1.18%
Regeneron Pharmaceuticals Inc1.09%
Moderna Inc0.97%
Securities Lending Cf0.93%
Boston Scientific Corp0.82%
Natera Inc0.76%
Becton Dickinson & Co0.70%
Edwards Lifesciences Corp0.70%
Agilent Technologies Inc0.66%
Waters Corp0.61%
Iqvia Holdings Inc0.59%
Idexx Labs Inc0.59%
Veeva Sys Inc Class A0.58%
Illumina Inc0.55%
Biogen Inc0.47%
Resmed Inc0.47%
Mettler-Toledo Intl Inc0.45%
Ge Healthcare Technologies Inc0.45%
Zoetis Inc Class A0.43%
Revolution Medicines Inc0.42%
Dexcom Inc0.40%
West Pharmaceutical Svcs Inc0.38%
Royalty Pharma PLC0.35%
Insmed Inc0.30%
Alnylam Pharmaceuticals Inc0.30%
United Therapeutics Corp Del0.29%
Steris PLC0.29%
Viatris Inc0.29%
Incyte Corp0.26%
Roivant Sciences Ltd0.25%
Zimmer Biomet Hldgs Inc0.24%
Revvity Inc0.24%
Charles River Labs Intl Inc0.23%
Halozyme Therapeutics Inc0.20%
Medpace Holdings Inc0.20%

Only in XHS

7 securities, 8.3% of XHS by weight

Billiontoone Inc Class A1.90%
Elevance Health Inc1.75%
Astrana Health Inc1.58%
Starling Oncology Inc1.18%
Fulgent Genetics Inc0.75%
Strata Critical Medical Inc0.72%
Community Health Systems Inc0.43%

Weight gaps

All 54 Holdings in both funds, largest gap first.

Holding weights in FHLC and XHS, widest gap first
Holding	More in FHLCMore in XHS	FHLC	XHS
UnitedHealth Group IncUNH	FHLC +3.09 points	4.81%	1.72%
Surgery Partners IncSGRY	XHS +2.69 points	0.02%	2.71%
Amn Healthcare Services IncAMN	XHS +2.23 points	0.02%	2.25%
Option Care Health IncOPCH	XHS +2.16 points	0.06%	2.22%
Hinge Health IncHNGE	XHS +2.04 points	0.07%	2.11%
Concentra Group Hld Parent IncCON	XHS +1.92 points	0.06%	1.98%
Corvel CorpCRVL	XHS +1.90 points	0.03%	1.93%
Us Physical Therapy IncUSPH	XHS +1.81 points	0.02%	1.83%
Pacs Group IncPACS	XHS +1.80 points	0.03%	1.83%
Privia Health Group IncPRVA	XHS +1.74 points	0.03%	1.77%
Pediatrix Medical Group IncMD	XHS +1.74 points	0.03%	1.77%
Lifestance Health Group IncLFST	XHS +1.74 points	0.04%	1.78%
Nutex Health IncNUTX	XHS +1.74 points	0.01%	1.75%
Clover Health Investements CorCLOV	XHS +1.72 points	0.02%	1.74%
Progyny IncPGNY	XHS +1.69 points	0.03%	1.72%
Healthequity IncHQY	XHS +1.69 points	0.11%	1.80%
Acadia Healthcare Co IncACHC	XHS +1.69 points	0.03%	1.72%
Addus Homecare CorpADUS	XHS +1.69 points	0.03%	1.72%
Hims & Hers Health IncHIMS	XHS +1.67 points	0.08%	1.75%
Davita IncDVA	XHS +1.66 points	0.08%	1.74%
Ensign Group IncENSG	XHS +1.64 points	0.14%	1.78%
Radnet IncRDNT	XHS +1.65 points	0.06%	1.71%
Neogenomics IncNEO	XHS +1.64 points	0.03%	1.67%
Chemed CorpCHE	XHS +1.63 points	0.09%	1.72%
Encompass Health CorpEHC	XHS +1.61 points	0.17%	1.78%
Guardant Health IncGH	XHS +1.58 points	0.29%	1.87%
Molina Healthcare IncMOH	XHS +1.56 points	0.13%	1.69%
Aveanna Healthcare Hldgs IncAVAH	XHS +1.55 points	0.01%	1.56%
Universal Health Svcs Inc Class BUHS	XHS +1.53 points	0.12%	1.65%
Guardian Pharmacy Services IncGRDN	XHS +1.52 points	0.01%	1.53%
Henry Schein IncHSIC	XHS +1.51 points	0.11%	1.62%
National Healthcare CorpNHC	XHS +1.51 points	0.03%	1.54%
Agilon Health IncAGL	XHS +1.50 points	0.01%	1.51%
Labcorp Holdings IncLH	XHS +1.50 points	0.39%	1.89%
Omada Health IncOMDA	XHS +1.49 points	0.01%	1.50%
Brightspring Hlth Services IncBTSG	XHS +1.47 points	0.13%	1.60%
Sonida Senior Living IncSNDA	XHS +1.41 points	0.01%	1.42%
Castle Biosciences IncCSTL	XHS +1.41 points	0.01%	1.42%
Quest Diagnostics IncDGX	XHS +1.41 points	0.36%	1.77%
Pennant Group IncPNTG	XHS +1.37 points	0.02%	1.39%
Brookdale Senior Living IncBKD	XHS +1.36 points	0.03%	1.39%
Tenet Healthcare CorpTHC	XHS +1.35 points	0.30%	1.65%
Genedx Holdings Corp-AWGS	XHS +1.33 points	0.02%	1.35%
Centene CorpCNC	XHS +1.32 points	0.44%	1.76%
Adapthealth CorpAHCO	XHS +1.31 points	<0.01%	1.32%
Humana IncHUM	XHS +1.06 points	0.65%	1.71%
Alignment Healthcare IncALHC	XHS +1.00 points	0.02%	1.02%
Cardinal Health IncCAH	XHS +0.96 points	0.76%	1.72%
Hca Healthcare IncHCA	XHS +0.90 points	0.96%	1.86%
Cencora IncCOR	XHS +0.89 points	0.79%	1.68%
Cigna Group (The)CI	XHS +0.74 points	1.02%	1.76%
Opko Health IncOPK	XHS +0.53 points	<0.01%	0.54%
Mckesson CorpMCK	XHS +0.33 points	1.48%	1.81%
Cvs Health CorpCVS	XHS +0.07 points	1.49%	1.56%

All 365 FHLC holdings⁠All 61 XHS holdings⁠

How we measure overlap

Each holding counts at its smaller weight in the two funds, summed over the full Holdings. Sector, country and asset class use the same rule on each fund’s split. Cash, FX and derivative lines stay out of the counts. Two bond funds get no overlap figure.

FHLC vs XHS Cost

Overpaying XHS vs FHLC

$5,353

On $10,000 over 30 years. 7% growth a year before fees, expense ratio only.

FHLC 0.084%
$1,773
XHS 0.35%
$7,126

Amount$10,000

Years30 years

Cost over time

FHLC 0.084%
XHS 0.35%
Overpaying

Year by year

Year	FHLC	XHS	Overpaying
10	$154	$634	$480
20	$603	$2,454	$1,851
30	$1,773	$7,126	$5,353

Expense ratio

0.08%FHLC, cheaper
0.35%XHS

FHLC0.08%XHS0.35%

0.08%0.85%

Middle half of Health Care (Broad) funds
Median 0.50%

FHLC 2nd cheapest of 25 funds

XHS 5th cheapest of 25 funds

FHLC vs XHS Dividends

Last 12 months to Oct 30, 2026

Yield (12M): FHLC 1.15%, better; XHS 0.15%
Payout (12M): FHLC $1.02; XHS $0.21
Last payment: FHLC $0.25; XHS $0.01
Ex-dividend: FHLC Sep 18, 2026; XHS Sep 21, 2026
Paid on: FHLC Sep 22, 2026; XHS Sep 23, 2026
Frequency: FHLC Quarterly; XHS Quarterly

Distribution history

Per share, 2017 to 2026, same scale for both

FHLCQuarterly · 40 paymentsAll FHLC payments⁠

XHSQuarterly · 39 paymentsAll XHS payments⁠

FHLC vs XHS Risk

Fall from peak · 5 years

FHLC
XHS

Risk facts

VolatilityStd dev, 3 years: FHLC 14.5%, betterXHS 20.8%
Return per unit of riskSharpe ratio, 3 years: FHLC 0.83XHS 0.85, better
Worst fallMax drawdown, 5 years: FHLC −17.7%, betterXHS −30.0%
Market sensitivityBeta, 5 years: FHLC 0.59XHS 0.93; Market = 1

FHLC and XHS in the news

All news⁠

Deep Dive
Health care's 1.8% week was four large caps, not a biotech rally
Sep 19, 2026FHLCXHS
Category Review
Health care funds trail the S&P 500 this year
Updated Oct 7, 2026FHLC
Deep Dive
Health care ETFs spent 2026 between a 28% biotech rally and a 16% device slide
Sep 14, 2026XHS

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