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OSCAR HEALTH, INC. – 10-Q – Management's Discussion and Analysis of Financial Condition and Results of Operations.
Edgar Glimpses
You should read the following discussion and analysis of our financial condition and results of operations together with our consolidated financial statements and related notes included elsewhere in this Quarterly Report on Form 10-Q, as well as our audited consolidated financial statements and related notes as disclosed in our Annual Report on Form 10-K. This discussion contains forward-looking statements based upon current plans, expectations and beliefs involving risks and uncertainties. Our actual results may differ materially from those anticipated in these forward-looking statements as a result of various factors, including those set forth in Part II, Item 1A "Risk Factors" of this Quarterly Report on Form 10-Q.
Overview
Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We offer innovative and consumer-oriented health plans in the Individual,Small Group and Medicare Advantage markets. We have also partnered with Cigna through the Cigna + Oscar ("C+O") partnership, which unites Oscar's highly-differentiated member experience with Cigna's broad provider networks, to exclusively serve theSmall Group employer market. Through +Oscar, we leverage our technology platform to sell services to providers and payers, which are designed to help drive improved efficiency, growth and superior engagement with members and patients as our clients shift to value-based care.
Recent Developments, Trends and Other Factors Impacting Performance
Reinsurance
We believe our reinsurance agreements help us achieve important goals for our
business, including risk management, capital efficiency, and greater
predictability in our earnings in the event of unexpected significant
fluctuations in MLR. Specifically, reinsurance is a financial arrangement under
which the reinsurer agrees to cover a portion of our medical claims (ceded
claims) in return for a portion of the premium (premiums ceded). Our reinsurance
agreements are contracted under two different types of arrangements: quota share
reinsurance contracts and excess of loss ("XOL") reinsurance contracts.
Reinsurance agreements do not relieve us of our primary medical claims incurred
obligations.
Quota Share Reinsurance
We currently use quota share agreements to limit our risk and capital
requirements, which has enabled us to grow while optimizing our use of capital.
In quota share reinsurance, the reinsurer agrees to assume a specified
percentage of the ceding company's losses arising out of a defined class of
business in exchange for a corresponding percentage of premiums. Premiums for
quota share reinsurance are based on a percentage of premiums earned before
ceded reinsurance. Each quota share reinsurance agreement includes a ceding
commission payment from the reinsurer to Oscar to cover administrative costs. To
the extent ceded premiums exceed ceded claims and commissions, we typically
receive an experience refund. Reinsurance recoveries are recorded as a reduction
to claims incurred, net.
Because reinsurers are entitled to a portion of our premiums under our quota
share reinsurance arrangements, changes in the amount of premiums ceded under
these arrangements affect our revenue. Furthermore, reductions in the amount of
premiums ceded under quota share reinsurance arrangements may result in an
increase to our minimum capital and surplus requirements, and an increase in
corresponding capital contributions by Holdco to our health insurance
subsidiaries.
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The Company currently has quota share reinsurance arrangements with more than
one counterparty with multiple state-level treaties. These arrangements are
accounted for under both reinsurance accounting and deposit accounting. Our
premiums ceded under quota share reinsurance agreements are as follows:
Three Months Ended Six Months Ended
Summary of Quota Share Reinsurance Program June 30, 2022 June 30, 2021 June 30, 2022 June 30, 2021
Percentage of premiums ceded under
reinsurance programs
(reinsurance accounting) 29 % 33 % 29 % 37 %
Percentage of premiums covered under
reinsurance programs
(deposit accounting) 18 % - % 19 % - %
XOL Reinsurance
We use ("XOL") reinsurance to limit our exposure to large catastrophic risk from
individual claims. Under XOL reinsurance, the reinsurer agrees to assume all or
a portion of the ceding company's losses in excess of a specified amount. The
premium payable to the reinsurer is negotiated by the parties based on losses on
an individual member in a given calendar year and their assessment of the amount
of risk being ceded to the reinsurer. Under our XOL reinsurance contracts, the
reinsurer is paid to cover claims related losses over a $750,000 attachment
point.
Risk Adjustment
The risk adjustment programs in the Individual, Small Group , and Medicare
Advantage markets we serve are administered federally by Centers for Medicare &
Medicaid Services ("CMS") and are designed to mitigate the potential impact of
adverse selection and provide stability for health insurers. Under this program,
each plan is assigned a risk score based upon demographic information and
current year claims information related to its members. The risk score is used
to adjust plan revenue to reflect the relative risk of the plan's enrolled
population. We reevaluate our risk transfer estimates as new information and
market data becomes available until we receive the final reporting from CMS in
later periods, up to twelve months in arrears.
Our risk transfer estimates are subject to a high degree of estimation and
variability, and are affected by the relative risk of our members, and in the
case of ACA, relative to that of other insurers. In the Individual and Small
Group lines, there is a higher degree of uncertainty associated with estimates
of risk transfers at the beginning of the policy year resulting from composition
of the risk score being based on concurrent claim data. Furthermore, there is
additional uncertainty for blocks of business that experience high growth
compounded by the lack of credible experience data on the newly enrolling
population. Actual risk adjustment calculations and transfers could materially
differ from our assumptions.
Seasonality
Our business is generally affected by the seasonal patterns of our member enrollment and medical expenses, health plan mix shift and, to a lesser extent, marketing spend in advance of an Open Enrollment Period or Annual Election Period. Direct policy premiums earned are historically highest in the first quarter, primarily due to the annual enrollment cycles and the enrollment of our members. Medical expenses are sensitive to the mix shift of the five "metal" health plan categories offered on the ACA, which differ based on the size of the monthly premium and the level of sharing of medical costs between us and our members. Medical expenses have historically been highest towards the second half of the year due to a number of factors discussed below.
Members
Our membership is measured as of a particular point in time and is concentrated in the Individual market. Membership typically declines throughout the year due to individuals disenrolling before they become effectuated members and the removal of members for non-payment or in accordance with our fraud, waste and abuse, and other operating policies. For Individual and Medicare Advantage products, the majority of our member growth occurs in connection with the annual Open Enrollment Period and Annual Election Period. Individual plan membership is historically at its highest at the beginning of the year, while Medicare Advantage plan membership typically increases throughout the year. ForSmall Group products, a large portion of membership is acquiredbetween December 1 and January 1 , with the remaining members acquired throughout the balance of the year. 27
-------------------------------------------------------------------------------- Table of Contents Claims Incurred Our medical expenses are impacted by seasonal effects of medical costs such as the utilization of deductibles and out-of-pocket maximums over the course of the policy year, which generally shifts more costs to us in the second half of the year as we pay a higher proportion of claims. Our medical costs can also vary according to the number of days and holidays in a given period as well as the proportion of our membership that is new in the calendar year. In 2022, due to our new membership growth and the mix shift to members with higher-premium/lower-deductible Silver plans, the medical claims pattern may differ from that in prior years. Impact of COVID-19 The COVID-19 pandemic, including its effect on the macroeconomic environment, and the response of our local, state, and federal governments to contain and manage the virus, continues to have an impact on our business. In addition, continued COVID-19 care, testing and vaccine administration, and the risk of new COVID-19 variants (which may be more contagious or severe, or less responsive to treatment or vaccines) may also result in increased future medical costs and drive changes in the way members utilize healthcare. The public health emergency extension for COVID-19 expires onOctober 13, 2022 , and once it expires, Medicaid redeterminations are expected to resume. We will continue to monitor announcements related to the public health emergency and redeterminations and the potential impact on our membership and underwriting margin. To date, we have experienced and may continue to experience changes in the utilization patterns of our members, as the pandemic continues to affectthe United States , and our members continue to change the way they utilize care. We experienced depressed non-COVID-19 related medical costs as a result of the pandemic and as vaccination rates have increased nationally, members began to resume their utilization of healthcare including care that was deferred, resulting in increased medical claims expenses. However, this trend may reverse if vaccination rates stall, COVID-19 variants continue to proliferate, or COVID-19 vaccines are not effective against new strains or become less effective over time. We also experienced, and may continue to experience, increased COVID-19 testing and treatment costs. We monitor external trends closely as these dynamics result in increased uncertainties around our expectations of both COVID-19 and non-COVID-19 related medical costs. We cannot accurately estimate the future net potential impact, positive or negative, to our medical claims expenses at this time. Overall measures to contain the COVID-19 outbreak may remain in place for a significant period of time, as certain geographic regions have experienced a resurgence of COVID-19 infections and new variants of COVID-19 that appear to be more transmissible have emerged. Although the number of people who have been vaccinated has been increasing, the duration and severity of this pandemic is unknown and the extent of the business disruption and financial impact depends on factors beyond our knowledge and control.
Financial Results Summary and Key Operating and Non-GAAP Financial Metrics
We regularly review a number of metrics, including the following key operating
and non-GAAP financial metrics, to evaluate our business, measure our
performance, identify trends in our business, prepare financial projections, and
make strategic decisions. We believe these operational and financial measures
are useful in evaluating our performance, in addition to our financial results
prepared in accordance with GAAP.
Financial Results Summary
Three Months Ended Six Months Ended
June 30, 2022 June 30, 2021 June 30, 2022 June 30, 2021
(in thousands)
Premiums before ceded reinsurance
Reinsurance premiums ceded
(373,882) (195,768) (733,545) (437,330) Premiums earned$ 994,595 $ 528,159 $ 1,949,996 $ 896,696 Total revenue$ 1,017,319 $
529,281
Total operating expenses
$ 1,123,806 $ 601,787 $ 2,165,100 $ 1,035,216 Net loss$ (112,125) $ (73,323) $ (189,445) $ (162,204) 28
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Key Operating and Non-GAAP Financial Metrics
As of June 30,
Membership by Offering 2022 2021
Individual and Small Group 986,017 554,748
Medicare Advantage 4,658 3,749
Cigna + Oscar (1) 46,045 4,617
Total 1,036,720 563,114
(1) Represents total membership for our co-branded partnership with Cigna.
Members
Members are defined as any individual covered by a health plan that we offer directly or through a co-branded arrangement. We view the number of members enrolled in our health plans as an important metric to help evaluate and estimate revenue and market share. Additionally, the more members we enroll, the more data we have, which allows us to improve the functionality of our platform. Membership increased 84% to 1,036,720 as ofJune 30, 2022 , from 563,114 as ofJune 30, 2021 . The increase in membership is driven largely by growth in the Individual market, as well as increases due to serving new C+O members. Our growth also reflects strong retention and growth in core Individual markets during open enrollment, including inFlorida ,Georgia andTexas , despite having the lowest cost plan in only 8% of our markets. Three Months Ended Six Months Ended June 30, 2022 June 30, 2021 June 30, 2022 June 30, 2021 Direct and Assumed Policy Premiums (in thousands)$ 1,694,927 $
841,260
Medical Loss Ratio
82.2 % 82.4 % 79.9 % 78.7 % InsuranceCo Administrative Expense Ratio 19.5 % 19.8 % 19.7 % 19.8 % InsuranceCo Combined Ratio 101.7 % 102.2 % 99.6 % 98.5 % Adjusted Administrative Expense Ratio 23.7 % 25.1 % 23.7 % 25.5 %
Adjusted EBITDA(1) (in thousands)
(1) Adjusted EBITDA is a non-GAAP measure. See "Adjusted EBITDA" below for a reconciliation to net loss, the most directly comparable GAAP measure, and for information regarding our use of Adjusted EBITDA.
Direct and Assumed Policy Premiums
Direct Policy Premiums are defined as the premiums collected from our members or from the federal government during the period indicated, before risk adjustment and reinsurance. These premiums include APTC, or premium subsidies, which are available to individuals and families with certain annual incomes. Assumed Policy Premiums are premiums we receive primarily as part of our reinsurance arrangements under our C+O small group plan offering. We believe Direct and Assumed Policy Premiums is an important metric to assess the growth of our individual and small group plan offerings going forward. Management also views Direct and Assumed Policy Premiums as a key operating metric because each of our MLR, InsuranceCo Administrative Expense Ratio, InsuranceCo Combined Ratio and Adjusted Administrative Expense Ratio are calculated on the basis of Direct and Assumed Policy Premiums. Direct and Assumed Policy Premiums increased for the three and six months endedJune 30, 2022 as compared to the three and six months endedJune 30, 2021 , driven primarily by higher membership, rate increases and mix shift to higher premium Silver plans. 29
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Medical Loss Ratio
Medical Loss Ratio is calculated as set forth in the table below. Medical claims
are total medical expenses incurred by members in order to utilize health care
services less any member cost sharing. These services include inpatient,
outpatient, pharmacy, and physician costs. Medical claims also include risk
sharing arrangements with certain of our providers. The impact of the federal
risk adjustment program is included in the denominator of our MLR. We believe
MLR is an important metric to demonstrate the ratio of our costs to pay for
health care of our members to the premiums before ceded reinsurance. MLRs in our
existing products are subject to various federal and state minimum requirements.
Below is a calculation of our MLR for the periods indicated.
Three Months Ended Six Months Ended
June 30, 2022 June 30, 2021 June 30, 2022 June 30, 2021
(in thousands)
Direct claims incurred before ceded
reinsurance (1) $ 1,092,416 $ 598,904 $ 2,102,451 $ 1,056,123
Assumed reinsurance claims 32,555 2,308 56,797 4,085
Excess of loss ceded claims (2) 1,509 (4,837) (9,924) (9,573)
State reinsurance (3) (6,946) (2,826) (18,275) (5,169)
Net claims before ceded quota share
reinsurance (A) $ 1,119,534 $ 593,549
Premiums before ceded reinsurance (4)
Excess of loss reinsurance premiums (5) (6,638) (3,277) (14,766) (6,212) Net premiums before ceded quota share reinsurance (B)$ 1,361,839 $ 720,650 $ 2,668,775 $ 1,327,814 Medical Loss Ratio (A divided by B) 82.2 % 82.4 % 79.9 % 78.7 % (1)See Note 4 - Reinsurance to our consolidated financial statements included elsewhere in this Quarterly Report on Form 10-Q for a reconciliation of direct claims incurred to claims incurred, net appearing on the face of our statement of operations.
(2)Represents claims ceded to reinsurers pursuant to an excess of loss treaty,
for which such reinsurers are financially liable. We use excess of loss
reinsurance to limit the losses on individual claims of our members.
(3)Represents payments made by certain state-run reinsurance programs
established subject to CMS approval under Section 1332 of the ACA.
(4)See Note 3 - Revenue Recognition to our consolidated financial statements included elsewhere in this Quarterly Report on Form 10-Q for an explanation of premiums before ceded reinsurance.
(5)Represents excess of loss insurance premiums paid.
MLR improved for the three months endedJune 30, 2022 as compared to the three months endedJune 30, 2021 , primarily due to lower net COVID-19 related costs and mix shifts in our member population, partially offset by the impact of prior period development. MLR increased slightly for the six months endedJune 30, 2022 as compared to the six months endedJune 30, 2021 . The increase was primarily due to unfavorable prior period development related to risk adjustment.
InsuranceCo Administrative Expense Ratio
InsuranceCo Administrative Expense Ratio is calculated as set forth in the table
below. The ratio reflects the costs associated with running our combined
insurance companies. We believe InsuranceCo Administrative Expense Ratio is
useful to evaluate our ability to manage our expenses as a percentage of
premiums before the impact of quota share reinsurance. Expenses necessary to run
the insurance company are included in other insurance costs and federal and
state assessments. These expenses include variable expenses paid to vendors and
distribution partners, premium taxes and healthcare exchange fees,
employee-related compensation, benefits, marketing costs, and other
administrative expenses. The impact of the Company's quota share arrangements is
excluded from the numerator and denominator in the calculation below. Below is a
calculation of our InsuranceCo Administrative Expense Ratio for the periods
indicated.
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Three Months Ended Six Months Ended
June 30, 2022 June 30, 2021 June 30, 2022 June 30, 2021
(in thousands)
Other insurance costs $ 170,200 $
94,790
Impact of quota share reinsurance (1) 39,189
20,466 75,668 39,772 Stock-based compensation expense (12,411) (9,171) (25,489) (18,866) Federal and state assessment of health insurance subsidiaries 68,561 36,616 138,772 67,214 Health insurance subsidiary adjusted administrative expenses (A)$ 265,539 $
142,701
Premiums before quota share reinsurance (2)$ 1,368,477 $
723,927
Excess of loss reinsurance premiums (6,638) (3,277) (14,766) (6,212) Net premiums before quota share reinsurance (B)$ 1,361,839 $
720,650
Insurance Co Administrative Expense
Ratio (A divided by B)
19.5 % 19.8 % 19.7 % 19.8 % (1)Includes ceding commissions received from reinsurers, net of the impact of deposit accounting of$(1,827) for the three months endedJune 30, 2022 , and$(3,659) for the six months endedJune 30, 2022 . (2)See Note 3 - Revenue Recognition to our consolidated financial statements included elsewhere in this Quarterly Report on Form 10-Q for an explanation of premiums before ceded reinsurance. The InsuranceCo Administrative Expense Ratio improved for the three and six months endedJune 30, 2022 as compared to the three and six months endedJune 30, 2021 , driven by operating expense leverage and variable cost efficiencies, partially offset by higher distribution expenses.
InsuranceCo Combined Ratio
InsuranceCo Combined Ratio is defined as the sum of MLR and InsuranceCo
Administrative Expense Ratio. We believe this ratio best represents the current
overall performance of our insurance business for activities that can be
compared to peers.
Three Months Ended Six Months Ended
June 30, 2022 June 30, 2021 June 30, 2022 June 30, 2021
Medical Loss Ratio 82.2 % 82.4 % 79.9 % 78.7 %
InsuranceCo Administrative Expense Ratio 19.5 % 19.8 % 19.7 % 19.8 %
InsuranceCo Combined Ratio 101.7 % 102.2 % 99.6 % 98.5 %
The InsuranceCo Combined Ratio improved for the three months ended
as compared to the three months ended
improvement in the MLR and InsuranceCo Administrative Expense Ratio.
The InsuranceCo Combined Ratio increased for the six months ended
as compared to the six months ended
increase in the MLR.
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Adjusted Administrative Expense Ratio
The Adjusted Administrative Expense Ratio is an operating ratio that reflects
the Company's total administrative expenses ("Total Administrative Expenses"),
net of non-cash and non-recurring items (as adjusted, "Adjusted Administrative
Expenses"), as a percentage of total revenue, including quota share reinsurance
premiums ceded and excluding excess of loss reinsurance premiums ceded and
non-recurring items ("Adjusted Total Revenue"). Total Administrative Expenses
are calculated as Total Operating Expenses, excluding non-administrative
insurance-based expenses and the impact of quota share reinsurance. Adjusted
Administrative Expenses are Total Administrative Expenses, net of non-cash and
non-recurring expense items. Adjusted Administrative Expenses exclude
insurance-based expenses, non-cash expenses and non-recurring expenses. We
believe Adjusted Administrative Expense Ratio is useful to evaluate our ability
to manage our overall administrative expense base. This ratio also provides
further clarity into our overall path to profitability. Below is a calculation
of our Adjusted Administrative Expense Ratio for the periods indicated.
Three Months Ended Six Months Ended
June 30, 2022 June 30, 2021 June 30, 2022 June 30, 2021
(in thousands)
Total Operating Expenses $ 1,123,806 $ 601,786 $ 2,165,100 $ 1,035,216
Claims incurred, net (808,639) (419,879) (1,543,205) (687,927)
Premium deficiency reserve release 4,536 921 7,741 10,464
Impact of quota share reinsurance (1) 39,189 20,466 75,668 39,772
Total Administrative Expenses $ 358,892 $
203,294
Stock-based compensation expense/warrant
expense
(26,991) (18,273) (54,681) (50,245) Depreciation and amortization (3,691) (3,587) (7,490) (6,990) Other non-recurring items (2) - - - (898) Adjusted Administrative Expenses (A)$ 328,210 $ 181,434 $ 643,133 $ 339,392 Total Revenue$ 1,017,319 $ 529,281 $ 1,990,084 $ 898,669 Reinsurance premiums ceded 373,882 195,768 733,545 437,330 Excess of loss reinsurance premiums (6,638) (3,277) (14,766) (6,212) Adjusted Total Revenue (B)$ 1,384,563 $
721,772
Adjusted Administrative Expense Ratio (A
divided by B)
23.7 % 25.1 % 23.7 % 25.5 % (1)Includes ceding commissions received from reinsurers, net of the impact of deposit accounting of$(1,827) for the three months endedJune 30, 2022 and$(3,659) for the six months endedJune 30, 2022 . (2)Represents approximately$0.9 million of non-recurring expenses incurred in connection with the Company's initial public offering ("IPO") during the six months endedJune 30, 2021 . The Adjusted Administrative Expense Ratio improved for the three and six months endedJune 30, 2022 as compared to the three and six months endedJune 30, 2021 . The improvement was primarily due to operating expense leverage and was partially offset by distribution expenses and additional expenses related to the cost of addressing operational challenges related to scale and implementing and performing under +Oscar arrangements.
Adjusted EBITDA
Adjusted EBITDA is defined as net loss for the Company and its consolidated
subsidiaries before interest expense, income tax (benefit) expense, depreciation
and amortization as further adjusted for stock-based compensation, warrant
contract expense, changes in the fair value of warrant liabilities, and other
non-recurring items as described below. We present Adjusted EBITDA because we
consider it to be an important supplemental measure of our performance and
believe it is frequently used by securities analysts, investors, and other
interested parties in the evaluation of companies in our industry. Adjusted
EBITDA is a non-GAAP measure. Management believes that investors' understanding
of our performance is enhanced by including this non-GAAP financial measure as a
reasonable basis for comparing our ongoing results of operations.
We caution investors that amounts presented in accordance with our definition of
Adjusted EBITDA may not be comparable to similar measures disclosed by our
competitors, because not all companies and analysts calculate Adjusted EBITDA in
the same manner.
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Management uses Adjusted EBITDA:
•as a measurement of operating performance because it assists us in comparing
the operating performance of our business on a consistent basis, as it removes
the impact of items not directly resulting from our core operations;
•for planning purposes, including the preparation of our internal annual
operating budget and financial projections;
•to evaluate the performance and effectiveness of our operational strategies;
and
•to evaluate our capacity to expand our business.
By providing this non-GAAP financial measure, together with a reconciliation to
the most comparable GAAP measure, we believe we are enhancing investors'
understanding of our business and our results of operations, as well as
assisting investors in evaluating how well we are executing our strategic
initiatives. Adjusted EBITDA has limitations as an analytical tool, and should
not be considered in isolation, or as an alternative to, or a substitute for net
loss or other financial statement data presented in our consolidated financial
statements as indicators of financial performance.
Three Months Ended Six Months Ended
June 30, 2022 June 30, 2021 June 30, 2022 June 30, 2021
(in thousands)
Net loss $ (112,125) $ (73,323) $ (189,445) $ (162,204)
Interest expense 6,141 228 10,362 3,925
Other expenses (793) - 2,260 -
Income tax expense 290 589 1,807 1,554
Depreciation and amortization 3,691 3,587 7,490 6,990
Stock-based compensation/warrant expense(1) 26,991 18,273 54,681 50,245
Other non-recurring items(2) - - - 21,076
Adjusted EBITDA $ (75,805) $ (50,646) $ (112,845) $ (78,414)
(1)Represents (i) non-cash expenses related to equity-based compensation
programs, which vary from period to period depending on various factors
including the timing, number, and the valuation of awards, (ii) warrant contract
expense, and (iii) changes in the fair value of warrant liabilities.
(2)Represents debt extinguishment costs of$20.2 million incurred on the prepayment of the Company's Term Loan (refer to Note 10 - Long-Term Debt) and approximately$0.9 million of non-recurring expenses incurred in connection with the IPO during the six months endedJune 30, 2021 .
Components of our Results of Operations
Premiums Before Ceded Reinsurance
Premiums before ceded reinsurance primarily consist of premiums received, or to be received, directly from our members or from CMS as part of the APTC program, net of the impact of our risk adjustment payable. Premiums before ceded reinsurance are generally impacted by the amount of risk sharing adjustments, our ability to acquire new members and retain existing members, and average size and premium rate of policies. Reinsurance Premiums Ceded Reinsurance premiums ceded represent the amount of premiums written that are ceded to reinsurers either through quota share or XOL reinsurance. We enter into reinsurance agreements, in part, to limit our exposure to potential losses as well as to provide additional capacity for growth. Reinsurance premiums ceded are recognized over the reinsurance contract period in proportion to the period of risk covered. The volume of our reinsurance premiums ceded is impacted by the level of our premiums earned and any decision we make to increase or decrease limits, retention levels, and co-participations.
Administrative Services Revenue
Administrative services revenue includes income earned from administrative
services performed as part of the +Oscar platform.
Investment Income (Loss) and Other Revenue
Investment income (loss) and other revenue primarily includes interest earned
and gains on our investment portfolio, along with sublease income.
33 -------------------------------------------------------------------------------- Table of Contents Claims Incurred, Net Claims incurred, net primarily consists of both paid and unpaid medical expenses incurred to provide medical services and products to our members. Medical claims include fee-for-service claims, pharmacy benefits, capitation payments to providers, provider disputed claims and various other medical-related costs. Under fee-for-service claims arrangements with providers, we retain the financial responsibility for medical care provided and incur costs based on actual utilization of hospital and physician services. Medical claims are recognized in the period health care services are provided. Unpaid medical expenses include claims reported and in the process of being settled, but that have not yet been paid, as well as health care costs incurred but not yet reported to us, which are collectively referred to as benefits payable or claim reserves. The development of the claim reserve estimate is based on actuarial methodologies that consider underlying claim payment patterns, medical cost inflation, historical developments, such as claim inventory levels and claim receipt patterns, and other relevant factors. The methods for making such estimates and for establishing the resulting liability are continuously reviewed and any adjustments are reflected in the period determined. Claims incurred, net also reflects the net impact of our ceded reinsurance claims.
Other Insurance Costs
Other insurance costs primarily include distribution costs, including broker commissions, wages, benefits, marketing, rent, costs of software and hardware, unallocated claims adjustment expenses, and administrative costs associated with functions that are necessary to support our health insurance business. Such functions include, but are not limited to, member concierge services, claims processing, utilization management, and related health plan operations, actuarial, compliance and portions of information systems, legal and finance. This line item also includes ceding commissions we receive from our reinsurance partners, net of the impact of deposit accounting.
General and Administrative Expenses
General and administrative expenses primarily include wages, benefits, costs of software and hardware, and administrative costs for our corporate and technology functions. Such functions include, but are not limited to executive management, and portions of legal, finance and information systems, including product management and development.
Federal and State Assessments
Federal and state assessments represent non-income tax charges from federal and state governments, including but not limited to healthcare exchange user fees, premium taxes, franchise taxes, and other state and local non-premium related taxes.
Premium Deficiency Reserve Release
Premium deficiency reserve release is the year over year change in the premium
deficiency reserve liability. Premium deficiency reserve liabilities are
established when it is probable that expected future claims and maintenance
expenses will exceed future premium and reinsurance recoveries on existing
medical insurance contracts without consideration of investment income.
Interest Expense
Interest expense consists primarily of interest expense associated with our debt arrangements, including amortization of debt issuance costs and discounts and revolving credit facility fees.
Other Expenses (Income)
Other expenses (income) consists primarily of miscellaneous expense or income that are not core to our operations, including profit sharing arrangements with our co-branded health plans and changes in the fair value of financial instruments.
Income Tax Provision
Income tax provision consists primarily of changes to our current and deferred
federal and state tax assets and liabilities. Income taxes are recorded as
deferred tax assets and deferred tax liabilities based on differences between
the book and tax bases of assets and liabilities. Our deferred tax assets and
liabilities are calculated by applying the current tax rates and laws to taxable
years in which such differences are expected to reverse.
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Results of Operations
Three Months Ended
The following table sets forth our results of operations for the periods
indicated:
Three Months Ended June 30,
2022 2021 $ Change % Change
(in thousands)
Revenue
Premiums before ceded reinsurance $ 1,368,477 $ 723,927 $ 644,550 89 %
Reinsurance premiums ceded (373,882) (195,768) (178,114) 91 %
Premiums earned 994,595 528,159 466,436 88 %
Administrative services revenue 20,452 353 20,099 *NM
Investment income and other revenue 2,272 769 1,503 195 %
Total revenue 1,017,319 529,281 488,038 92 %
Operating Expenses
Claims incurred, net 808,639 419,879 388,760 93 %
Other insurance costs 170,200 94,790 75,410 80 %
General and administrative expenses 80,754 51,166 29,588
58 % Federal and state assessments 68,749 36,873 31,876 86 % Premium deficiency reserve release (4,536) (921) (3,615) 393 % Total operating expenses 1,123,806 601,787 522,019 87 % Loss from operations (106,487) (72,506) (33,981) 47 % Interest expense 6,141 228 5,913 *NM Other expenses (income) (793) - (793) *NM Loss before income taxes (111,835) (72,734) (39,101) 54 % Income tax provision 290 589 (299) (51) % Net loss$ (112,125) $ (73,323) $ (38,802) 53 % *NM - not meaningful
Premiums Before Ceded Reinsurance
Premiums before ceded reinsurance increased$644.6 million , or 89%, to$1.4 billion for the three months endedJune 30, 2022 , from$723.9 million for the three months endedJune 30, 2021 . The increase was primarily due to higher membership driven largely by growth in the Individual line of business, as well as increases due to serving new C+O members and a mix shift towards higher premium plans. Oscar's growth also reflects strong retention and growth in core markets during open enrollment, including inFlorida ,Georgia andTexas , despite having the lowest cost plan in only 8% of its markets.
Reinsurance Premiums Ceded
Reinsurance premiums ceded increased$178.1 million , or 91%, to$373.9 million for the three months endedJune 30, 2022 , from$195.8 million for the three months endedJune 30, 2021 . The increase is driven by the growth in premiums before ceded reinsurance discussed above. 35 -------------------------------------------------------------------------------- Table of Contents Administrative Services Revenue Administrative services revenue increased$20.1 million to$20.5 million for the three months endedJune 30, 2022 , from$0.3 million for the three months endedJune 30, 2021 . This increase was driven by the launch of our newest +Oscar client, inJanuary 2022 ,Health First Health Plans , which is utilizing our technology and services to support their Individual and Medicare Advantage members.
Investment Income and Other Revenue
Investment income and other revenue increased to$2.3 million for the three months endedJune 30, 2022 , from$0.8 million for the three months endedJune 30, 2021 , primarily due to changes in market condition and interest rates and miscellaneous other revenue. Claims Incurred, Net Claims incurred, net, increased$388.8 million , or 93%, to$808.6 million for the three months endedJune 30, 2022 , from$419.9 million for the three months endedJune 30, 2021 . The increase was primarily volume-driven due to growth in membership and higher utilization, partially offset by favorable prior period development. Other Insurance Costs Other insurance costs increased$75.4 million , or 80%, to$170.2 million for the three months endedJune 30, 2022 , from$94.8 million for the three monthsJune 30, 2021 . The increase was primarily attributable to higher broker commissions, exchange user fees and premium taxes, which were driven by the increase in membership.
General and Administrative Expenses
General and administrative expenses increased$29.6 million , or 58%, to$80.8 million for the three months endedJune 30, 2022 , from$51.2 million for the three months endedJune 30, 2021 . The increase was primarily attributable to higher headcount and other employee-related costs.
Federal and State Assessments
Federal and state assessments increased$31.9 million , or 86%, to$68.7 million for the three months endedJune 30, 2022 , from$36.9 million for the three months endedJune 30, 2021 , which was primarily due to higher user exchange fees and premium taxes as a result of membership growth.
Premium Deficiency Reserve Release
Premium deficiency reserve release increased$3.6 million , to$4.5 million for the three months endedJune 30, 2022 , from$0.9 million for the three months endedJune 30, 2021 , due to the amortization patterns that vary by line of business.
Income Tax Provision
Our effective tax rate for the three months ended
2021
36
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Table of Contents
Six Months Ended
The following table sets forth our results of operations for the periods
indicated:
Six Months Ended June 30,
2022 2021 $ Change % Change
(in thousands)
Revenue
Premiums before ceded reinsurance $ 2,683,541 $ 1,334,026 $ 1,349,515 101 %
Reinsurance premiums ceded (733,545) (437,330) (296,215) 68 %
Premiums earned 1,949,996 896,696 1,053,300 117 %
Administrative services revenue 38,945 694 38,251 *NM
Investment income and other revenue 1,143 1,279 (136) (11) %
Total revenue 1,990,084 898,669 1,091,415 121 %
Operating Expenses
Claims incurred, net 1,543,205 687,927 855,278 124 %
Other insurance costs 335,602 174,627 160,975 92 %
General and administrative expenses 155,418 115,738
39,680 34 % Federal and state assessments 138,616 67,388
71,228 106 %
Premium deficiency reserve release (7,741) (10,464)
2,723 (26) % Total operating expenses 2,165,100 1,035,216 1,129,884 109 % Loss from operations (175,016) (136,547) (38,469) 28 % Interest expense 10,362 3,925 6,437 164% Other expenses (income) 2,260 - 2,260 *NM Loss on extinguishment of debt - 20,178 (20,178) *NM Loss before income taxes (187,638) (160,650) (26,988) 17 % Income tax provision 1,807 1,554 253 16 % Net loss$ (189,445) $ (162,204) $ (27,241) 17 % *NM - not meaningful
Premiums Before Ceded Reinsurance
Premiums before ceded reinsurance increased$1.3 billion , or 101%, to$2.7 billion for the six months endedJune 30, 2022 , from$1.3 billion for the six months endedJune 30, 2021 . The increase was primarily due to higher membership driven largely by growth in the Individual line of business, as well as increases due to serving new C+O members and a mix shift towards higher premium plans. Oscar's growth also reflects strong retention and growth in core markets during open enrollment, including inFlorida ,Texas andGeorgia , despite having the lowest cost plan in only 8% of its markets.
Reinsurance Premiums Ceded
Reinsurance premiums ceded increased$296.2 million , or 68%, to$733.5 million for the six months endedJune 30, 2022 , from$437.3 million for the six months endedJune 30, 2021 . The increase is driven by the growth in premiums before ceded reinsurance discussed above. 37 -------------------------------------------------------------------------------- Table of Contents Administrative Services Revenue Administrative services revenue increased$38.3 million to$38.9 million for the six months endedJune 30, 2022 , from$0.7 million for the six months endedJune 30, 2021 . This increase was driven by the launch of our newest +Oscar client, inJanuary 2022 ,Health First Health Plans , which is utilizing our technology and services to support their Individual and Medicare Advantage members.
Investment Income and Other Revenue
Investment income and other revenue decreased to$1.1 million for the six months endedJune 30, 2022 , from$1.3 million for the six months endedJune 30, 2021 , primarily due to changes in market condition and interest rates.
Claims Incurred, Net
Claims incurred, net, increased$855.3 million , or 124%, to$1.5 billion for the six months endedJune 30, 2022 , from$687.9 million for the six months endedJune 30, 2021 . The increase was primarily volume-driven due to growth in membership and higher utilization, partially offset by favorable prior period development. Other Insurance Costs Other insurance costs increased$161.0 million , or 92%, to$335.6 million for the six months endedJune 30, 2022 , from$174.6 million for the six monthsJune 30, 2021 . The increase was primarily attributable to higher broker commissions and user exchange fees, which were driven by the increase in membership.
General and Administrative Expenses
General and administrative expenses increased$39.7 million , or 34%, to$155.4 million for the six months endedJune 30, 2022 , from$115.7 million for the six months endedJune 30, 2021 . The increase was primarily attributable to higher headcount and other employee-related costs.
Federal and State Assessments
Federal and state assessments increased$71.2 million , or 106%, to$138.6 million for the six months endedJune 30, 2022 , from$67.4 million for the six months endedJune 30, 2021 , which was primarily due to higher user exchange fees and premium taxes as a result of membership growth.
Premium Deficiency Reserve Release
Premium deficiency reserve release decreased$2.7 million , to$7.7 million for the six months endedJune 30, 2022 , from$10.5 million for the six months endedJune 30, 2021 , due to the lower premium deficiency reserve established at the end of 2021 as compared to the reserve established at the end of 2020 and the amortization patterns that vary by line of business.
Income Tax Provision
Our effective tax rate for the months ended
approximately (0.96)% and (0.98)%, respectively.
Liquidity and Capital Resources
Overview
We maintain liquidity at two levels of our corporate structure, through our
health insurance subsidiaries and through
excluding our regulated insurance subsidiaries.
The majority of the assets held by our health insurance subsidiaries is in the form of cash and cash equivalents and investments. As ofJune 30, 2022 andDecember 31, 2021 , total cash and cash equivalents and investments held by our health insurance subsidiaries was$3.0 billion and$1.8 billion , respectively, of which$17.5 million and$17.0 million , respectively, was on deposit with regulators as required for statutory licensing purposes and are classified as restricted deposits on the balance sheet. 38 -------------------------------------------------------------------------------- Table of Contents Our health insurance subsidiaries' states of domicile have statutory minimum capital requirements that are intended to measure capital adequacy, taking into account the risk characteristics of an insurer's investments and products. The combined statutory capital and surplus of our health insurance subsidiaries was$668.8 million and$474.8 million atJune 30, 2022 andDecember 31, 2021 , respectively, which was in compliance with and in excess of the minimum capital requirements for each period. The health insurance subsidiaries historically have required capital contributions fromHoldco to maintain minimum levels. The health insurance subsidiaries may be subject to additional capital and surplus requirements in the future, which may require us to incur additional indebtedness, sell capital stock, or access other sources of funding in order to fund such requirements. During periods of increased volatility, such as the current macroeconomic environment, adverse securities and credit markets, including due to rising interest rates, may exert downward pressure on the availability of liquidity and credit capacity for certain issuers, and any such funding may not be available on favorable terms, or at all. Our health insurance subsidiaries also utilize quota share reinsurance arrangements to reduce our minimum capital and surplus requirements, which enables us to efficiently deploy capital to fund our growth. During the six months endedJune 30, 2022 and the year endedDecember 31, 2021 ,Holdco made$268.0 million and$540.9 million of capital contributions, respectively, to the health insurance subsidiaries. We estimate that had we not had any quota share reinsurance arrangements in place, the insurance subsidiaries would have been required to hold approximately$452.0 million and$147.9 million of additional capital as ofJune 30, 2022 andDecember 31, 2021 , respectively, whichHoldco would have been required to fund. The actual amount of any required capital contributions to our insurance subsidiaries may differ at any given time depending on each insurance subsidiary's capital adequacy. For additional information on our capital contributions and reinsurance arrangements, see Part II, Item 1A "Risk Factors-Risks Related to Our Business-If state regulators do not approve payments of dividends and distributions by our health insurance subsidiaries to us, we may not have sufficient funds to implement our business strategy" and "Risk Factors-Risks Related to Our Business-We utilize quota share reinsurance to reduce our capital and surplus requirements and protect against downside risk on medical claims. If regulators do not approve our reinsurance agreements for this purpose, or if we cannot negotiate renewals of our quota share arrangements on acceptable terms, or at all, enter into new agreements with reinsurers, or otherwise obtain capital through debt or equity financings, our capital position would be negatively impacted, and we could fall out of compliance with applicable regulatory requirements," each in this Quarterly Report on Form 10-Q. The majority of the assets held byHoldco are in the form of cash and cash equivalents and investments. As ofJune 30, 2022 andDecember 31, 2021 , total cash and cash equivalents and investments held byHoldco was$611.0 million and$738.6 million , respectively, of which$9.7 million and$11.0 million was restricted for 2022 and 2021, respectively. We believe the cash, and cash equivalents and investments held byHoldco , not including restricted cash, will be sufficient to fund our operating requirements for at least the next twelve months. Our cash flows used in operations may differ substantially from our net loss due to non-cash charges or due to changes in balance sheet accounts. The timing of our cash flows from operating activities can also vary among periods due to the timing of payments made or received. Some of our payments and receipts, including risk adjustment and subsequent reinsurance receipts, can be significant. For example, during the third quarter of 2022, we expect to make a payment through our health insurance subsidiaries of approximately$785 million into the risk adjustment program for the 2021 policy year. Therefore, their timing can influence cash flows from operating activities in any given period which would have a negative impact on our operating cash flows.
Convertible Senior Notes
OnJanuary 27, 2022 , we entered into an investment agreement (the "Investment Agreement") pursuant to which we agreed to issue and sell$305.0 million in aggregate principal amount of 7.25% convertible senior notes due 2031 (the "2031 Notes") in a private placement to funds affiliated with or advised byDragoneer Investment Group, LLC, Thrive Capital, LionTree Investment Management, LLC andTenere Capital LLC . The transaction contemplated by the Investment Agreement closed onFebruary 3, 2022 (the "Closing Date"). In connection with the issuance of the 2031 Notes, onFebruary 3, 2022 , we entered into an Indenture between us andU.S. Bank National Association , as trustee. The 2031 Notes bear interest at a rate of 7.25% per annum, payable in cash, semi-annually in arrears onJune 30 andDecember 31 of each year, commencing onJune 30, 2022 . The Company may determine in the future to repurchase portions of the outstanding 2031 Notes from time to time in accordance with applicableSEC and other legal requirements and in consideration of market and other conditions. See Note 10 - Long-Term Debt for additional information. 39 -------------------------------------------------------------------------------- Table of Contents Revolving Credit Facility OnFebruary 21, 2021 , we entered into a senior secured credit agreement (the "Revolving Credit Facility"), withWells Fargo Bank, National Association as administrative agent, and certain other lenders for a revolving loan credit facility, or the Revolving Credit Facility, in the aggregate principal amount of$200 million . The Revolving Credit Facility is guaranteed byOscar Management Corporation (formerlyMulberry Management Corporation ) andOscar Management Corporation of Florida , each wholly owned subsidiaries of Oscar, and all of our future direct and indirect subsidiaries (subject to certain permitted exceptions, including exceptions for guarantees that would require material governmental consents or in respect of joint venture) (the "Guarantors"). Our Revolving Credit Facility is secured by a lien on substantially all of our and the Guarantors' assets (subject to certain exceptions). Proceeds are to be used solely for general corporate purposes of the Company. The Revolving Credit Facility is available untilFebruary 2024 , provided we are in compliance with all covenants. The Revolving Credit Facility permits us to increase commitments under the Revolving Credit Facility by an aggregate amount not to exceed$50 million . The incurrence of any such incremental Revolving Credit Facility will be subject to the following conditions measured at the time of incurrence of such commitments: (i) no default or event of default, (ii) all representations and warranties must be true and correct in all material respects immediately prior to, and after giving effect to, the incurrence of such incremental Revolving Credit Facility and (iii) and any such conditions as agreed between the Borrower and the lender providing such incremental commitment.
As of
Credit Facility.
Term Loan Facility OnOctober 30, 2020 , we entered into the term loan credit agreement withHPS Investment Partners, LLC , as administrative agent, and certain other lenders for the term loan facility ("Term Loan Facility") in the aggregate principal amount of$150 million . In connection with the IPO, we repaid in full outstanding borrowings, including fees and expenses, under our Term Loan Facility, including a prepayment premium equal to 6.50% of the principal amount of the Term Loan Facility plus accrued and unpaid interest through the six-month anniversary of the closing date of the Term Loan Facility. For additional information regarding the Term Loan Facility, see Note 10 - Long-Term Debt of our consolidated financial statements included elsewhere in this Quarterly Report on Form 10-Q.
Interest Rate, Commitment Fees
The interest rate applicable to borrowings under our Revolving Credit Facility
is determined as follows, at our option: (a) a rate per annum equal to an
adjusted London Inter-bank Offered Rate ("LIBOR") plus an applicable margin of
4.50% (LIBOR is calculated based on one-, three- or six-month LIBOR, or such
other period as agreed by all relevant Lenders, which is determined by reference
to ICE Benchmark Administration Limited , but not less than 1.00%), or (b) a rate
per annum equal to the Alternate Base Rate plus the applicable margin of 3.50%
(the Alternate Base Rate is equal to the highest of (i) the prime rate, (ii) the
federal funds effective rate plus 0.50%, and (iii) LIBOR based on a one-month
interest period, plus 1.00%). A commitment fee of 0.50% per annum is payable
under our Revolving Credit Facility on the actual daily unused portions of the
Revolving Credit Facility. The Revolving Credit Facility also contains LIBOR
replacement provisions in the event LIBOR becomes unavailable during the term of
this facility.
The Revolving Credit Facility requires us to comply with certain restrictive
covenants, including but not limited to covenants relating to limitations on
indebtedness, liens, investments, loans and advances, restricted payments and
restrictive agreements, mergers, consolidations, sale of assets and
acquisitions, sale and leaseback transactions and affiliate transactions.
In addition, the Revolving Credit Facility contains financial covenants that
require us to maintain specified levels of direct policy premiums and liquidity
and require compliance with a maximum combined ratio.
Investments
We generally invest cash of our health insurance subsidiaries inU.S. treasury and agency securities. We primarily invest cash of the Company in investment-grade, marketable debt securities to improve our overall investment return. These investments are purchased pursuant to board approved investment policies which conform to applicable state laws and regulations. Our investment policies are designed to provide liquidity, preserve capital, and maximize total return on invested assets, all in a manner consistent with state requirements that prescribe the types of instruments in which our subsidiaries may invest. 40 -------------------------------------------------------------------------------- Table of Contents These investment policies require that our investments have final maturities of a maximum of three years from the settlement date. Professional portfolio managers operating under documented guidelines manage our investments and a portion of our cash equivalents. Our portfolio managers must obtain our prior approval before selling investments where the loss position of those investments exceeds certain levels. Our restricted investments are invested principally in cash and cash equivalents andU.S. treasury securities; we have the ability to hold such restricted investments until maturity. The Company maintains cash and cash equivalents and investments on deposit or pledged to various state agencies as a condition for licensure. We classify our restricted deposits as long-term given the requirement to maintain such assets on deposit with regulators. Summary of Cash Flows Our cash flows used in operations may differ substantially from our net loss due to non-cash charges or due to changes in balance sheet accounts. The timing of our cash flows from operating activities can also vary among periods due to the timing of payments made or received. Some of our payments and receipts, including loss settlements and subsequent reinsurance receipts, can be significant. Therefore, their timing can influence cash flows from operating activities in any given period. The potential for a large claim under an insurance or reinsurance contract means that our health insurance subsidiaries may need to make substantial payments within relatively short periods of time, which would have a negative impact on our operating cash flows. The following table shows summary cash flows information for the periods indicated: Six Months Ended June 30, 2022 2021 Change (in thousands) Net cash provided by operating activities$ 777,316 $ 373,028 $ 404,288 Net cash provided by (used in) investing activities 181,388 (742,314) 923,702 Net cash provided by financing activities 300,160 1,214,538 (914,378) Net increase in cash and cash equivalents and restricted cash equivalents$ 1,258,864
Operating Activities
Net cash provided by operating activities increased$404.3 million to$777.3 million for the six months endedJune 30, 2022 , compared to$373.0 million provided by operating activities for the six months endedJune 30, 2021 , primarily due to membership growth, which resulted in increased premiums and accounts receivable and reinsurance recoverable under our quota share reinsurance program. Our risk adjustment transfer payable also increased as a result of membership growth and the health status of our members, who continue to have lower than average risk scores compared to the health status of other participants in ACA plans. Investing Activities Net cash provided by investing activities increased to$181.4 million for the six months endedJune 30, 2022 , compared to$742.3 million net cash used in investing activities for the six months endedJune 30, 2021 , an increase of$923.7 million . The increase was primarily due to the sale and maturity of securities within our investment portfolio and lower purchases of investments in 2022 compared to 2021. Financing Activities Net cash provided by financing activities decreased$914.4 million to$300.2 million for the six months endedJune 30, 2022 , compared to$1.2 billion for the six months endedJune 30, 2021 . The decrease was primarily due to net proceeds received from the sale of common stock during our IPO inMarch 2021 , slightly offset by net proceeds received from the issuance of convertible notes inFebruary 2022 . 41
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