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Oscar Health Announces Results for First Quarter 2021

05/13/2021
  • Membership as of March 31, 2021 of 542,220, a 28.9% increase YoY
  • For the quarter ended March 31, 2021:
    • Direct policy premiums of $820.8 million, a 43.5% increase YoY
    • Premiums earned of $368.5 million, a 332.5% increase YoY
    • Medical Loss Ratio of 74.4%, improved 670 bps YoY
    • InsuranceCo Administrative Expense Ratio of 19.8%, improved 380 bps YoY
    • InsuranceCo Combined Ratio of 94.2%, improved 1040 bps YoY
    • Net loss of $(87.4) million, improved $9.5 million YoY and Adjusted EBITDA of $(26.3) million, improved $59.9 million YoY

Health insure-tech company Oscar Health, Inc. (NYSE: OSCR) today announced its financial results for the three months ended March 31, 2021.

“Our first quarter results show that our model is delivering value to the market, our provider partners and to our members,” said Mario Schlosser, CEO and Co-Founder of Oscar. “We achieved very attractive first quarter growth, while simultaneously lowering our medical loss ratio and administrative cost ratio year-over-year. This trend, coupled with the recent launch of +Oscar, positions our company well for continued sustainable growth and improving profitability.”

Total direct policy premiums were $820.8 million in the quarter, up 43.5% year-over-year (“YoY”), driven primarily by higher membership growth in existing and new states and business mix shifts. Premiums earned in the quarter were up 332.5% YoY, driven both by membership growth and lower quota share cession rates in 2021.

Oscar’s InsuranceCo Combined Ratio, which is the sum of its Medical Loss Ratio (“MLR”) and the InsuranceCo Administrative Expense Ratio, improved 1040 bps YoY to 94.2% reflecting a consolidated profit across the insurance companies. Oscar’s MLR improved 670 bps YoY, driven by the absence of reserve increases that occurred in the quarter ended March 31, 2020 and a modest benefit from favorable prior period development in the quarter ended March 31, 2021. The InsuranceCo Administrative Expense Ratio improved by 380 bps YoY, driven by operating leverage, scale efficiencies from our tech stack, and the repeal of the health insurer fee (“HIF”).

Net loss was $(87.4) million in the quarter, an improvement of $9.5 million YoY and Adjusted EBITDA loss was $(26.3) million, an improvement of $59.9 million YoY.

Key Metrics and Non-GAAP Financial Metrics

 

 

Three Months Ended March 31,

 

 

2021

 

2020

Members

 

542,220

 

 

420,552

 

Direct Policy Premiums (in thousands)

 

$

820,814

 

 

$

572,011

 

Medical Loss Ratio

 

74.4

%

 

81.1

%

InsuranceCo Administrative Expense Ratio

 

19.8

%

 

23.6

%

InsuranceCo Combined Ratio

 

94.2

%

 

104.6

%

Adjusted EBITDA(1) (in thousands)

 

$

(26,258)

 

 

$

(86,168)

 

  1. Adjusted EBITDA is a non-GAAP measure. See “Key Operating and Non-GAAP Metrics - Adjusted EBITDA” in this release for a reconciliation to net loss, the most directly comparable GAAP measure, and for information regarding Oscar’s use of Adjusted EBITDA.

Membership by Offering

 

 

 

 

 

 

 

As of

 

 

March 31, 2021

 

March 31, 2020

Individual and Small Group

 

535,001

 

 

418,924

 

Medicare Advantage

 

3,628

 

 

1,628

 

Cigna + Oscar(1)

 

3,591

 

 

 

Total Members

 

542,220

 

 

420,552

 

  1. Represents total membership for Oscar’s co-branded partnership with Cigna.

Full Year 2021 Outlook

 

 

Low

 

High

Direct and Assumed Policy Premiums (in thousands)

 

$

3,075,000

 

 

$

3,175,000

 

Medical Loss Ratio

 

84.0

%

 

86.0

%

InsuranceCo Administrative Expense Ratio

 

22.5

%

 

23.5

%

InsuranceCo Combined Ratio

 

107.0

%

 

109.0

%

Adjusted EBITDA(1) (in thousands)

 

$

(380,000)

 

 

$

(350,000)

 

  1. Oscar has not provided a quantitative reconciliation of forecasted Adjusted EBITDA to forecasted GAAP net loss within this press release because Oscar is unable, without making unreasonable efforts, to calculate certain reconciling items with confidence. These items include, but are not limited to, stock-based compensation expense. These items, which could materially affect the computation of forecasted GAAP net loss, are inherently uncertain and depend on various factors, some of which are outside of Oscar’s control. As such, any associated estimate and its impact on GAAP net loss could vary materially. For more information regarding Adjusted EBITDA, please see “Key Operating and Non-GAAP Metrics” below.

The foregoing statements represent management's current estimates as of the date of this release. Actual results may differ materially depending on a number of factors. Investors are urged to read the Cautionary Note Regarding Forward-Looking Statements included in this release. Management does not assume any obligation to update these estimates.

Quarterly Conference Call Details

Oscar will host a conference call to discuss the financial results today, May 13, 2021 at 5:00 p.m. (ET). A live audio webcast and a supplemental presentation will be available via the Investor Relations page of Oscar’s website at ir.hioscar.com. A replay of the webcast will be available for on-demand listening shortly after the completion of the call, at the same web link, and will remain available for approximately 90 days.

Non-GAAP Financial Information

This release presents Adjusted EBITDA, a non-GAAP financial metrics, which is provided as a complement to the results provided in accordance with accounting principles generally accepted in the United States of America (“GAAP”). A reconciliation of the non-GAAP financial information to the most directly comparable GAAP financial measure is provided in the accompanying tables found at the end of this release.

Cautionary Note Regarding Forward-Looking Statements

This press release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. All statements other than statements of historical fact contained herein are forward-looking statements. These statements include, but are not limited to, statements about our financial outlook and estimates, including direct policy premiums, medical loss ratio, administrative expense ratio and other financial performance, and the related underlying assumptions, our business and financial prospects, general and healthcare industry market conditions and trends, and our management’s plans and objectives for future operations, expectations and business strategy. In some cases, you can identify forward-looking statements by terms such as “may,” “will,” “should,” “expects,” “plans,” “anticipates,” “could,” “intends,” “targets,” “projects,” “contemplates,” “believes,” “estimates,” “predicts,” “potential,” or “continue” or the negative of these terms or other similar expressions. Accordingly, we caution you that any such forward-looking statements are not guarantees of future performance and are subject to risks, assumptions, and uncertainties that are difficult to predict and generally beyond our control.

Although we believe that the expectations reflected in these forward-looking statements are reasonable as of the date made, there are or will be important factors that could cause our actual results to differ materially from those indicated in these forward-looking statements, including, but not limited to, the following: the impact of COVID-19 on global markets, economic conditions, the healthcare industry and our results of operations, and the response by governments and other third parties; our ability to retain and expand our member base; our ability to execute our growth strategy; our ability to maintain or enter into new partnerships or collaborations with healthcare industry participants; negative publicity, unfavorable shifts in perception of our digital platform or other member service channels; our ability to achieve and/or maintain profitability in the future; changes in federal or state laws or regulations, including changes with respect to the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, as amended (collectively, the “ACA”) and any regulations enacted thereunder; our ability to accurately estimate our incurred claims expenses or effectively manage our claims costs or related administrative costs, including as a result of fluctuations in medical utilization rates due to the impact of COVID-19; our ability to comply with ongoing regulatory requirements and applicable performance standards, including as a result of our participation in government-sponsored programs, such as Medicare; changes or developments in the health insurance markets in the United States, including the passage and implementation of a law to create a single-payer or government-run health insurance program; our ability to comply with applicable privacy, security, and data laws, regulations, and standards; our ability to maintain key in-network providers and good relations with the physicians, hospitals, and other providers within and outside our provider networks, or to arrange for the delivery of quality care; unfavorable or otherwise costly outcomes of lawsuits and claims that arise from the extensive laws and regulations to which we are subject; unanticipated results of risk adjustment programs; delays in our receipt of premiums; disruptions or challenges to our relationship with the Oscar Medical Group; cyber-security breaches of our and our partners’ information and technology systems; unanticipated changes in population morbidity and large-scale changes in health care utilization; and the other factors set forth under the caption “Risk Factors” in our prospectus dated March 2, 2021, filed with the Securities and Exchange Commission (“SEC”) pursuant to Rule 424(b) and our other filings with the SEC.

You are cautioned not to place undue reliance on any forward-looking statements made in this press release. Any forward-looking statement speaks only as of the date as of which it is made, and, except as otherwise required by law, we do not undertake any obligation to publicly update or review any forward-looking statement, whether as a result of new information, future developments or otherwise. New factors emerge from time to time, and it is not possible for us to predict which will arise.

About Oscar Health

Oscar Health, Inc. (“Oscar”) is the first health insurance company built around a full stack technology platform and a relentless focus on serving its members. At Oscar, our mission is to make a healthier life accessible and affordable for all. Headquartered in New York City, Oscar has been challenging the health care system's status quo since our founding in 2012. The company’s member-first philosophy and innovative approach to care has earned us the trust of approximately 540,000 membersas of March 31, 2021. We offer Individual & Family, Small Group and Medicare Advantage plans, and +Oscar, our full stack technology platform to others within the provider and payor space. Our vision is to refactor health care to make good care cost less. Refactor is a term used in software engineering that means to improve the design, structure, and implementation of the software, while preserving its functionality. At Oscar, we take this definition a step further. We improve our members’ experience by building trust through deep engagement, personalized guidance, and rapid iteration.

Oscar Health, Inc.

Consolidated Statements of Operations

(in thousands, except share and per share amounts)

(unaudited)

 

 

 

Three Months Ended March 31,

 

2021

 

2020

Revenue

 

 

 

Premiums before ceded reinsurance

$

610,099

 

 

$

424,448

 

Reinsurance premiums ceded

(241,562)

 

 

(339,229)

 

Premiums earned

368,537

 

 

85,219

 

Investment income and other revenue

851

 

 

2,884

 

Total revenue

369,388

 

 

88,103

 

 

 

 

 

Operating Expenses

 

 

 

Claims incurred, net

268,048

 

 

84,216

 

Other insurance cost (including non-cash stock-based compensation expense of $9.7 million and $4.1 million as of March 31, 2021 and 2020, respectively)

79,837

 

 

40,904

 

General and administrative expenses (including non-cash stock-based compensation expense of $9.4 million and $4.0 million as of March 31, 2021 and 2020, respectively)

63,062

 

 

31,839

 

Federal and state assessments

30,515

 

 

22,297

 

Health insurance industry fee

 

 

4,813

 

Premium deficiency reserve release

(9,543)

 

 

(18)

 

Total operating expenses

431,919

 

 

184,051

 

Loss from operations

(62,531)

 

 

(95,948)

 

Interest expense

3,697

 

 

 

Loss on extinguishment of debt

20,178

 

 

 

Loss before income tax expense

(86,406)

 

 

(95,948)

 

Income tax provision

965

 

 

931

 

Net loss

$

(87,371)

 

 

$

(96,879)

 

 

 

 

 

Earnings (Loss) per Share

 

 

 

Net loss per share, basic and diluted

$

(0.98)

 

 

$

(3.36)

 

Weighted average common shares outstanding, basic and diluted

88,865,726

 

 

28,874,520

 

 

 

 

 

 

Oscar Health, Inc.

Consolidated Balance Sheets

(in thousands, except share and per share amounts)

(unaudited)

 

March 31, 2021

 

December 31, 2020

Assets:

 

 

 

Current Assets:

 

 

 

Cash and cash equivalents

$

2,321,287

 

 

$

826,326

 

Short-term investments

389,016

 

 

366,387

 

Premium and other receivables

75,851

 

 

65,322

 

Risk adjustment transfer receivable

37,765

 

 

31,157

 

Accrued investment income

1,445

 

 

1,862

 

Balances due from reinsurance programs

353,996

 

 

579,393

 

Total Current Assets

3,179,360

 

 

1,870,447

 

Property, equipment, and capitalized software, net

38,993

 

 

35,812

 

Long-term investments

329,597

 

 

325,740

 

Restricted deposits

26,449

 

 

26,478

 

Other assets

19,472

 

 

13,136

 

Net deferred tax asset

485

 

 

493

 

Total Assets

$

3,594,356

 

 

$

2,272,106

 

 

 

 

 

Liabilities, Convertible Preferred Stock and Stockholders' Equity (Deficit)

 

 

Current Liabilities:

 

 

 

Benefits payable

$

358,066

 

 

$

311,914

 

Risk adjustment transfer payable

922,069

 

 

716,370

 

Premium deficiency reserve

75,029

 

 

84,571

 

Unearned premiums

71,946

 

 

71,904

 

Accounts payable and accrued liabilities

120,954

 

 

137,524

 

Reinsurance payable

260,055

 

 

343,313

 

Total current liabilities

1,808,119

 

 

1,665,596

 

Long-term debt

 

 

142,487

 

Warrant liabilities

 

 

15,005

 

Total liabilities

1,808,119

 

 

1,823,088

 

Commitments and contingencies

 

 

 

Convertible Preferred Stock, $0.00001 par value; 407,156,831 shares authorized; 400,904,302 shares issued and outstanding as of December 31, 2020

 

 

1,744,911

 

Stockholders' Equity (Deficit)

 

 

 

Preferred stock, $0.00001 par value; 82,500,000 shares authorized, none issued or outstanding as of March 31, 2021

 

 

 

Class A common stock, $0.00001 par value; 825,000,000 shares authorized, 172,060,630 shares issued and outstanding as of March 31, 2021

2

 

 

 

Class B common stock, $0.00001 par value; 82,500,000 shares authorized, 35,115,807 shares issued and outstanding as of March 31, 2021

 

 

 

Series A common stock, $0.00001 par value, 680,000,000 shares authorized; 8,291,917 issued and outstanding;
Series B common stock, $0.00001 par value, 69,487,963 shares authorized; 23,162,654 shares issued and outstanding as of December 31, 2020;
Series C common stock, $0.00001 par value, 10,000,000 shares authorized, no shares issued and outstanding as of December 31, 2020

 

 

2

 

Treasury stock at (314,600 shares at March 31, 2021 and December 31, 2020)

(2,923)

 

 

(2,923)

 

Additional paid-in capital

3,303,031

 

 

133,255

 

Accumulated deficit

(1,514,477)

 

 

(1,427,106)

 

Accumulated other comprehensive income (loss)

604

 

 

879

 

Total Stockholders’ Equity (Deficit)

1,786,237

 

 

(1,295,893)

 

Total Liabilities, Convertible Preferred Stock and Stockholders' Equity (Deficit)

3,594,356

 

 

2,272,106

 

 

Oscar Health Inc.

Consolidated Statements of Cash Flows

(in thousands)

(unaudited)

 

Three Months Ended March 31,

 

2021

 

2020

Cash flows from operating activities:

 

 

 

Net loss

$

(87,371)

 

 

$

(96,879)

 

Adjustments to reconcile net loss to net cash used in operating activities:

 

 

 

Deferred tax

8

 

 

120

 

Net realized gain on sale of financial instruments

(113)

 

 

(654)

 

(Gain) loss on fair value of warrant expense

12,856

 

 

(860)

 

Depreciation and amortization expense

3,403

 

 

2,544

 

Amortization of debt issuance costs

329

 

 

 

Stock-based compensation expense

19,115

 

 

8,096

 

Investment amortization, net of accretion

1,074

 

 

155

 

Debt extinguishment loss

20,178

 

 

 

Changes in assets and liabilities:

 

 

 

(Increase) / decrease in:

 

 

 

Premium and other receivables

(10,529)

 

 

(75,271)

 

Risk adjustment transfer receivable

(6,608)

 

 

(11,151)

 

Accrued investment income

417

 

 

322

 

Balances due from reinsurance programs

225,397

 

 

(92,900)

 

Other assets

(6,336)

 

 

(14,823)

 

Increase / (decrease) in:

 

 

 

Benefits payable

46,152

 

 

96,423

 

Unearned premiums

42

 

 

(2,855)

 

Premium deficiency reserve

(9,542)

 

 

(18)

 

Accounts payable and accrued liabilities

(13,222)

 

 

15,461

 

Reinsurance payable

(83,258)

 

 

119,881

 

Risk adjustment transfer payable

205,699

 

 

158,759

 

Net cash provided by operating activities

317,691

 

 

106,350

 

Cash flows from investing activities:

 

 

 

Purchase of fixed maturity securities

(245,694)

 

 

(150,752)

 

Sale of investments

83,798

 

 

163,887

 

Maturity of investments

134,199

 

 

39,211

 

Purchase of property, equipment and capitalized software

(6,583)

 

 

(3,978)

 

Change in restricted deposits

 

 

(356)

 

Net cash (used in) provided by investing activities

(34,280)

 

 

48,012

 

Cash flows from financing activities:

 

 

 

Debt prepayment

(153,173)

 

 

 

Debt extinguishment costs

(12,994)

 

 

 

Proceeds from IPO, net of underwriting discounts

1,348,321

 

 

 

Offering costs from IPO

(9,447)

 

 

 

Proceeds from exercise of warrants and call options

9,191

 

 

 

Proceeds from exercise of stock options

29,652

 

 

442

 

Net cash provided by financing activities

1,211,550

 

 

442

 

Increase in cash, cash equivalents and restricted cash equivalents

1,494,961

 

 

154,804

 

Cash, cash equivalents, restricted cash and cash equivalents—beginning of period

843,105

 

 

353,380

 

Cash, cash equivalents, restricted cash and cash equivalents—end of period

$

2,338,066

 

 

$

508,184

 

 

 

 

 

Cash and cash equivalents

$

2,321,287

 

 

$

491,711

 

Restricted cash and cash equivalents included in restricted deposits

16,779

 

 

16,473

 

Total cash, cash equivalents and restricted cash and cash equivalents

$

2,338,066

 

 

$

508,184

 

 

 

 

 

Supplemental Disclosures:

 

 

 

Interest payments

$

3,553

 

 

$

 

 

 

 

 

Non-cash investing and financing activities:

 

 

 

Conversion of redeemable convertible preferred stock to common stock upon initial public offering

$

1,744,911

 

 

$

 

Net exercise of preferred stock warrants to preferred stock upon initial public offering

$

28,248

 

 

$

 

Adjustment to fair value of preferred stock warrant liability upon initial public offering

$

(13,243)

 

 

$

 

Key Operating and Non-GAAP 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.

Members

Members are defined as any individual covered by one of our health plans. 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.

Direct 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. Through March 31, 2021, APTC was available to those individuals and families with annual incomes between 100% and 600% of the federal poverty level in California and 100% and 400% of the federal poverty level in all other states under the ACA. Starting April 1, 2021, consumers enrolling in Individual health plans through a health insurance marketplace could take advantage of additional subsidies available under the American Rescue Plan, which caps premium payment at 8.5% of household income, and expands maximum coverage subsidies to anyone who received unemployment insurance benefits in 2021. We believe direct policy premiums are an important metric to assess our growth. We expect direct policy premiums will increase over time as we increase membership and continue to shift our member mix more towards higher value metal tiers like Silver and diversify across our product markets.

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 loss ratio of our costs to pay for health care of our members to the premiums before ceded reinsurance. We believe our member engagement engine and full stack technology platform will allow us to more efficiently manage total claims incurred. 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

 

 

March 31, 2021

 

March 31, 2020

 

 

(in thousands)

Direct claims incurred before ceded quota share reinsurance (1)

 

$

457,219

 

 

$

345,509

 

Assumed reinsurance claims

 

1,777

 

 

(2)

 

Excess of loss ceded claims (2)

 

(4,736)

 

 

(4,935)

 

State reinsurance (3)

 

(2,343)

 

 

(904)

 

Net claims before ceded quota share reinsurance (A)

 

$

451,917

 

 

$

339,668

 

 

 

 

 

 

Premiums before ceded reinsurance

 

$

610,099

 

 

$

424,448

 

Excess of loss reinsurance premiums (4)

 

(2,935)

 

 

(5,547)

 

Net premiums before ceded quota share reinsurance (B)

 

$

607,164

 

 

$

418,901

 

Medical Loss Ratio (A divided by B)

 

74.4

%

 

81.1

%

  1. See the Appendix to this release 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. Represents excess of loss insurance premiums paid.

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 lower our expenses as a percentage of premiums before ceded 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 exchange fees, employee-related compensation, benefits, marketing costs, and other administrative expenses. Below is a calculation of our InsuranceCo Administrative Expense Ratio for the periods indicated.

 

 

Three Months Ended

 

 

March 31, 2021

 

March 31, 2020

 

 

(in thousands)

Other insurance costs

 

$

79,837

 

 

$

40,904

 

Ceding commissions

 

19,306

 

 

35,026

 

Stock-based compensation expense

 

(9,695)

 

 

(4,086)

 

Health insurance industry fee

 

 

 

4,813

 

Federal and state assessment of health insurance subsidiaries

 

30,598

 

 

22,024

 

Health insurance subsidiary adjusted administrative expenses(A)

 

$

120,046

 

 

$

98,681

 

 

 

 

 

 

Premiums before ceded reinsurance

 

$

610,099

 

 

$

424,448

 

Excess of loss reinsurance premiums

 

(2,935)

 

 

(5,547)

 

Net premiums before ceded quota share reinsurance(B)

 

$

607,164

 

 

$

418,901

 

Insurance Co Administrative Expense Ratio(A divided by B)

 

19.8

%

 

23.6

%

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.

Adjusted EBITDA

Adjusted EBITDA is defined as net loss for the Company and its consolidated subsidiaries before interest expense, income tax 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.

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

 

 

March 31, 2021

 

March 31, 2020

 

 

(in thousands)

Net loss

 

$

(87,371)

 

 

$

(96,879)

 

Interest expense

 

3,697

 

 

 

Income tax expense

 

965

 

 

931

 

Depreciation and amortization

 

3,403

 

 

2,544

 

Stock-based compensation/warrant expense (1)

 

31,972

 

 

7,236

 

Other non-recurring items (2)

 

21,076

 

 

 

Adjusted EBITDA

 

$

(26,258)

 

 

$

(86,168)

 

  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 and approximately $0.9 million of non-recurring expenses incurred in connection with our initial public offering.

Appendix

Reinsurance Impact

 

 

Three Months Ended

 

 

March 31, 2021

 

March 31, 2020

 

 

(in thousands)

Quota share ceded premiums

 

$

(261,852)

 

 

$

(352,163)

 

Quota share ceded claims

 

183,869

 

 

255,451

 

Ceding commission

 

19,306

 

 

35,026

 

Experience refund

 

23,225

 

 

18,481

 

Net quota share impact

 

$

(35,452)

 

 

$

(43,205)

 

The composition of total reinsurance premiums ceded and reinsurance premiums assumed, which are included as components of total earned premiums in the consolidated statement of operations, is as follows:

 

 

Three Months Ended

 

 

March 31, 2021

 

March 31, 2020

 

 

(in thousands)

Reinsurance premiums ceded, gross

 

$

(264,787)

 

 

$

(357,710)

 

Experience refunds

 

23,225

 

 

18,481

 

Reinsurance premiums ceded

 

(241,562)

 

 

(339,229)

 

Reinsurance premiums assumed

 

2,411

 

 

 

Total reinsurance premiums ceded and assumed

 

$

(239,151)

 

 

$

(339,229)

 

The Company records claims expense net of reinsurance recoveries. The following table reconciles the total claims expense to the net claims expense as presented in the consolidated statement of operations:

 

 

Three Months Ended

 

 

March 31, 2021

 

March 31, 2020

 

 

(in thousands)

Direct claims incurred

 

$

457,219

 

 

$

345,508

 

Ceded reinsurance claims

 

(190,948)

 

 

(261,290)

 

Assumed reinsurance claims

 

1,777

 

 

(2)

 

Total claims incurred, net

 

$

268,048

 

 

$

84,216

 

The Company records selling, general and administrative expenses net of ceding commissions. The following table reconciles total other insurance costs to the amount presented in the consolidated statement of operations:

 

 

Three Months Ended

 

 

March 31, 2021

 

March 31, 2020

 

 

(in thousands)

Other insurance costs, gross

 

$

99,143

 

 

$

75,930

 

Ceding commissions

 

(19,306)

 

 

(35,026)

 

Other insurance costs, net

 

$

79,837

 

 

$

40,904

 

The Company records reinsurance recoverables as “balances due from reinsurance programs” within current assets on its consolidated balance sheets. The composition of the reinsurance recoverables balance is as follows:

 

 

March 31, 2021

 

December 31, 2020

 

 

(in thousands)

Ceded reinsurance claim recoverables

 

$

307,943

 

 

$

435,331

 

Reinsurance ceding commissions

 

27,469

 

 

41,586

 

Experience refunds on reinsurance agreements

 

18,584

 

 

102,476

 

Balances due from reinsurance programs

 

$

353,996

 

 

$

579,393

 

 

Investor Contact:
Cornelia Miller
VP of Investor Relations
ir@hioscar.com
917-397-0251

Media Contact:
Jackie Kahn
VP of Communications
comms@hioscar.com
202-538-0128

Source: Oscar Health, Inc.

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