Oscar Health Announces Strong Financial Results for Second Quarter 2023

08/08/2023
  • For the quarter ended June 30, 2023:
    • Direct and Assumed Policy Premiums of $1.6 billion, a 3% decrease YoY
    • Premiums earned of $1.5 billion, a 48% increase YoY
    • Medical Loss Ratio of 79.9%, a 230 bps improvement YoY
    • Net loss of ($15.4) million, an improvement of $96.7 million YoY
    • Adjusted EBITDA of $35.6 million, an improvement of $111.4 million YoY
    • InsuranceCo Administrative Expense Ratio of 16.7%, a 280 bps improvement YoY
    • InsuranceCo Combined Ratio of 96.7%, a 500 bps improvement YoY
    • Adjusted Administrative Expense Ratio of 19.5%, a 420 bps improvement YoY

Health tech company Oscar Health, Inc. (NYSE: OSCR) today announced its financial results for the second quarter ended June 30, 2023.

“Our strong second quarter results demonstrate that our pricing discipline, renewed operational focus, and solid execution are driving meaningful impact across our business,” said Mark Bertolini, CEO of Oscar. “Based on strong year-to-date performance, we now expect to be towards the low-end of our MLR guidance and high-end of our full year Adjusted EBITDA guidance. We remain on track to deliver on our profitability targets and I am pleased with our progress to date.”

Total Direct and Assumed Policy Premiums were $1.6 billion in the quarter, down 3% year-over-year (“YoY”), driven primarily by lower membership, partially offset by rate increases. Premiums earned in the quarter were up 48% YoY, driven primarily by lower risk transfer per member as a percent of premiums, and the impact of deposit accounting for quota share reinsurance agreements.

Oscar’s InsuranceCo Combined Ratio, which is the sum of its Medical Loss Ratio (“MLR”) and the InsuranceCo Administrative Expense Ratio, improved 500 bps YoY to 96.7%, reflecting a consolidated profit across the insurance companies, driven by both an improved MLR and administrative cost efficiencies. Specifically, the MLR improved 230 bps YoY to 79.9%, due to a disciplined pricing strategy and total cost of care initiatives. The InsuranceCo Administrative Expense Ratio improved 280 bps YoY to 16.7%, driven primarily by lower distribution expenses.

The Adjusted Administrative Expense Ratio improved 420 bps YoY to 19.5%, driven primarily by lower distribution expenses, variable expense efficiencies, and higher investment income. Adjusted EBITDA of $35.6 million significantly improved by $111.4 million YoY, and also improved as a percentage of premiums before ceded reinsurance by 8 points as compared to the prior period. Net loss of ($15.4) million improved by $96.7 million YoY, and decreased as a percentage of premiums before ceded reinsurance by 7 points YoY.

Oscar is reaffirming its full year 2023 outlook across all metrics as provided in its financial results press release dated February 9, 2023, with MLR now projected to be towards the low-end of the 82% - 84% range and Adjusted EBITDA1 projected to be towards the high-end of the ($175) million - ($75) million range, towards a ($75) million loss.

Effective August 14, 2023, Oscar’s current Chief Transformation Officer, R. Scott Blackley, will transition to the role of Chief Financial Officer. Mr. Blackley will oversee treasury, actuarial, financial reporting, capital management and investor relations functions. Oscar’s current Chief Financial Officer and Board Member, Sid Sankaran, will step down effective August 13, 2023, and will maintain his position on the Board.

______________________________

1

See “Non-GAAP Financial Information” below.

Financial Results Summary

 

 

 

 

 

 

 

 

 

Three Months Ended June 30,

 

Six Months Ended June 30,

 

 

2023

 

 

 

2022

 

 

 

2023

 

 

 

2022

 

 

(in thousands)

Premiums before ceded reinsurance

$

1,484,538

 

 

$

1,368,477

 

 

$

2,910,800

 

 

$

2,683,541

 

Reinsurance premiums ceded

 

(9,572

)

 

 

(373,882

)

 

 

(7,208

)

 

 

(733,545

)

Premiums earned

$

1,474,966

 

 

$

994,595

 

 

$

2,903,592

 

 

$

1,949,996

 

Total revenue

$

1,521,535

 

 

$

1,017,319

 

 

$

2,991,220

 

 

$

1,990,084

 

Total operating expenses

$

1,528,064

 

 

$

1,123,806

 

 

$

3,023,114

 

 

$

2,165,100

 

Net loss

$

(15,425

)

 

$

(112,125

)

 

$

(55,053

)

 

$

(189,445

)

Key Metrics and Non-GAAP Financial Metrics

 

 

 

 

 

 

 

 

 

Three Months Ended June 30,

 

Six Months Ended June 30,

 

 

2023

 

 

 

2022

 

 

 

2023

 

 

 

2022

 

Direct and Assumed Policy Premiums (in thousands)

$

1,645,169

 

 

$

1,694,927

 

 

$

3,364,578

 

 

$

3,376,138

 

Medical Loss Ratio

 

79.9

%

 

 

82.2

%

 

 

78.2

%

 

 

79.9

%

InsuranceCo Administrative Expense Ratio

 

16.7

%

 

 

19.5

%

 

 

17.7

%

 

 

19.7

%

InsuranceCo Combined Ratio

 

96.7

%

 

 

101.7

%

 

 

95.8

%

 

 

99.6

%

Adjusted Administrative Expense Ratio

 

19.5

%

 

 

23.7

%

 

 

20.6

%

 

 

23.7

%

Adjusted EBITDA(1) (in thousands)

$

35,572

 

 

$

(75,805

)

 

$

86,640

 

 

$

(112,845

)

(1)

Adjusted EBITDA is a non-GAAP measure. See “Key Operating and Non-GAAP Financial 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.

 

 

 

 

 

 

 

As of June 30,

Membership by Offering

 

2023

 

2022

Individual and Small Group

 

900,228

 

986,017

Medicare Advantage

 

1,843

 

4,658

Cigna + Oscar(1)

 

68,472

 

46,045

Total Members

 

970,543

 

1,036,720

(1)

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

Quarterly Conference Call Details

Oscar will host a conference call to discuss the financial results today, August 8, 2023, 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 metric, 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. 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 Financial Metrics” below.

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 and assumed policy premiums, medical loss ratio, administrative expense ratio, Adjusted EBITDA and other financial performance metrics, and the related underlying assumptions, our business and financial prospects, 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: our ability to execute our strategy and manage our growth effectively; our ability to retain and expand our member base; heightened competition in the markets in which we participate; our ability to accurately estimate our incurred medical expenses or effectively manage our medical costs or related administrative costs; our ability to achieve 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 comply with ongoing regulatory requirements, including capital reserve and surplus requirements and applicable performance standards; changes or developments in the health insurance markets in the United States, including 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, including as a result of our participation in government-sponsored programs, such as Medicare; our ability to arrange for the delivery of quality care and maintain good relations with the physicians, hospitals, and other providers within and outside our provider networks; unanticipated results of risk adjustment programs; our ability to utilize quota share reinsurance to reduce our capital and surplus requirements and protect against downside risk on medical claims; unfavorable or otherwise costly outcomes of lawsuits and claims that arise from the extensive laws and regulations to which we are subject; our ability to attract and retain qualified personnel; incurrence of cyber-security breaches of our and our partners’ information and technology systems; our ability to remediate a material weakness in our internal controls over financial reporting and the identification of additional material weaknesses in the future or other failure to maintain an effective system of internal controls; adverse publicity or other adverse consequences related to our dual class structure or “controlled company” status; and the other factors set forth under the caption “Risk Factors” in our Quarterly Report on Form 10-Q for the quarterly period ended March 31, 2023, filed with the Securities and Exchange Commission (“SEC”), and our other filings with the SEC, including our Quarterly Report on Form 10-Q for the quarterly period ended June 30, 2023, to be filed 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 nearly one million members,as of June 30, 2023. 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 June 30,

 

Six Months Ended June 30,

 

 

2023

 

 

 

2022

 

 

 

2023

 

 

 

2022

 

Revenue

 

 

 

 

 

 

 

Premiums before ceded reinsurance

$

1,484,538

 

 

$

1,368,477

 

 

$

2,910,800

 

 

$

2,683,541

 

Reinsurance premiums ceded

 

(9,572

)

 

 

(373,882

)

 

 

(7,208

)

 

 

(733,545

)

Premiums earned

 

1,474,966

 

 

 

994,595

 

 

 

2,903,592

 

 

 

1,949,996

 

Administrative services revenue

 

3,856

 

 

 

20,452

 

 

 

7,741

 

 

 

38,945

 

Investment income and other revenue

 

42,713

 

 

 

2,272

 

 

 

79,887

 

 

 

1,143

 

Total revenue

 

1,521,535

 

 

 

1,017,319

 

 

 

2,991,220

 

 

 

1,990,084

 

 

 

 

 

 

 

 

 

Operating Expenses

 

 

 

 

 

 

 

Claims incurred, net

 

1,181,999

 

 

 

808,639

 

 

 

2,273,591

 

 

 

1,543,205

 

Other insurance costs

 

197,784

 

 

 

170,200

 

 

 

425,215

 

 

 

335,602

 

General and administrative expenses

 

76,453

 

 

 

80,754

 

 

 

178,603

 

 

 

155,418

 

Federal and state assessments

 

72,647

 

 

 

68,749

 

 

 

146,538

 

 

 

138,616

 

Premium deficiency reserve release

 

(819

)

 

 

(4,536

)

 

 

(833

)

 

 

(7,741

)

Total operating expenses

 

1,528,064

 

 

 

1,123,806

 

 

 

3,023,114

 

 

 

2,165,100

 

Loss from operations

 

(6,529

)

 

 

(106,487

)

 

 

(31,894

)

 

 

(175,016

)

Interest expense

 

6,120

 

 

 

6,141

 

 

 

12,256

 

 

 

10,362

 

Other expenses (income)

 

1,612

 

 

 

(793

)

 

 

7,718

 

 

 

2,260

 

Loss before income taxes

 

(14,261

)

 

 

(111,835

)

 

 

(51,868

)

 

 

(187,638

)

Income tax expense

 

1,164

 

 

 

290

 

 

 

3,185

 

 

 

1,807

 

Net loss

 

(15,425

)

 

 

(112,125

)

 

 

(55,053

)

 

 

(189,445

)

Less: Net income (loss) attributable to noncontrolling interests

 

103

 

 

 

39

 

 

 

247

 

 

 

(2,129

)

Net loss attributable to Oscar Health, Inc.

$

(15,528

)

 

$

(112,164

)

 

$

(55,300

)

 

$

(187,316

)

 

 

 

 

 

 

 

 

Earnings (Loss) per Share

 

 

 

 

 

 

 

Net loss per share attributable to Oscar Health, Inc., basic and diluted

$

(0.07

)

 

$

(0.53

)

 

$

(0.25

)

 

$

(0.89

)

Weighted average common shares outstanding, basic and diluted

 

219,400,458

 

 

 

211,311,494

 

 

 

218,163,533

 

 

 

210,930,686

 

 

Oscar Health, Inc.

Consolidated Balance Sheets

(in thousands, except share and per share amounts)

(unaudited)

 

 

June 30, 2023

 

December 31, 2022

Assets

 

 

 

Current Assets:

 

 

 

Cash and cash equivalents

$

2,322,069

 

 

$

1,558,595

 

Short-term investments

 

1,255,705

 

 

 

1,397,287

 

Premiums and accounts receivable

 

193,079

 

 

 

216,475

 

Risk adjustment transfer receivable

 

60,335

 

 

 

49,861

 

Reinsurance recoverable

 

353,883

 

 

 

892,887

 

Other current assets

 

7,561

 

 

 

6,450

 

Total current assets

 

4,192,632

 

 

 

4,121,555

 

Property, equipment, and capitalized software, net

 

63,053

 

 

 

59,888

 

Long-term investments

 

189,638

 

 

 

222,919

 

Restricted deposits

 

27,292

 

 

 

27,483

 

Other assets

 

92,330

 

 

 

94,756

 

Total Assets

$

4,564,945

 

 

$

4,526,601

 

 

 

 

 

Liabilities and Stockholders' Equity

 

 

 

Current Liabilities:

 

 

 

Benefits payable

$

855,711

 

 

$

937,727

 

Risk adjustment transfer payable

 

1,982,999

 

 

 

1,517,493

 

Premium deficiency reserve

 

3,381

 

 

 

4,214

 

Unearned premiums

 

73,072

 

 

 

78,998

 

Accounts payable and other liabilities

 

261,519

 

 

 

297,841

 

Reinsurance payable

 

67,635

 

 

 

427,649

 

Total current liabilities

 

3,244,317

 

 

 

3,263,922

 

Long-term debt

 

298,388

 

 

 

297,999

 

Other liabilities

 

70,275

 

 

 

72,280

 

Total liabilities

 

3,612,980

 

 

 

3,634,201

 

Commitments and contingencies

 

 

 

Stockholders' Equity

 

 

 

Preferred stock, $0.00001 par value; 82,500,000 shares authorized, none issued or outstanding as of June 30, 2023 and December 31, 2022

 

 

 

 

 

Class A common stock, $0.00001 par value; 825,000,000 shares authorized, 186,789,874 and 181,176,239 shares issued and outstanding as of June 30, 2023 and December 31, 2022, respectively

 

2

 

 

 

2

 

Class B common stock, $0.00001 par value; 82,500,000 shares authorized, 35,115,807 shares issued and outstanding as of June 30, 2023 and December 31, 2022

 

 

 

 

 

Treasury stock (314,600 shares as of June 30, 2023 and December 31, 2022)

 

(2,923

)

 

 

(2,923

)

Additional paid-in capital

 

3,620,766

 

 

 

3,509,007

 

Accumulated deficit

 

(2,661,287

)

 

 

(2,605,987

)

Accumulated other comprehensive income (loss)

 

(6,856

)

 

 

(9,715

)

Total Oscar Health, Inc. stockholders' equity

 

949,702

 

 

 

890,384

 

Noncontrolling interests

 

2,263

 

 

 

2,016

 

Total stockholders' equity

 

951,965

 

 

 

892,400

 

Total Liabilities and Stockholders' Equity

$

4,564,945

 

 

$

4,526,601

 

 

Oscar Health, Inc.

Consolidated Statements of Cash Flows

(in thousands) (unaudited)

 

 

Six Months Ended June 30,

 

 

2023

 

 

 

2022

 

Cash flows from operating activities:

 

 

 

Net loss

$

(55,053

)

 

$

(189,445

)

Adjustments to reconcile net loss to net cash provided by operating activities:

 

 

 

Deferred taxes

 

26

 

 

 

4

 

Net realized loss on sale of financial instruments

 

9

 

 

 

508

 

Depreciation and amortization expense

 

13,761

 

 

 

7,490

 

Amortization of debt issuance costs

 

389

 

 

 

324

 

Stock-based compensation expense

 

104,773

 

 

 

54,681

 

Investment amortization, net of accretion

 

(15,275

)

 

 

3,141

 

Changes in assets and liabilities:

 

 

 

(Increase) / decrease in:

 

 

 

Premiums and accounts receivable

 

23,396

 

 

 

(35,835

)

Risk adjustment transfer receivable

 

(10,474

)

 

 

(13,859

)

Reinsurance recoverable

 

539,004

 

 

 

(308,214

)

Other assets

 

1,294

 

 

 

(16,826

)

Increase / (decrease) in:

 

 

 

Benefits payable

 

(82,016

)

 

 

366,945

 

Unearned premiums

 

(5,925

)

 

 

(2,353

)

Premium deficiency reserve

 

(832

)

 

 

(7,741

)

Accounts payable and other liabilities

 

(38,330

)

 

 

(11,125

)

Reinsurance payable

 

(360,015

)

 

 

225,687

 

Risk adjustment transfer payable

 

465,507

 

 

 

703,934

 

Net cash provided by operating activities

 

580,239

 

 

 

777,316

 

Cash flows from investing activities:

 

 

 

Purchase of investments

 

(537,688

)

 

 

(312,104

)

Sale of investments

 

19,160

 

 

 

243,400

 

Maturity of investments

 

711,453

 

 

 

261,334

 

Purchase of property, equipment and capitalized software

 

(12,996

)

 

 

(12,265

)

Change in restricted deposits

 

(522

)

 

 

1,023

 

Net cash provided by investing activities

 

179,407

 

 

 

181,388

 

Cash flows from financing activities:

 

 

 

Proceeds from long-term debt

 

 

 

 

305,000

 

Payments of debt issuance costs

 

 

 

 

(7,035

)

Proceeds from joint venture contribution

 

471

 

 

 

1,271

 

Proceeds from exercise of stock options

 

2,586

 

 

 

924

 

Net cash provided by financing activities

 

3,057

 

 

 

300,160

 

Increase in cash, cash equivalents and restricted cash equivalents

 

762,703

 

 

 

1,258,864

 

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

 

1,580,497

 

 

 

1,125,557

 

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

 

2,343,200

 

 

 

2,384,421

 

Cash and cash equivalents

 

2,322,069

 

 

 

2,362,632

 

Restricted cash and cash equivalents included in restricted deposits

 

21,131

 

 

 

21,789

 

Total cash, cash equivalents and restricted cash and cash equivalents

$

2,343,200

 

 

$

2,384,421

 

 

Six Months Ended June 30,

 

 

2023

 

 

2022

Supplemental Disclosures:

 

 

 

Interest payments

$

22,636

 

$

9,550

Income tax payments

$

400

 

$

1,105

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.

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.

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 arrangement under our Cigna+Oscar small group plan offering, and are presented here net of Risk Adjustment for these assumed policies.

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.

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 June 30,

 

Six Months Ended June 30,

 

 

2023

 

 

 

2022

 

 

 

2023

 

 

 

2022

 

 

(in thousands)

Direct claims incurred before ceded reinsurance (1)

$

1,136,687

 

 

$

1,092,416

 

 

$

2,184,745

 

 

$

2,102,451

 

Assumed reinsurance claims

 

60,255

 

 

 

32,555

 

 

 

107,413

 

 

 

56,797

 

Excess of loss ceded claims (2)

 

(1,474

)

 

 

1,509

 

 

 

(5,620

)

 

 

(9,924

)

State reinsurance (3)

 

(10,683

)

 

 

(6,946

)

 

 

(16,596

)

 

 

(18,275

)

Net claims before ceded quota share reinsurance (A)

$

1,184,785

 

 

$

1,119,534

 

 

$

2,269,942

 

 

$

2,131,049

 

 

 

 

 

 

 

 

 

Premiums before ceded reinsurance

$

1,484,538

 

 

$

1,368,477

 

 

$

2,910,800

 

 

$

2,683,541

 

Excess of loss reinsurance premiums (4)

 

(2,233

)

 

 

(6,638

)

 

 

(6,524

)

 

 

(14,766

)

Net premiums before ceded quota share reinsurance (B)

$

1,482,305

 

 

$

1,361,839

 

 

$

2,904,276

 

 

$

2,668,775

 

Medical Loss Ratio (A divided by B)

 

79.9

%

 

 

82.2

%

 

 

78.2

%

 

 

79.9

%

(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 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 numerator and denominator in the calculation below reflect an adjustment to remove the impact of the Company’s quota share arrangements. Below is a calculation of our InsuranceCo Administrative Expense Ratio for the periods indicated.

 

Three Months Ended June 30,

 

Six Months Ended June 30,

 

 

2023

 

 

 

2022

 

 

 

2023

 

 

 

2022

 

 

(in thousands)

Other insurance costs

$

197,784

 

 

$

170,200

 

 

$

425,215

 

 

$

335,602

 

Impact of quota share reinsurance (1)

 

(6,967

)

 

 

39,189

 

 

 

(16,262

)

 

 

75,668

 

Stock-based compensation expense

 

(14,637

)

 

 

(12,411

)

 

 

(41,791

)

 

 

(25,489

)

Federal and state assessment of health insurance subsidiaries

 

71,913

 

 

 

68,561

 

 

 

145,480

 

 

 

138,772

 

Health insurance subsidiary adjusted administrative expenses(A)

$

248,093

 

 

$

265,539

 

 

$

512,642

 

 

$

524,553

 

 

 

 

 

 

 

 

 

Premiums before ceded reinsurance

$

1,484,538

 

 

$

1,368,477

 

 

$

2,910,800

 

 

$

2,683,541

 

Excess of loss reinsurance premiums

 

(2,233

)

 

 

(6,638

)

 

 

(6,524

)

 

 

(14,766

)

Net premiums before ceded quota share reinsurance(B)

$

1,482,305

 

 

$

1,361,839

 

 

$

2,904,276

 

 

$

2,668,775

 

InsuranceCo Administrative Expense Ratio(A divided by B)

 

16.7

%

 

 

19.5

%

 

 

17.7

%

 

 

19.7

%

(1)

Includes ceding commissions received from reinsurers, net of the impact of deposit accounting of $(7,557) and $(1,827) for the three months ended June 30, 2023 and 2022, respectively, and $(15,316) and $(3,659) for the six months ended June 30, 2023 and 2022, respectively.

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 core performance of the insurance business, prior to the impact of quota share and net investment income.

 

Three Months Ended June 30,

 

Six Months Ended June 30,

 

2023

 

 

2022

 

 

2023

 

 

2022

 

Medical Loss Ratio

79.9

%

 

82.2

%

 

78.2

%

 

79.9

%

InsuranceCo Administrative Expense Ratio

16.7

%

 

19.5

%

 

17.7

%

 

19.7

%

InsuranceCo Combined Ratio

96.7

%

 

101.7

%

 

95.8

%

 

99.6

%

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. The Company believes Adjusted Administrative Expense Ratio is useful to evaluate the Company’s ability to manage its overall administrative expense base. This ratio also provides further clarity into the Company’s overall path to profitability. Below is a calculation of our Adjusted Administrative Expense Ratio for the periods indicated.

 

Three Months Ended June 30,

 

Six Months Ended June 30,

 

 

2023

 

 

 

2022

 

 

 

2023

 

 

 

2022

 

 

(in thousands)

Total Operating Expenses

$

1,528,064

 

 

$

1,123,806

 

 

$

3,023,114

 

 

$

2,165,100

 

Claims incurred, net

 

(1,181,999

)

 

 

(808,639

)

 

 

(2,273,591

)

 

 

(1,543,205

)

Premium deficiency reserve release

 

819

 

 

 

4,536

 

 

 

833

 

 

 

7,741

 

Impact of quota share reinsurance (1)

 

(6,967

)

 

 

39,189

 

 

 

(16,262

)

 

 

75,668

 

Total Administrative Expenses

$

339,917

 

 

$

358,892

 

 

$

734,094

 

 

$

705,304

 

Stock-based compensation expense

 

(33,279

)

 

 

(26,991

)

 

 

(104,773

)

 

 

(54,681

)

Depreciation and amortization

 

(8,822

)

 

 

(3,691

)

 

 

(13,761

)

 

 

(7,490

)

Adjusted Administrative Expenses (A)

$

297,816

 

 

$

328,210

 

 

$

615,560

 

 

$

643,133

 

Total Revenue

$

1,521,535

 

 

$

1,017,319

 

 

$

2,991,220

 

 

$

1,990,084

 

Reinsurance premiums ceded

 

9,572

 

 

 

373,882

 

 

 

7,208

 

 

 

733,545

 

Excess of loss reinsurance premiums

 

(2,233

)

 

 

(6,638

)

 

 

(6,524

)

 

 

(14,766

)

Adjusted Total Revenue (B)

$

1,528,874

 

 

$

1,384,563

 

 

$

2,991,904

 

 

$

2,708,863

 

Adjusted Administrative Expense Ratio (A divided by B)

 

19.5

%

 

 

23.7

%

 

 

20.6

%

 

 

23.7

%

(1)

Includes ceding commissions received from reinsurers, net of the impact of deposit accounting of $(7,557) and $(1,827) for the three months ended June 30, 2023 and 2022, respectively, and $(15,316) and $(3,659) for the six months ended June 30, 2023 and 2022, respectively.

Adjusted EBITDA

Adjusted EBITDA is defined as net loss for the Company and its consolidated subsidiaries before interest expense, income tax expense (benefit), depreciation and amortization as further adjusted for stock-based compensation, 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 U.S. 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 June 30,

 

Six Months Ended June 30,

 

 

2023

 

 

 

2022

 

 

 

2023

 

 

 

2022

 

 

(in thousands)

Net loss

$

(15,425

)

 

$

(112,125

)

 

$

(55,053

)

 

$

(189,445

)

Interest expense

 

6,120

 

 

 

6,141

 

 

 

12,256

 

 

 

10,362

 

Other expenses (income)

 

1,612

 

 

 

(793

)

 

 

7,718

 

 

 

2,260

 

Income tax expense

 

1,164

 

 

 

290

 

 

 

3,185

 

 

 

1,807

 

Depreciation and amortization

 

8,822

 

 

 

3,691

 

 

 

13,761

 

 

 

7,490

 

Stock-based compensation (1)

 

33,279

 

 

 

26,991

 

 

 

104,773

 

 

 

54,681

 

Adjusted EBITDA

$

35,572

 

 

$

(75,805

)

 

$

86,640

 

 

$

(112,845

)

(1)

Represents 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. Includes a non-recurring charge of $46.3 million related to accelerated stock-based compensation expense recognized as a result of the cancellation of the Founders Awards previously granted to Mario Schlosser and Joshua Kushner.

Appendix

Reinsurance Impact

 

Three Months Ended June 30,

 

Six Months Ended June 30,

 

 

2023

 

 

 

2022

 

 

 

2023

 

 

 

2022

 

 

(in thousands)

Quota share ceded premiums

$

(5,537

)

 

$

(383,337

)

 

$

6,823

 

 

$

(743,265

)

Quota share ceded claims

 

2,787

 

 

 

310,897

 

 

 

(3,648

)

 

 

587,845

 

Ceding commission, net of deposit accounting impact (1)

 

(6,967

)

 

 

39,189

 

 

 

(16,262

)

 

 

75,668

 

Experience refund

 

(1,801

)

 

 

16,093

 

 

 

(7,506

)

 

 

24,486

 

Net quota share impact

$

(11,518

)

 

$

(17,158

)

 

$

(20,593

)

 

$

(55,266

)

(1)

Includes ceding commissions received from reinsurers, net of the impact of deposit accounting of $(7,557) and $(1,827) for the three months ended June 30, 2023 and 2022, respectively, and $(15,316) and $(3,659) for the six months ended June 30, 2023 and 2022, respectively.

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 June 30,

 

Six Months Ended June 30,

 

 

2023

 

 

 

2022

 

 

 

2023

 

 

 

2022

 

 

(in thousands)

Reinsurance premiums ceded, gross

$

(7,210

)

 

$

(393,857

)

 

$

2,868

 

 

$

(760,968

)

Experience refunds

 

(2,362

)

 

 

19,975

 

 

 

(10,076

)

 

 

27,423

 

Reinsurance premiums ceded

 

(9,572

)

 

 

(373,882

)

 

 

(7,208

)

 

 

(733,545

)

Reinsurance premiums assumed

 

60,395

 

 

 

34,095

 

 

 

116,330

 

 

 

58,885

 

Total reinsurance premiums (ceded) and assumed

$

50,823

 

 

$

(339,787

)

 

$

109,122

 

 

$

(674,660

)

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 June 30,

 

Six Months Ended June 30,

 

 

2023

 

 

 

2022

 

 

 

2023

 

 

 

2022

 

 

(in thousands)

Direct claims incurred

$

1,136,687

 

 

$

1,092,416

 

 

$

2,184,745

 

 

$

2,102,451

 

Ceded reinsurance claims

 

(14,943

)

 

 

(316,332

)

 

 

(18,567

)

 

 

(616,043

)

Assumed reinsurance claims

 

60,255

 

 

 

32,555

 

 

 

107,413

 

 

 

56,797

 

Total claims incurred, net

$

1,181,999

 

 

$

808,639

 

 

$

2,273,591

 

 

$

1,543,205

 

The Company records 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 June 30,

 

Six Months Ended June 30,

 

 

2023

 

 

 

2022

 

 

 

2023

 

 

2022

 

 

(in thousands)

Other insurance costs, gross

$

198,373

 

 

$

211,216

 

 

$

424,269

 

$

414,929

 

Reinsurance ceding commissions

 

(589

)

 

 

(41,016

)

 

 

946

 

 

(79,327

)

Other insurance costs, net

$

197,784

 

 

$

170,200

 

 

$

425,215

 

$

335,602

 

The Company records reinsurance recoverables within current assets on its consolidated balance sheets. The composition of the reinsurance recoverable balance is as follows:

 

 

June 30, 2023

 

December 31, 2022

 

 

(in thousands)

Ceded reinsurance claim recoverables

 

$

344,810

 

$

776,266

Reinsurance ceding commissions

 

 

2,319

 

 

42,805

Experience refunds on reinsurance agreements

 

 

6,754

 

 

73,816

Reinsurance recoverable

 

$

353,883

 

$

892,887

 

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

Media Contact:
JoAnna DiTullio
Senior Director of Communications
press@hioscar.com
310-592-8046

Source: Oscar Health, Inc.