NEW YORK--(BUSINESS WIRE)--Health tech company Oscar Health, Inc. (NYSE: OSCR) today announced its financial results for the fourth quarter and year ended December 31, 2022 including significant improvement in core operating margins, delivering ~5 points of Combined Ratio improvement YoY.
“We enter 2023 with strong positive momentum, having executed according to our plan in 2022 and making meaningful improvements in many of the key metrics for our business,” said Mario Schlosser, CEO and Co-Founder of Oscar. “Our progress in bringing down our total cost of care and the work to achieve administrative cost savings positions us well vis a vis our profitability goals for 2023 and beyond.”
Total Direct and Assumed Policy Premiums for 2022 were $6.8 billion, up 99% year-over-year (“YoY”), driven primarily by robust membership growth, rate increases, and mix shifts to higher premium plans. Premiums earned for the year were up 111% YoY, driven by the same factors that drove the increase in Direct and Assumed Policy Premiums, as well as a lower percentage of ceded premiums to reinsurance partners.
Oscar’s InsuranceCo Combined Ratio, which is the sum of its Medical Loss Ratio (“MLR”) and the InsuranceCo Administrative Expense Ratio, improved 490 bps YoY to 105.8% for 2022, driven by both an improved MLR and lower administrative costs. Specifically, the MLR improved 360 bps YoY to 85.3%, primarily due to lower net COVID-19-related costs, pricing actions, mix shifts in member population, and medical management actions, partially offset by unfavorable prior period development. The InsuranceCo Administrative Expense Ratio improved 125 bps YoY to 20.6%, driven by operating expense leverage and scale efficiencies, partially offset by higher distribution expenses.
The 2022 Adjusted Administrative Expense Ratio improved 440 bps YoY to 24.6%, primarily due to operating expense leverage and scale efficiencies. The Adjusted EBITDA loss of $462 million increased by $32 million YoY, but decreased as a percentage of premiums before ceded reinsurance by 7 points as compared to the prior year. Net loss of $610 million increased by $38 million YoY and decreased as a percentage of premiums before ceded reinsurance by 10 points YoY.
The Company is introducing its outlook for 2023 including anticipated Direct and Assumed Policy Premiums of $6.4 billion to $6.6 billion, an InsuranceCo Combined Ratio at or less than 100%, and a significantly improved Adjusted EBITDA loss of ($175) million to ($75) million.
Financial Results Summary |
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Three Months Ended December 31, |
|
Year Ended December 31, |
||||||||||||
|
|
2022 |
|
|
|
2021 |
|
|
|
2022 |
|
|
|
2021 |
|
|
(in thousands) |
||||||||||||||
Premiums before ceded reinsurance |
$ |
1,332,931 |
|
|
$ |
705,502 |
|
|
$ |
5,334,520 |
|
|
$ |
2,712,988 |
|
Reinsurance premiums ceded |
|
(365,474 |
) |
|
|
(212,921 |
) |
|
|
(1,463,403 |
) |
|
|
(881,968 |
) |
Premiums earned |
$ |
967,457 |
|
|
$ |
492,581 |
|
|
$ |
3,871,117 |
|
|
$ |
1,831,020 |
|
Total revenue |
$ |
995,127 |
|
|
$ |
496,067 |
|
|
$ |
3,963,638 |
|
|
$ |
1,838,715 |
|
Total operating expenses |
$ |
1,217,606 |
|
|
$ |
692,322 |
|
|
$ |
4,553,505 |
|
|
$ |
2,383,196 |
|
Net loss |
$ |
(226,560 |
) |
|
$ |
(197,742 |
) |
|
$ |
(609,552 |
) |
|
$ |
(571,426 |
) |
Key Metrics and Non-GAAP Financial Metrics |
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Three Months Ended December 31, |
|
Year Ended December 31, |
||||||||||||
|
|
2022 |
|
|
|
2021 |
|
|
|
2022 |
|
|
|
2021 |
|
Direct and Assumed Policy Premiums (in thousands) |
$ |
1,784,012 |
|
|
$ |
872,904 |
|
|
$ |
6,842,439 |
|
|
$ |
3,436,626 |
|
Medical Loss Ratio |
|
91.6 |
% |
|
|
97.9 |
% |
|
|
85.3 |
% |
|
|
88.9 |
% |
InsuranceCo Administrative Expense Ratio |
|
22.3 |
% |
|
|
24.5 |
% |
|
|
20.6 |
% |
|
|
21.8 |
% |
InsuranceCo Combined Ratio |
|
113.9 |
% |
|
|
122.4 |
% |
|
|
105.8 |
% |
|
|
110.7 |
% |
Adjusted Administrative Expense Ratio |
|
26.0 |
% |
|
|
34.4 |
% |
|
|
24.6 |
% |
|
|
28.9 |
% |
Adjusted EBITDA(1) (in thousands) |
$ |
(189,656 |
) |
|
$ |
(164,017 |
) |
|
$ |
(462,255 |
) |
|
$ |
(429,826 |
) |
(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. |
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Membership by Offering |
|
As of December 31, |
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|
|
2022 |
|
2021 |
Individual and Small Group |
|
1,084,404 |
|
577,799 |
Medicare Advantage |
|
4,452 |
|
3,864 |
Cigna + Oscar(1) |
|
62,627 |
|
16,506 |
Total Members |
|
1,151,483 |
|
598,169 |
(1) |
|
Represents total membership for Oscar’s co-branded partnership with Cigna. |
Full Year 2023 Outlook |
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|
|
Low |
|
High |
||||
Direct and Assumed Policy Premiums (in thousands) |
|
$ |
6,400,000 |
|
|
$ |
6,600,000 |
|
Medical Loss Ratio |
|
|
82 |
% |
|
|
84 |
% |
InsuranceCo Administrative Expense Ratio |
|
|
17 |
% |
|
|
18 |
% |
InsuranceCo Adjusted EBITDA (1) (in thousands) |
|
$ |
20,000 |
|
|
$ |
120,000 |
|
Adjusted Administrative Expense Ratio |
|
|
20.5 |
% |
|
|
21.5 |
% |
Adjusted EBITDA(2) (in thousands) |
|
$ |
(175,000 |
) |
|
$ |
(75,000 |
) |
(1) |
|
Oscar has not provided a quantitative reconciliation of forecasted InsureCo Adjusted EBITDA to the appropriate forecasted GAAP metric within this press release because Oscar is unable, without making unreasonable efforts, to calculate certain reconciling items with confidence. InsureCo Adjusted EBITDA is defined as premiums before ceded reinsurance less medical claims and administrative expenses for the InsureCo, adjusting for the impact of quota share reinsurance, premium deficiency reserves, investment income, depreciation and amortization and stock-based compensation expense. |
(2) |
|
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, February 9, 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.
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 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: 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 and scale our operations; our ability to meet increased capital requirements as a result of expanding membership; our ability to maintain or enter into new partnerships, service arrangements 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, and as a result of changing regulatory requirements; 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, regulatory investigations and audits 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 Quarterly Report on Form 10-Q for the quarterly period ended September 30, 2022, filed with the Securities and Exchange Commission (“SEC”), and our other filings with the SEC, including our Annual Report on Form 10-K for the annual period ended December 31, 2022, 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 over one million members as of December 31, 2022. 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.
|
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Three Months Ended December 31, |
|
Year Ended December 31, |
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|
|
2022 |
|
|
|
2021 |
|
|
|
2022 |
|
|
|
2021 |
|
|
(unaudited) |
|
(unaudited) |
|
(unaudited) |
|
|
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Revenue |
|
|
|
|
|
|
|
||||||||
Premiums before ceded reinsurance |
$ |
1,332,931 |
|
|
$ |
705,502 |
|
|
$ |
5,334,520 |
|
|
$ |
2,712,988 |
|
Reinsurance premiums ceded |
|
(365,474 |
) |
|
$ |
(212,921 |
) |
|
|
(1,463,403 |
) |
|
|
(881,968 |
) |
Premiums earned |
|
967,457 |
|
|
|
492,581 |
|
|
|
3,871,117 |
|
|
|
1,831,020 |
|
Administrative services revenue |
|
2,681 |
|
|
|
3,152 |
|
|
|
61,047 |
|
|
|
5,394 |
|
Investment income and other revenue |
|
24,989 |
|
|
|
334 |
|
|
|
31,474 |
|
|
|
2,301 |
|
Total revenue |
|
995,127 |
|
|
|
496,067 |
|
|
|
3,963,638 |
|
|
|
1,838,715 |
|
|
|
|
|
|
|
|
|
||||||||
Operating Expenses |
|
|
|
|
|
|
|
||||||||
Claims incurred, net |
|
884,904 |
|
|
|
482,492 |
|
|
|
3,280,798 |
|
|
|
1,623,995 |
|
Other insurance costs |
|
195,859 |
|
|
|
124,434 |
|
|
|
706,439 |
|
|
|
410,363 |
|
General and administrative expenses |
|
75,808 |
|
|
|
89,338 |
|
|
|
309,783 |
|
|
|
265,078 |
|
Federal and state assessments |
|
71,788 |
|
|
|
36,244 |
|
|
|
281,518 |
|
|
|
139,085 |
|
Premium deficiency reserve release |
|
(10,753 |
) |
|
|
(40,186 |
) |
|
|
(25,033 |
) |
|
|
(55,325 |
) |
Total operating expenses |
|
1,217,606 |
|
|
|
692,322 |
|
|
|
4,553,505 |
|
|
|
2,383,196 |
|
Loss from operations |
|
(222,479 |
) |
|
|
(196,255 |
) |
|
|
(589,867 |
) |
|
|
(544,481 |
) |
Interest expense |
|
6,135 |
|
|
|
397 |
|
|
|
22,623 |
|
|
|
4,720 |
|
Other expenses (income) |
|
(1,339 |
) |
|
|
1,201 |
|
|
|
(2,415 |
) |
|
|
1,201 |
|
Loss on extinguishment of debt |
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
20,178 |
|
Loss before income taxes |
|
(227,275 |
) |
|
|
(197,853 |
) |
|
|
(610,075 |
) |
|
|
(570,580 |
) |
Income tax expense (benefit) |
|
(715 |
) |
|
|
(111 |
) |
|
|
(523 |
) |
|
|
846 |
|
Net loss |
|
(226,560 |
) |
|
|
(197,742 |
) |
|
|
(609,552 |
) |
|
|
(571,426 |
) |
Less: Net income (loss) attributable to noncontrolling interests |
$ |
(514 |
) |
|
$ |
1,180 |
|
|
$ |
(3,277 |
) |
|
$ |
1,180 |
|
Net loss attributable to Oscar Health, Inc. |
$ |
(226,046 |
) |
|
$ |
(198,922 |
) |
|
$ |
(606,275 |
) |
|
$ |
(572,606 |
) |
|
|
|
|
|
|
|
|
||||||||
Earnings (Loss) per Share |
|
|
|
|
|
|
|
||||||||
Net loss per share attributable to Oscar Health, Inc., basic and diluted |
$ |
(1.05 |
) |
|
$ |
(0.95 |
) |
|
$ |
(2.85 |
) |
|
$ |
(3.20 |
) |
Weighted average common shares outstanding, basic and diluted |
|
215,194,230 |
|
|
|
209,775,333 |
|
|
|
212,474,615 |
|
|
|
178,967,056 |
|
Oscar Health, Inc.
|
|||||
|
December 31, 2022 |
|
December 31, 2021 |
||
|
(unaudited) |
|
|
||
Assets: |
|
|
|
||
Current Assets: |
|
|
|
||
Cash and cash equivalents |
1,558,595 |
|
|
1,103,995 |
|
Short-term investments |
1,397,287 |
|
|
587,086 |
|
Premium and other receivables |
216,475 |
|
|
138,414 |
|
Risk adjustment transfer receivable |
49,861 |
|
|
40,659 |
|
Reinsurance recoverable |
892,887 |
|
|
431,990 |
|
Other current assets |
6,450 |
|
|
3,782 |
|
Total current assets |
4,121,555 |
|
|
2,305,926 |
|
Property, equipment, and capitalized software, net |
59,888 |
|
|
46,611 |
|
Long-term investments |
222,919 |
|
|
844,476 |
|
Restricted deposits |
27,483 |
|
|
28,085 |
|
Other assets |
94,756 |
|
|
96,552 |
|
Total Assets |
4,526,601 |
|
|
3,321,650 |
|
|
|
|
|
||
Liabilities and Stockholders' Equity |
|
|
|||
Current Liabilities: |
|
|
|
||
Benefits payable |
937,727 |
|
|
513,582 |
|
Risk adjustment transfer payable |
1,517,493 |
|
|
794,398 |
|
Premium deficiency reserve |
4,214 |
|
|
29,246 |
|
Unearned premiums |
78,998 |
|
|
75,044 |
|
Accounts payable and accrued liabilities |
297,841 |
|
|
234,788 |
|
Reinsurance payable |
427,649 |
|
|
205,231 |
|
Total current liabilities |
3,263,922 |
|
|
1,852,289 |
|
Long-term debt |
297,999 |
|
|
— |
|
Other liabilities |
72,280 |
|
|
76,839 |
|
Total liabilities |
3,634,201 |
|
|
1,929,128 |
|
Commitments and contingencies |
|
|
|
||
Stockholders' Equity |
|
|
|
||
Preferred stock, $0.00001 par value; 82,500,000 shares authorized, none issued or outstanding as of December 31, 2022 and 2021 |
— |
|
|
— |
|
Class A common stock, $0.00001 par value; 825,000,000 shares authorized, 181,176,239 and 175,212,223 shares issued and outstanding as of December 31, 2022 and 2021, 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 December 31, 2022 and 2021 |
— |
|
|
— |
|
Treasury stock (314,600 shares as of December 31, 2022 and 2021) |
(2,923 |
) |
|
(2,923 |
) |
Additional paid-in capital |
3,509,007 |
|
|
3,393,533 |
|
Accumulated deficit |
(2,605,987 |
) |
|
(1,999,712 |
) |
Accumulated other comprehensive loss |
(9,715 |
) |
|
(3,671 |
) |
Total Oscar Health, Inc. stockholders’ equity |
890,384 |
|
|
1,387,229 |
|
Noncontrolling interests |
2,016 |
|
|
5,293 |
|
Total stockholders’ equity |
892,400 |
|
|
1,392,522 |
|
Total Liabilities and Stockholders' Equity |
4,526,601 |
|
|
3,321,650 |
|
Oscar Health, Inc.
|
|||||||
|
Year Ended December 31, |
||||||
|
|
2022 |
|
|
|
2021 |
|
|
(unaudited) |
|
|
||||
Cash flows from operating activities: |
|
|
|
||||
Net loss |
|
(609,552 |
) |
|
$ |
(571,426 |
) |
Adjustments to reconcile net loss to net cash (used in) provided by operating activities: |
|
|
|
||||
Deferred taxes |
|
(165 |
) |
|
|
(101 |
) |
Net realized loss (gain) on sale of financial instruments |
|
1,274 |
|
|
|
(209 |
) |
Loss on fair value of warrant liabilities |
|
— |
|
|
|
12,856 |
|
Depreciation and amortization expense |
|
15,283 |
|
|
|
14,605 |
|
Amortization of debt issuance costs |
|
713 |
|
|
|
329 |
|
Stock-based compensation expense |
|
112,329 |
|
|
|
86,296 |
|
Investment amortization, net of accretion |
|
2,480 |
|
|
|
8,031 |
|
Debt extinguishment loss |
|
— |
|
|
|
20,178 |
|
Changes in assets and liabilities: |
|
|
|
||||
(Increase) / decrease in: |
|
|
|
||||
Premium and other receivables |
|
(78,061 |
) |
|
|
(66,953 |
) |
Risk adjustment transfer receivable |
|
(9,202 |
) |
|
|
(9,502 |
) |
Reinsurance recoverable |
|
(460,897 |
) |
|
|
147,403 |
|
Other assets |
|
(243 |
) |
|
|
(11,299 |
) |
Increase / (decrease) in: |
|
|
|
||||
Benefits payable |
|
424,146 |
|
|
|
201,667 |
|
Unearned premiums |
|
3,953 |
|
|
|
3,140 |
|
Premium deficiency reserve |
|
(25,033 |
) |
|
|
(55,325 |
) |
Accounts payable and other liabilities |
|
57,811 |
|
|
|
98,619 |
|
Reinsurance payable |
|
222,418 |
|
|
|
(138,082 |
) |
Risk adjustment transfer payable |
|
723,095 |
|
|
|
78,028 |
|
Net cash (used in) provided by operating activities |
|
380,349 |
|
|
|
(181,745 |
) |
Cash flows from investing activities: |
|
|
|
||||
Purchase of investments |
|
(1,192,706 |
) |
|
|
(1,810,076 |
) |
Sale of investments |
|
360,616 |
|
|
|
624,077 |
|
Maturity of investments |
|
633,467 |
|
|
|
430,694 |
|
Purchase of property, equipment and capitalized software |
|
(29,012 |
) |
|
|
(25,885 |
) |
Change in restricted deposits |
|
1,116 |
|
|
|
6,675 |
|
Net cash used in investing activities |
|
(226,519 |
) |
|
|
(774,515 |
) |
Cash flows from financing activities: |
|
|
|
||||
Proceeds from long-term debt |
|
305,000 |
|
|
|
— |
|
Payments of debt issuance costs |
|
(7,035 |
) |
|
|
— |
|
Proceeds from joint venture contribution |
|
1,846 |
|
|
|
— |
|
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 |
) |
Convertible preferred stock and call option issuances |
|
— |
|
|
|
— |
|
Proceeds from exercise of warrants and call options |
|
— |
|
|
|
9,191 |
|
Proceeds from partial sale of subsidiary to noncontrolling interest |
|
— |
|
|
|
7,230 |
|
Proceeds from exercise of stock options |
|
1,299 |
|
|
|
49,584 |
|
Net cash provided by financing activities |
|
301,110 |
|
|
|
1,238,712 |
|
Increase in cash, cash equivalents and restricted cash equivalents |
|
454,940 |
|
|
|
282,452 |
|
Cash, cash equivalents, restricted cash and cash equivalents—beginning of period |
|
1,125,557 |
|
|
|
843,105 |
|
Cash, cash equivalents, restricted cash and cash equivalents—end of period |
$ |
1,580,497 |
|
|
$ |
1,125,557 |
|
|
|
|
|
||||
Cash and cash equivalents |
|
1,558,595 |
|
|
|
1,103,995 |
|
Restricted cash and cash equivalents included in restricted deposits |
|
21,902 |
|
|
|
21,562 |
|
Total cash, cash equivalents and restricted cash and cash equivalents |
$ |
1,580,497 |
|
|
$ |
1,125,557 |
|
Supplemental Disclosures: |
|
|
|
||||
Interest payments |
$ |
10,079 |
|
|
$ |
4,256 |
|
Income tax payments |
$ |
1,893 |
|
|
$ |
697 |
|
|
|
|
|
||||
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 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 arrangements under our Cigna+Oscar 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.
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 December 31, |
|
Year Ended December 31, |
||||||||||||
|
|
2022 |
|
|
|
2021 |
|
|
|
2022 |
|
|
|
2021 |
|
|
(in thousands) |
||||||||||||||
Direct claims incurred before ceded reinsurance (1) |
$ |
1,172,279 |
|
|
$ |
678,019 |
|
|
$ |
4,428,000 |
|
|
$ |
2,403,108 |
|
Assumed reinsurance claims |
|
47,683 |
|
|
|
12,067 |
|
|
|
143,147 |
|
|
|
21,656 |
|
Excess of loss ceded claims (2) |
|
(4,316 |
) |
|
|
505 |
|
|
|
(18,632 |
) |
|
|
(12,500 |
) |
State reinsurance (3) |
|
(1,901 |
) |
|
|
(4,786 |
) |
|
|
(30,544 |
) |
|
|
(14,655 |
) |
Net claims before ceded quota share reinsurance (A) |
$ |
1,213,745 |
|
|
$ |
685,805 |
|
|
$ |
4,521,971 |
|
|
$ |
2,397,609 |
|
|
|
|
|
|
|
|
|
||||||||
Premiums before ceded reinsurance |
$ |
1,332,931 |
|
|
$ |
705,502 |
|
|
$ |
5,334,520 |
|
|
$ |
2,712,988 |
|
Excess of loss reinsurance premiums (4) |
|
(8,115 |
) |
|
|
(4,971 |
) |
|
|
(31,502 |
) |
|
|
(16,266 |
) |
Net premiums before ceded quota share reinsurance (B) |
$ |
1,324,816 |
|
|
$ |
700,531 |
|
|
$ |
5,303,018 |
|
|
$ |
2,696,722 |
|
Medical Loss Ratio (A divided by B) |
|
91.6 |
% |
|
|
97.9 |
% |
|
|
85.3 |
% |
|
|
88.9 |
% |
(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 December 31, |
|
Year Ended December 31, |
||||||||||||
|
|
2022 |
|
|
|
2021 |
|
|
|
2022 |
|
|
|
2021 |
|
|
(in thousands) |
||||||||||||||
Other insurance costs |
$ |
195,859 |
|
|
$ |
124,434 |
|
|
$ |
706,439 |
|
|
$ |
410,363 |
|
Impact of quota share reinsurance (1) |
|
40,745 |
|
|
|
24,260 |
|
|
|
154,741 |
|
|
|
82,246 |
|
Stock-based compensation expense |
|
(13,043 |
) |
|
|
(13,307 |
) |
|
|
(51,495 |
) |
|
|
(42,295 |
) |
Federal and state assessment of health insurance subsidiaries |
|
71,471 |
|
|
|
36,043 |
|
|
|
281,049 |
|
|
|
138,369 |
|
Health insurance subsidiary adjusted administrative expenses(A) |
$ |
295,032 |
|
|
$ |
171,430 |
|
|
$ |
1,090,734 |
|
|
$ |
588,683 |
|
|
|
|
|
|
|
|
|
||||||||
Premiums before ceded reinsurance |
$ |
1,332,931 |
|
|
$ |
705,502 |
|
|
$ |
5,334,520 |
|
|
$ |
2,712,988 |
|
Excess of loss reinsurance premiums |
|
(8,115 |
) |
|
|
(4,971 |
) |
|
|
(31,502 |
) |
|
|
(16,266 |
) |
Net premiums before ceded quota share reinsurance(B) |
$ |
1,324,816 |
|
|
$ |
700,531 |
|
|
$ |
5,303,018 |
|
|
$ |
2,696,722 |
|
InsuranceCo Administrative Expense Ratio(A divided by B) |
|
22.3 |
% |
|
|
24.5 |
% |
|
|
20.6 |
% |
|
|
21.8 |
% |
(1) |
|
Includes ceding commissions received from reinsurers, net of the impact of deposit accounting of $(1,788) for the three months ended December 31, 2022 and $(7,205) for the year ended December 31, 2022. |
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 consolidated insurance business, prior to the impact of quota share and net investment income.
|
Three Months Ended December 31, |
|
Year Ended December 31, |
||||||||
|
2022 |
|
|
2021 |
|
|
2022 |
|
|
2021 |
|
Medical Loss Ratio |
91.6 |
% |
|
97.9 |
% |
|
85.3 |
% |
|
88.9 |
% |
InsuranceCo Administrative Expense Ratio |
22.3 |
% |
|
24.5 |
% |
|
20.6 |
% |
|
21.8 |
% |
InsuranceCo Combined Ratio |
113.9 |
% |
|
122.4 |
% |
|
105.8 |
% |
|
110.7 |
% |
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 December 31, |
|
Year Ended December 31, |
||||||||||||
|
|
2022 |
|
|
|
2021 |
|
|
|
2022 |
|
|
|
2021 |
|
|
(in thousands) |
||||||||||||||
Total Operating Expenses |
$ |
1,217,606 |
|
|
$ |
692,322 |
|
|
$ |
4,553,505 |
|
|
$ |
2,383,196 |
|
Claims incurred, net |
|
(884,904 |
) |
|
|
(482,492 |
) |
|
|
(3,280,798 |
) |
|
|
(1,623,995 |
) |
Premium deficiency reserve release |
|
10,753 |
|
|
|
40,186 |
|
|
|
25,033 |
|
|
|
55,325 |
|
Impact of quota share reinsurance (1) |
|
40,745 |
|
|
|
24,260 |
|
|
|
154,741 |
|
|
|
82,246 |
|
Total Administrative Expenses |
$ |
384,200 |
|
|
$ |
274,276 |
|
|
$ |
1,452,481 |
|
|
$ |
896,772 |
|
Stock-based compensation expense/warrant expense |
|
(29,088 |
) |
|
|
(28,268 |
) |
|
|
(112,329 |
) |
|
|
(99,152 |
) |
Depreciation and amortization |
|
(3,735 |
) |
|
|
(3,970 |
) |
|
|
(15,283 |
) |
|
|
(14,605 |
) |
Other non-recurring items (2) |
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(898 |
) |
Adjusted Administrative Expenses (A) |
$ |
351,377 |
|
|
$ |
242,038 |
|
|
$ |
1,324,869 |
|
|
$ |
782,117 |
|
Total Revenue |
$ |
995,127 |
|
|
$ |
496,067 |
|
|
$ |
3,963,638 |
|
|
$ |
1,838,715 |
|
Reinsurance premiums ceded |
|
365,474 |
|
|
|
212,921 |
|
|
|
1,463,403 |
|
|
|
881,968 |
|
Excess of loss reinsurance premiums |
|
(8,115 |
) |
|
|
(4,971 |
) |
|
|
(31,502 |
) |
|
|
(16,266 |
) |
Adjusted Total Revenue (B) |
$ |
1,352,486 |
|
|
$ |
704,017 |
|
|
$ |
5,395,539 |
|
|
$ |
2,704,417 |
|
Adjusted Administrative Expense Ratio (A divided by B) |
|
26.0 |
% |
|
|
34.4 |
% |
|
|
24.6 |
% |
|
|
28.9 |
% |
(1) |
|
Includes ceding commissions received from reinsurers, net of the impact of deposit accounting of $(1,788) for the three months ended December 31, 2022 and $(7,205) for the year ended December 31, 2022. |
(2) |
|
Represents approximately $0.9 million of non-recurring expenses incurred in connection with the Company’s initial public offering (“IPO”) during the year ended December 31, 2021. |
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, 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 December 31, |
|
Year Ended December 31, |
||||||||||||
|
|
2022 |
|
|
|
2021 |
|
|
|
2022 |
|
|
|
2021 |
|
|
(in thousands) |
||||||||||||||
Net loss |
$ |
(226,560 |
) |
|
$ |
(197,742 |
) |
|
$ |
(609,552 |
) |
|
$ |
(571,426 |
) |
Interest expense |
|
6,135 |
|
|
|
397 |
|
|
|
22,623 |
|
|
|
4,720 |
|
Other expenses (income) |
|
(1,339 |
) |
|
|
1,201 |
|
|
|
(2,415 |
) |
|
|
1,201 |
|
Income tax expense (benefit) |
|
(715 |
) |
|
|
(111 |
) |
|
|
(523 |
) |
|
|
846 |
|
Depreciation and amortization |
|
3,735 |
|
|
|
3,970 |
|
|
|
15,283 |
|
|
|
14,605 |
|
Stock-based compensation/warrant expense (1) |
|
29,088 |
|
|
|
28,268 |
|
|
|
112,329 |
|
|
|
99,152 |
|
Other non-recurring items (2) |
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
21,076 |
|
Adjusted EBITDA |
$ |
(189,656 |
) |
|
$ |
(164,017 |
) |
|
$ |
(462,255 |
) |
|
$ |
(429,826 |
) |
(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 $150.0 million first lien term loan and approximately $0.9 million of non-recurring expenses incurred in connection with our IPO during the year ended December 31, 2021. |
Appendix
Reinsurance Impact
|
Three Months Ended December 31, |
|
Year Ended December 31, |
||||||||||||
|
|
2022 |
|
|
|
2021 |
|
|
|
2022 |
|
|
|
2021 |
|
|
(in thousands) |
||||||||||||||
Quota share ceded premiums |
$ |
(372,168 |
) |
|
$ |
(192,003 |
) |
|
$ |
(1,489,525 |
) |
|
$ |
(904,764 |
) |
Quota share ceded claims |
|
328,841 |
|
|
|
203,314 |
|
|
|
1,241,173 |
|
|
|
773,615 |
|
Ceding commission, net of deposit accounting impact (1) |
|
40,745 |
|
|
|
24,260 |
|
|
|
154,741 |
|
|
|
82,246 |
|
Experience refund |
|
14,809 |
|
|
|
(15,948 |
) |
|
|
57,625 |
|
|
|
39,062 |
|
Net quota share impact |
$ |
12,227 |
|
|
$ |
19,623 |
|
|
$ |
(35,986 |
) |
|
$ |
(9,841 |
) |
(1) |
|
Includes ceding commissions received from reinsurers, net of the impact of deposit accounting of $(1,788) for the three months ended December 31, 2022 and $(7,205) for the year ended December 31, 2022 |
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 December 31, |
|
Year Ended December 31, |
||||||||
|
2022 |
|
|
2021 |
|
|
2022 |
|
|
2021 |
|
|
(in thousands) |
||||||||||
Reinsurance premiums ceded, gross |
(380,592 |
) |
|
(197,441 |
) |
|
(1,524,157 |
) |
|
(921,953 |
) |
Experience refunds |
15,118 |
|
|
(15,480 |
) |
|
60,754 |
|
|
39,985 |
|
Reinsurance premiums ceded |
(365,474 |
) |
|
(212,921 |
) |
|
(1,463,403 |
) |
|
(881,968 |
) |
Reinsurance premiums assumed |
41,815 |
|
|
6,872 |
|
|
138,109 |
|
|
16,298 |
|
Total reinsurance premiums (ceded) and assumed |
(323,659 |
) |
|
(206,049 |
) |
|
(1,325,294 |
) |
|
(865,670 |
) |
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 December 31, |
|
Year Ended December 31, |
||||||||
|
2022 |
|
|
2021 |
|
|
2022 |
|
|
2021 |
|
|
(in thousands) |
||||||||||
Direct claims incurred |
1,172,279 |
|
|
678,019 |
|
|
4,428,000 |
|
|
2,403,108 |
|
Ceded reinsurance claims |
(335,058 |
) |
|
(207,594 |
) |
|
(1,290,349 |
) |
|
(800,769 |
) |
Assumed reinsurance claims |
47,683 |
|
|
12,067 |
|
|
143,147 |
|
|
21,656 |
|
Total claims incurred, net |
884,904 |
|
|
482,492 |
|
|
3,280,798 |
|
|
1,623,995 |
|
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 December 31, |
|
Year Ended December 31, |
||||||||
|
2022 |
|
|
2021 |
|
|
2022 |
|
|
2021 |
|
|
(in thousands) |
||||||||||
Other insurance costs, gross |
238,392 |
|
|
148,694 |
|
|
868,385 |
|
|
492,609 |
|
Ceding commissions |
(42,533 |
) |
|
(24,260 |
) |
|
(161,946 |
) |
|
(82,246 |
) |
Other insurance costs, net |
195,859 |
|
|
124,434 |
|
|
706,439 |
|
|
410,363 |
|
The Company records reinsurance recoverables within current assets on its consolidated balance sheets. The composition of the reinsurance recoverable balance is as follows:
|
|
As of December 31, |
||||
|
|
|
2022 |
|
|
2021 |
|
|
(in thousands) |
||||
Ceded reinsurance claim recoverables |
|
$ |
776,266 |
|
$ |
406,017 |
Reinsurance ceding commissions |
|
|
42,805 |
|
|
23,517 |
Experience refunds on reinsurance agreements |
|
|
73,816 |
|
|
2,456 |
Reinsurance recoverable |
|
$ |
892,887 |
|
$ |
431,990 |
