Summary of Conference Call for Oscar Health Company Overview - **Company**: Oscar Health - **Industry**: Health Insurance Key Points and Arguments Third-Quarter Results - The third-quarter results were impacted by weekly data fluctuations, with expectations for stability moving forward [1][2] - Full-year guidance assumes no further decay in market morbidity for 2025, based on recent data [2] Market Morbidity and Risk Scores - Members who lost subsidies and left Oscar had higher risk scores, but this group represents less than 2% of the total membership [3] - Increased utilization pressure was noted in the industry, but Oscar's utilization has stabilized and is trending down [4][5] Utilization Management - Oscar has implemented measures to ensure members receive care at appropriate sites, contributing to improved utilization metrics [5][7] - The company has seen a positive shift in care categories due to proactive engagement with providers and members [7] Pricing Strategy - Oscar's premium increase of 28% year-over-year is competitive, with the company positioned as the lowest cost in 30% of its markets [8][9] - The pricing strategy involved extensive modeling, considering market morbidity, potential market contraction, and program integrity measures [10][11] Market Dynamics and Enrollment - The company anticipates a 20-30% contraction in the marketplace due to the expiration of enhanced subsidies, affecting affordability for many members [12][24] - Oscar has expanded into approximately 70 new counties, leveraging existing network relationships to enhance visibility and performance [13][14] Open Enrollment Performance - Early indicators of open enrollment are positive, with strong engagement from brokers and creative plan designs aimed at affordability [15][16] - Retention rates are expected to be lower than previous years due to subsidy losses, but initial retention stats are promising [16][25] Enhanced Subsidies and Future Outlook - Oscar has planned for 2026 without enhanced subsidies, indicating readiness for market changes [21] - The company remains optimistic about potential bipartisan solutions to support families in affording healthcare [19][20] Capital Management - Oscar has over $1 billion in excess capital, positioning the company well for growth and potential market changes [34][36] - The recent convertible debt reduction was a strategic move to improve liquidity and financial performance [31][33] Risks and Opportunities - The primary risk for 2026 is accurately pricing market morbidity, as mispricing could impact profitability [40][41] - Despite risks, Oscar is excited about opportunities for market share growth and profitability improvements in 2026 [41][42] Additional Important Insights - The company is focusing on Individual Coverage Health Reimbursement Arrangements (ICRAs) as a growth opportunity, despite skepticism in the market [38][39] - Oscar emphasizes the importance of maintaining access to affordable healthcare for essential workers and the gig economy [27][28]

Financial Data and Key Metrics Changes - The company reiterated its 2025 outlook, indicating improved utilization trends throughout the second quarter and into the third quarter, with no significant concerns regarding core performance [3][4] - Membership loss due to dual enrollment and failure to reconcile was modest and deemed immaterial, suggesting positive trends for market morbidity in 2025 [5][8] - The company expects an increase in Medical Loss Ratio (MLR) in the second half of the year, aligning more closely with 2023 dynamics rather than 2024 [11][12] Business Line Data and Key Metrics Changes - The company has seen a strong amount of Special Enrollment Period (SEP) growth, but anticipates less pressure from SEPs in the second half of the year due to the end of continuous SEP for individuals at 150% of the federal poverty level [11][12] - Membership is expected to be modestly below second quarter amounts by the end of the year, but more member months are anticipated in the second half compared to the first half [19][20] Market Data and Key Metrics Changes - The company is preparing for the 2026 rate re-filing, considering various factors including market morbidity shifts and the expiration of subsidies [21][22] - Pricing strategies for 2026 are being built on historical trends and expected market conditions, with a focus on ensuring appropriate pricing for risks [22][24] Company Strategy and Development Direction - The company is optimistic about the ICHRA market, having launched new plans and formed partnerships to enhance community engagement [59][61] - There is a focus on leveraging technology to improve operational efficiency and reduce costs, with ongoing initiatives in areas like fraud prevention and administrative expenses [55][57] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the company's ability to navigate the current market environment, noting that utilization trends are not causing concern [4][35] - There is cautious optimism regarding the potential extension of enhanced subsidies, which could positively impact financial performance [42][43] Other Important Information - The company has significant excess capital and feels well-positioned to fund operations across various scenarios, with minimal leverage on its balance sheet [48][49] - The company is actively working with brokers to ensure members are informed about changes and can navigate potential subsidy losses effectively [30][29] Q&A Session Summary Question: What are the expectations regarding dual enrollment and FTR populations? - Management noted that the impact of dual enrollment and FTR populations has been modest, with a slight positive effect on market morbidity [7][8] Question: How does the company view MLR progression in the first half of the year? - Management expects MLR to increase in the second half, aligning more with 2023 trends, and has built expectations for increased utilization in Q4 [11][14] Question: What is the company's strategy for pricing in 2026? - The company is stacking risks in pricing for 2026, considering various factors including market morbidity shifts and the expiration of subsidies [22][23] Question: How does the company plan to manage capital levels? - Management feels confident about capital levels, indicating that they have adequate resources to fund operations and minimal leverage on the balance sheet [48][49] Question: What are the prospects for the ICHRA market? - Management remains optimistic about the ICHRA market, highlighting recent partnerships and the potential for growth despite short-term pricing challenges [59][61]