Financial Data and Key Metrics Changes - Total revenue for Q2 2025 was reported at $2,900,000,000, representing a 29% increase year over year [7][18] - The medical loss ratio (MLR) increased by 12 points year over year to 91.1%, primarily due to an overall increase in average market morbidity [7][19] - The SG&A ratio improved by 90 basis points year over year to 18.7% [8][21] - The loss from operations was $230,000,000, a decrease of $298,000,000 year over year, while the adjusted EBITDA loss was $199,000,000 [8][22] - The company reaffirmed its 2025 guidance, projecting total revenue between $12,000,000,000 and $12,200,000,000 [8][24] Business Line Data and Key Metrics Changes - Membership grew to over 2,000,000, an increase of 28% year over year, driven by solid retention and above-market growth during open enrollment [19] - The second quarter MLR was impacted by a $316,000,000 increase in risk adjustment payable for 2025 due to higher ACA marketplace morbidity [19] Market Data and Key Metrics Changes - The latest risk adjustment data indicates a meaningful market-wide increase in morbidity in 2025, affecting all carriers with increases in mid to high single digits [9] - The company anticipates double-digit rate increases in the market for 2026 to address current morbidity pressures [10] Company Strategy and Development Direction - The company is focused on the individual market, believing it will stabilize in 2026 and is taking actions to mitigate current industry headwinds [8][12] - Oscar Health is acquiring early-stage assets to build a consumer marketplace, including a brokerage and a direct enrollment technology platform [13][14] - The company is launching a new ICRA product in partnership with Hy Vee Inc., targeting employers and employees in Des Moines, Iowa [15] Management's Comments on Operating Environment and Future Outlook - Management believes the individual market has significant long-term growth potential and is taking corrective actions to return to profitability in 2026 [16][27] - The company is confident in its capital position and expects to absorb the majority of forecasted losses through its excess capital [32][90] Other Important Information - The company is reducing its workforce in the second half of 2025, expecting to save approximately $60,000,000 in administrative costs for 2026 [12][27] - The company has a strong capital position with approximately $5,400,000,000 in cash and investments [22][90] Q&A Session Summary Question: Guidance on 2025 free cash flow and risk adjustment payable - Management confirmed a strong capital position and indicated that the majority of expected losses would be absorbed by excess capital [31] Question: Long-term targets for 2027 - Management reaffirmed the 5% margin target and stated that no changes to long-term forecasts are being made at this time [34] Question: Multiyear earnings levers - Management indicated that there are still opportunities to improve medical costs and administrative efficiencies [41] Question: Potential risk pool deterioration - Management expressed confidence that the risk pool would not deteriorate further and that they have factored risks into their pricing for 2026 [48] Question: Market stabilization assumptions for 2026 - Management stated that conservative assumptions have been built into the 2026 guidance, considering market morbidity shifts and program integrity impacts [52] Question: Membership shifts and retention - Management noted that improved membership retention and lower lapse rates contributed to membership growth, with no adverse selection observed [105]

Financial Data and Key Metrics Changes - Total revenue for the second quarter of 2025 was reported at $2,900,000,000, representing a 29% year-over-year increase [5][18] - The medical loss ratio (MLR) increased by 12 points year-over-year to 91.1%, primarily due to an overall increase in average market morbidity [5][19] - The SG&A ratio improved by 90 basis points year-over-year to 18.7% [6][21] - The loss from operations was $230,000,000, a decrease of $298,000,000 year-over-year, while the adjusted EBITDA loss was $199,000,000, a decrease of $34,000,000 year-over-year [6][22] - The company reaffirmed its updated 2025 guidance, projecting total revenues between $12,000,000,000 and $12,200,000,000 and a loss from operations between $200,000,000 and $300,000,000 [6][24] Business Line Data and Key Metrics Changes - Membership grew to over 2,000,000, an increase of 28% year-over-year, driven by solid retention and above-market growth during open enrollment [19] - The second quarter MLR was impacted by a $316,000,000 increase in risk adjustment payable for 2025 due to higher ACA marketplace morbidity [19] Market Data and Key Metrics Changes - The latest risk adjustment data indicated a meaningful market-wide increase in morbidity in 2025, affecting all carriers with increases in mid to high single digits [7] - The company expects double-digit rate increases in the market for 2026 to address current morbidity pressures [9] Company Strategy and Development Direction - The company is focused on managing expenses and optimizing operations through technology and AI-driven efficiencies, aiming to eliminate approximately $60,000,000 in administrative costs for 2026 [10][11] - Strategic acquisitions include an individual market brokerage and a direct enrollment technology platform to enhance capabilities in the consumer marketplace [12][13] - The company is launching a new ICRA product in partnership with Hy Vee Inc., targeting employers and employees in Des Moines, Iowa [14] Management's Comments on Operating Environment and Future Outlook - Management believes the individual market will stabilize in 2026 and expects to return to profitability in that year [15][26] - The company is taking corrective actions to ensure a strong position for profitability next year, despite current market challenges [18][26] Other Important Information - The company has a strong capital position with approximately $5,400,000,000 in cash and investments, including $579,000,000 in excess capital [22][90] - The company is reducing its workforce in the second half of 2025 to solidify its profitability position for 2026 [26][85] Q&A Session Summary Question: Guidance on 2025 free cash flow and risk adjustment payable - Management indicated a strong capital position and that the majority of expected losses would be absorbed by excess capital [30] Question: Long-term targets for 2027 - Management reaffirmed the 5% margin target but stated that adjustments may be made after assessing the pricing season [32] Question: Multiyear earnings levers - Management highlighted ongoing opportunities to improve medical costs and administrative efficiencies [38] Question: Potential risk pool deterioration - Management expressed confidence in their current position and noted that they have factored risks into their pricing for 2026 [47] Question: Market stabilization assumptions for 2026 - Management built conservative assumptions into their guidance, expecting to improve margins and return to profitability [51] Question: Membership shifts and retention - Management noted that improved membership retention and lower lapse rates contributed to membership growth [105]

Financial Data and Key Metrics Changes - Oscar Health reported total revenue of $3 billion in Q1 2025, a 42% increase year over year [5] - Net income was approximately $275 million, a significant improvement of $98 million over the prior year period [6][20] - Earnings from operations grew by $112 million to $297 million, with an operating margin of 9.8%, an increase of 110 basis points year over year [6][18] - The medical loss ratio (MLR) increased by 120 basis points year over year to 75.4% [6][15] - The SG&A ratio improved to 15.8%, a 260 basis point improvement year over year, marking the lowest in the company's history [6][17] Business Line Data and Key Metrics Changes - The company closed the quarter with approximately 2 million effectuated members, a 41% increase year over year [7][14] - Membership growth was driven by strong retention and above-market growth during open enrollment [14] Market Data and Key Metrics Changes - Oscar Health is deepening its market presence with new partnerships, including the launch of Oscar Community Resources with Find Help, connecting members to local services [8] - The company is experiencing high levels of digital engagement across its IFP and ICRA membership [7] Company Strategy and Development Direction - Oscar Health's strategic plan focuses on top-line growth, bottom-line performance, and margin expansion [6][12] - The company is advocating for constructive solutions to strengthen the individual market and is engaged with policymakers [10][11] - Oscar aims to create a marketplace that meets consumer and employer expectations for choice, quality, and affordability [12] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in achieving 2025 targets, citing disciplined execution and strong growth [12][22] - The current policy environment, including proposed CMS initiatives, is viewed as positive for long-term market sustainability, despite potential enrollment constraints [10][11] - Management anticipates membership trends to increase in the first half of the year but expects a decline in the latter half due to policy changes [29] Other Important Information - The company reaffirmed its full-year guidance metrics, expecting total revenue in the range of $11.2 billion to $11.3 billion for 2025 [21] - Oscar Health's capital position remains strong, with approximately $4.9 billion in cash and investments [20] Q&A Session Summary Question: Membership expectations for the second quarter and the rest of the year - Management expects membership to trend up in the first half of the year but anticipates a decline in the latter half due to policy changes [28][30] Question: Context around grace period membership and its impact - Management indicated that the gap between effectuated and paid membership is expected to normalize, with a portion of members ending their grace period [34] Question: Utilization patterns between new and retired members - Management noted higher inpatient utilization with favorable pharmacy trends, but no specific condition was driving the inpatient increase [39] Question: Opportunities and risks around competitor exits - Management views competitor exits as an opportunity to attract members and maintain disciplined pricing in the market [42][58] Question: Regulatory environment and enrollment changes - Management supports CMS efforts to strengthen the ACA but expressed concerns about the shortened enrollment period affecting consumer shopping [48] Question: Risk adjustment expectations for 2025 - Management indicated no significant adjustments to risk adjustment payables at this time, but elevated claims could impact future percentages [60] Question: Drivers of SG&A performance - Management attributed SG&A improvements to fixed cost leverage, variable cost efficiencies, and lower exchange fee rates [70][71] Question: Valuation concerns and fraudulent member estimates - Management is conducting its own analysis regarding fraudulent members and remains committed to long-term targets despite market challenges [75] Question: CSR refund proposal and its implications - Management expressed concerns about the practical implementation of CSR refunds and recommended against moving forward with the proposal for 2026 [80]