8/6/2025

speaker
Conference Operator
Conference Operator

Star 1 again. Thank you. I will now turn the conference over to Chris Portachar, Vice President of Treasury and Investor Relations. Please go ahead.

speaker
Chris Portachar
Vice President of Treasury and Investor Relations

Good morning, everyone. Thank you for joining us for our second quarter 2025 earnings call. Mark Berlini, Oscar Hell's Chief Executive Officer, and Scott Blackley, Oscar's Chief Financial Officer, will host this morning's call. This call can also be accessed through our investor relations website at .hioscar.com. Full details of our results and additional management commentary are available in our earnings release, which can be found on our investor relations website at .hioscar.com. Any remarks that Oscar makes about the future constitute forward-looking statements within the meaning of safe harbor provisions under the Private Securities Litigation Reform Act of 1995. Actual results may differ materially from those indicated by those forward-looking statements as a result of various important factors, including those discussed in our annual report on Form 10-K for the period ended December 31, 2024, and the quarterly report on Form 10-Q for the period ended March 31, 2025, each is filed with the SEC, and other filings with the SEC, including our quarterly report on Form 10-Q for the quarterly period ended June 30, 2025, to be filed with the SEC. Such forward-looking statements are based on current expectations as of today. Oscar anticipates that subsequent events and developments may cause estimates to change. While the company may elect to update these forward-looking statements at some point in the future, we specifically disclaim any obligation to do so. The call will also refer to certain non-GAAP measures. A reconciliation of these measures to the most directly comparable GAAP measures can be found in the second quarter earnings press release available on the company's investor relations website at .hioscar.com. We have not provided a quantitative reconciliation of estimated full year 2025 adjusted EBITDA as described on this call to GAAP net income because Oscar is unable, without making unreasonable efforts, to calculate certain reconciling items with confidence. With that, I would like to turn the call over to our CEO, Mark Bertolini.

speaker
Mark Bertolini
Chief Executive Officer

Good morning. Thank you, Chris, and thank you all for joining us. Today Oscar announced second quarter results which are consistent with the preliminary results we released on July 22nd. We reported total revenue of $2.9 billion, a 29% increase year over year. MLR increased 12 points year over year to 91.1%, primarily driven by an overall increase in average market morbidity. Conversely, our SG&A ratio of .7% improved 90 basis points year over year. Overall, Oscar reported a loss from operations of $230 million and the adjusted EBITDA loss was $199 million. In the first half of the year, earnings from operations were $66 million and adjusted EBITDA was $129 million. We are also reaffirming our updated 2025 guidance, including revenue of $12 billion to $12.2 million and a loss from operations of $200 million to $300 million. Scott will walk through our financial updates in greater detail in a few moments. Now I want to share our view of what we are seeing in the individual market and why we believe the market will stabilize in 2026. We continue to believe in the long-term importance of the individual market for millions of consumers and employers. Let's start with recent market dynamics. The latest risk adjustment data from Weickly, which includes claims data through April 30th, indicates a meaningful market-wide increase in morbidity in 2025. This morbidity shift is impacting all carriers, increasing by mid to high single digits across Oscar's markets. We attribute market morbidity increases to consumers entering the individual market for Medicaid re-determinations and healthier low-utilizing consumers leaving the market in part due to program integrity efforts. Oscar is taking several actions to drive value and mitigate the impact of current industry-wide headwinds. We resubmitted 2026 rate filings in states covering nearly all current membership to reflect morbidity increases. Our engagement with state regulators continues to be productive. Our initial rate filings already reflected program integrity changes and the expiration of enhanced premium tax credits. We expect the market will have double-digit rate increases next year. We believe these overall rate increases will address the current morbidity pressure and the effects of program integrity efforts for 2026. We also see potential upside with growing support to renew enhanced premium tax credits in the upcoming continuing resolution. Oscar is a leader in the individual market with a 12-year track record of navigating dynamic markets. We are focused on what we can control. In addition to repricing, we remain disciplined in our expense management. Our team is right-sizing the cost of the business in the back half of this year. We continue to harvest technology and AI-driven efficiencies to optimize our operations and drive several medical cost affordability initiatives. The team is also reducing fixed cost headcount. We expect these actions will eliminate approximately $60 million in administrative costs for 2026. We also improved our 2025 SG&A guidance by 50 basis points at the midpoint compared to initial guidance. The individual market is experiencing a reset moment, but the market is resilient and we see significant opportunity for long-term growth. The individual market's fundamental characteristics combined with ICRA will drive a growing and stable risk pool over the long term. Oscar is at the center of building this future and is creating a competitive healthcare market for many more consumers and businesses. We are announcing several strategic steps to power ICRA and further diversify our business. We acquired important early stage assets with capabilities to help us build the consumer marketplace of the future. These assets include an individual market brokerage, a direct enrollment technology platform and a consumer education website, healthinsurance.org. We are also launching a new ICRA product with a well-known consumer brand in the Midwest, Hy-Vee Inc. Our new ICRA assets will give us capabilities to meet and exceed the expectations of consumers and employers. The technology platform, INSXcloud, is a fundamental asset of the marketplace. It is one of only 11 CMS approved solutions creating a digital storefront for all health products. The brokerage, IHC Specialty Benefits, offers individual medical and supplemental health products across carriers in all 50 states. The brokerage will allow us to offer consumers the supplemental health products they typically buy with health insurance. While the acquisition will not have a meaningful impact on our near-term results, we believe these capabilities are important building blocks of our long-term strategy. Hy-Vee is one of the most trusted brands in the nation with 570 grocery and convenience stores and 270 retail pharmacies. Hy-Vee and Oscar are introducing a new Hy-Vee Health branded ICRA plan. We are initially launching this product for employers and employees in Des Moines, Iowa for plan year 2026, subject to state approval. The plan offers superior benefits, including concierge medicine at an affordable fixed price through Hy-Vee Health exemplar care clinics. Our partnership is an example of the innovation we intend to drive with other employers, provider systems and consumer brands in the United States. In summary, Oscar is well positioned to manage through the market reset in 2025. We believe the market will stabilize next year and we expect a return to profitability in 2026. Oscar's track record of disciplined execution, strong management processes and a highly skilled team will continue moving us toward long-term growth. The individual market has greater long-term upside and is the future of health care. It is a market powered by individual choice. Choice drives a competitive market where consumers direct the innovation they want. Every American and American business deserves high quality, affordable health care that fits their needs. I want to thank the Oscar team for their leadership and hard work. We continue to execute against our strategy, stay responsive to the consumer and harness AI to move faster than the market. We are a company built on great technology with an exceptional member experience that will change health care. Now I will turn the call over to Scott to discuss our financials in more detail. Scott?

Disclaimer

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