Oscar Health Inc (OSCR) 2025 Q1 法說會逐字稿

Good morning, everyone. My name is Ellie, and I will be your conference operator for today. At this time, I would like to welcome everyone to the Oscar Health's first quarter 2025 earnings conference call. At this time, after the speaker's prepared remarks, there will be a question-and-answer session.

大家早安。我叫艾莉，今天我將擔任你們的會議主持人。現在，我歡迎大家參加 Oscar Health 2025 年第一季財報電話會議。此時，在演講者準備好的發言之後，將會有一個問答環節。

(Operator Instructions)

（操作員指示）

Thank you. I would now like to turn the call over to Chris Potochar, Vice President of Treasury and Investor relations.

謝謝。現在我想將電話轉給財務與投資人關係副總裁 Chris Potochar。

Good morning, everyone.

大家早安。

Thank you for joining us for our first quarter 2025 earnings call. Mark Berlini, Oscar Health'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 ir.hioscar.com.

感謝您參加我們的 2025 年第一季財報電話會議。Oscar Health 執行長 Mark Berlini 和 Oscar 財務長 Scott Blackley 將主持今天上午的電話會議。您也可以透過我們的投資者關係網站 ir.hioscar.com 存取此電話會議。

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 ir.hioskir.com.

我們的業績詳情和其他管理評論均可在我們的收益報告中查閱，該報告可在我們的投資者關係網站 ir.hioskir.com 上找到。

Any remarks that Oscar makes about the future constitute forward-looking statements within the meaning of safe harbour provisions under the Private Securities Litigation Reform Act of 1,995.

Oscar 對未來發表的任何言論均構成 1995 年《私人證券訴訟改革法案》安全港條款所定義的前瞻性聲明。

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 10k for the period ended December 31, 2024, filed with the SEC. And other filings with the SEC, including our quarterly report on Form 10Q for the quarterly period ended March 30, 2025; to be filed with the SEC.

由於各種重要因素，包括我們向美國證券交易委員會提交的截至 2024 年 12 月 31 日的 10k 表格年度報告中所討論的因素，實際結果可能與這些前瞻性陳述所示的結果存在重大差異。以及向美國證券交易委員會提交的其他文件，包括我們截至 2025 年 3 月 30 日的季度 10Q 表季度報告；需向美國證券交易委員會 (SEC) 提交文件。

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.

此類前瞻性陳述是基於截至今天的當前預期。奧斯卡預計後續事件和發展可能會導致估計發生變化。雖然公司可能選擇在未來某個時間點更新這些前瞻性聲明，但我們明確表示不承擔任何這樣做的義務。

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 first quarter earnings press release available on the company's investor relations website at ir.hioskr.com.

此次電話會議也將參考某些非公認會計準則指標。這些指標與最直接可比較的 GAAP 指標的對帳可以在公司投資者關係網站 ir.hioskr.com 上的第一季財報新聞稿中找到。

We have not provided a quantitative reconciliation of estimated full year 2025 adjusted IPETA as described on the call to GAAP net income because Oscar is unable without making unreasonable efforts to calculate certain reconciling items with confidence.

我們沒有提供 GAAP 淨收入電話中所述的 2025 年全年預計調整後的 IPETA 的定量對賬，因為 Oscar 無法在不付出不合理努力的情況下自信地計算某些對賬項目。

With that, I would like to turn the call over to our CEO Mark Bertolini.

說到這裡，我想把電話轉給我們的執行長馬克貝托里尼 (Mark Bertolini)。

Good morning.

早安.

Thank you, Chris, and thank you all for joining us.

謝謝你，克里斯，也謝謝大家加入我們。

Today, Oscar reported strong first quarter results. Our positive results were driven by continued top line growth, bottom line performance, and year over year improvements across nearly all core metrics. Oscar reported total revenue of $3 billion in the quarter, a 42% increase year over year.

今天，Oscar 公佈了強勁的第一季業績。我們的正面成果得益於持續的營收成長、獲利表現以及幾乎所有核心​​指標的逐年改善。Oscar 報告本季總營收為 30 億美元，年增 42%。

We also generated net income of approximately $275 million a significant improvement of $98 million over the prior year period.

我們還創造了約 2.75 億美元的淨收入，比去年同期大幅增加了 9,800 萬美元。

Earnings from operations grew by $112 million to $297 million and we improved our operating margin by 110 basis points year over year to 9.8%. MLR increased 120 basis points year over year to 75.4%, primarily due to a risk adjustment true up for 2024.

營業利潤成長 1.12 億美元，達到 2.97 億美元，營業利益率年增 110 個基點，達到 9.8%。MLR 年比增加 120 個基點至 75.4%，主要原因是 2024 年風險調整。

We also drove greater efficiency in the business and reported the lowest SG&A ratio in the company's history at 15.8%. A 260-basis point improvement year over year. Our first quarter performance demonstrates the strength of our strategic plan, and we expect meaningful margin expansion this year.

我們也提高了業務效率，並將銷售、一般及行政費用比率降至公司歷史上最低的 15.8%。年比提高 260 個基點。我們第一季的業績證明了我們策略計畫的實力，我們預計今年的利潤率將大幅擴大。

Scott will review our first quarter results in a few moments. First, I will cover key business highlights. Oscar's first quarter results put us on a solid path for 2025. We closed the quarter with approximately $2 million effectuated members, a 41% increase year over year.

斯科特稍後將回顧我們的第一季業績。首先，我將介紹主要的業務亮點。Oscar 第一季的業績為我們 2025 年的發展奠定了堅實的基礎。本季結束時，我們擁有約 200 萬美元的有效會員，年增 41%。

Our solid retention and new membership growth reflect the value of Oscar's innovative plan designs and superior member experience. Our condition focused plans are strong performance in the book.

我們穩固的保留率和新會員的成長反映了 Oscar 創新計畫設計和卓越會員體驗的價值。我們的以條件為重點的計劃在書中表現強勁。

We are also seeing high levels of digital engagement across our IFP and ICRA membership, allowing us to more effectively manage member care.

我們也看到 IFP 和 ICRA 會員的數位參與度很高，這使我們能夠更有效地管理會員服務。

Oscar is deepening our market presence with new partnerships that give members more value-added services. In the quarter, we launched Oscar Community Resources with Find Help, a social care network. The program connects members with local food, housing, transportation, and other services beyond medical care that impact health.

Oscar 正在透過新的合作夥伴關係深化我們的市場影響力，為會員提供更多增值服務。本季度，我們與社會關懷網絡 Find Help 合作推出了 Oscar Community Resources。該計劃為會員提供當地的食品、住房、交通以及醫療保健以外的其他影響健康的服務。

These resources will ultimately support our clinical intervention and case management programs to lower spend and improve clinical outcomes. Our technology is also further optimizing our operations and improving the member experience.

這些資源最終將支持我們的臨床幹預和病例管理計劃，以降低支出並改善臨床結果。我們的技術也進一步優化了我們的營運並改善了會員體驗。

The team recently launched a free live chat feature for Oscar Virtual Urgent Care, which collects patients symptoms and severity before provider engagement.

該團隊最近為 Oscar Virtual Urgent Care 推出了一項免費即時聊天功能，可在服務提供者介入之前收集患者的症狀和嚴重程度。

Use of the new capability decreased member response times by 90% and drove a 28% boost in provider efficiency.

使用新功能可將會員回應時間縮短 90%，並將提供者效率提高 28%。

Similarly, our new AI tool for care guides is more quickly addressing member needs. We continue to build a scalable and efficient technology infrastructure that positions us to grow and differentiate the Oscar experience. Before I close, I want to talk about the current policy environment and attention on the individual market.

同樣，我們用於護理指南的新 AI 工具可以更快地滿足會員的需求。我們將繼續建立可擴展且高效的技術基礎設施，以使我們能夠發展和區分奧斯卡體驗。最後，我想談談目前的政策環境和個人市場的焦點。

CMS's proposed program integrity initiatives targeting fraud, waste, and abuse are positive for the long-term sustainability of the market.

CMS 提出的針對詐欺、浪費和濫用的專案誠信措施對市場的長期永續性具有積極作用。

However, rules such as the shortened enrolment window will constrain Americans' ability to shop amid many enrolment changes for 2026.

然而，由於 2026 年入學制度將發生許多變化，縮短入學期限等規定將限制美國人的購物能力。

Many individuals are already facing meaningful premium increases if the enhanced premium tax credits expire. They deserve adequate time to shop for plans that meet their needs.

如果增強保費稅收抵免到期，許多人將面臨保費大幅上漲。他們應該有足夠的時間來購買滿足他們需求的計劃。

Oscar advocates for constructive solutions that strengthen the individual market. We are engaged with federal and state policymakers on both sides of the aisle.

奧斯卡提倡加強個人市場的建設性解決方案。我們與聯邦和州兩黨的政策制定者進行了接觸。

The individual market is a cornerstone of American healthcare, driving a record low uninsured rate and a cost trend below CPI for the last several years.

個人市場是美國醫療保健的基石，推動了過去幾年無保險率創歷史新低，成本趨勢低於消費者物價指數 (CPI)。

Policymakers recognize the market's role in our economy and the gap it fills for their hardworking constituents. Oscar has been in this business since the ACA's inception, and we look forward to building an even larger individual market for individuals, families, and the business community.

政策制定者認識到市場在我們經濟中的作用以及它為辛勤工作的選民填補的空白。Oscar 自 ACA 成立以來就一直從事這項業務，我們期待為個人、家庭和商業界建立更大的個人市場。

In summary, Oscar is off to a solid start in 2025. Our disciplined execution, strong top line growth, and marginal expansion position us to achieve our 2025 targets. Oscar has the talent, technology, and products to continue scaling a profitable business.

總而言之，奧斯卡在 2025 年將有一個良好的開端。我們嚴謹的執行、強勁的營收成長和邊際擴張使我們能夠實現 2025 年的目標。Oscar 擁有人才、技術和產品來繼續擴大盈利業務。

Oscar is one of the fastest growing players in the individual insurance market. We are creating a marketplace that meets consumer and employer expectations for choice, quality, and affordability.

Oscar 是個人保險市場中成長最快的公司之一。我們正在創建一個滿足消費者和雇主對選擇、品質和可負擔性的期望的市場。

Our team's ability to stay responsive to stakeholder needs and consistently execute in dynamic markets will continue to unlock new pathways for growth.

我們的團隊能夠及時回應利害關係人的需求並在動態市場中持續執行，這將繼續開闢新的成長途徑。

Before I hand the call over to Scott, I want to thank the Oscar team for their dedication and commitment to our members and partners. We look forward to delivering strong results in 2025, Scott.

在我將電話交給斯科特之前，我想感謝奧斯卡團隊對我們的成員和合作夥伴的奉獻和承諾。我們期待在 2025 年取得優異成績，斯科特。

Thank you, Mark, and good morning, everyone. We delivered strong financial results in the first quarter in line with our expectations.

謝謝你，馬克，大家早安。我們第一季的財務表現強勁，符合我們的預期。

We continued to demonstrate consistent, strong execution and reported approximately $275 million of net income in the first quarter or $0.92 per diluted share. Total revenue increased 42% year over year to $3 billion in the first quarter, driven by higher membership.

我們繼續展現一致、強勁的執行力，並報告第一季淨收入約為 2.75 億美元，即每股攤薄收益 0.92 美元。由於會員人數增加，第一季總營收年增 42%，達到 30 億美元。

We ended the quarter with more than $2 million effectuated members, an increase of 41% year over year, and 22% sequentially. Membership growth was driven by strong retention.

本季結束時，我們的有效會員數量超過 200 萬美元，年增 41%，季增 22%。會員數量的增長得益於強大的保留率。

Above market growth during open enrolment and SEP member editions. We had approximately $1.9 million paid members at the end of the first quarter. As expected, we experienced minimal churn from members who failed to file and reconcile. The first quarter medical loss ratio was 75.4%, an increase of 120 basis points year over year.

開放註冊和 SEP 會員版期間的成長高於市場成長。第一季末，我們擁有約 190 萬美元的付費會員。正如預期的那樣，未能提交文件和進行核對的會員流失率極低。第一季醫療損失率為75.4%，較去年同期增加120個基點。

The first quarter MLR was impacted by $31 million of unfavourable prior period development as an increase to our 2024 risk adjustment payable was partially offset by favorable claims run out from the prior year and the CSR recovery. On a year-to-year basis, the impact was approximately 60 basis points.

第一季 MLR 受到 3,100 萬美元的不利前期發展的影響，因為我們 2024 年風險調整應付款項的增加被上一年的有利索賠和 CSR 恢復部分抵消。以年計算，影響約 60 個基點。

Turning to utilization in the first quarter, we saw a higher inpatient utilization that was partially offset by favorable pharmacy. Outpatient and professional were largely in line with our expectations.

談到第一季的使用率，我們發現住院病人利用率較高，但被有利的藥房條件部分抵消。門診和專業基本上符合我們的預期。

Switching to administrative costs, we continue to deliver meaningful improvement in the expense ratio. The first quarter SG&A expense ratio improved by 260 basis points year over year to 15.8%, the lowest quarterly SG&A expense ratio in the company's history.

轉向管理費用，我們繼續在費用率方面取得顯著改善。第一季銷售、一般及行政費用率較去年同期改善260個基點至15.8%，為公司史上最低的季度銷售、一般及行政費用率。

The year over year improvement was driven by fixed cost leverage, lower exchange fee rates, and variable cost efficiencies. Our strong first quarter results position us to deliver meaningful margin expansion this year.

年成長得益於固定成本槓桿、較低的匯率和變動成本效率。我們第一季的強勁業績使我們能夠在今年實現利潤率的大幅提升。

Earnings from operations was $297 million a significant $112 million dollar increase year over year. Operating margin was 9.8%, 110 basis point increase year over year.

營業利潤為 2.97 億美元，較上年同期大幅增加 1.12 億美元。營業利益率為9.8%，較去年成長110個基點。

Net income was approximately $275 million a significant $98 million dollar increase year over year. Adjusted EBITDA was $329 million in the quarter, also substantially improved by approximately $110 million year over year.

淨收入約 2.75 億美元，較上年同期大幅增加 9,800 萬美元。本季調整後的 EBITDA 為 3.29 億美元，較去年同期大幅增加約 1.1 億美元。

Shifting to the balance sheet, our capital position remains very strong. We ended the first quarter with approximately $4.9 billion of cash and investments, including $150 million of cash investments at the parent.

從資產負債表來看，我們的資本狀況依然非常強勁。截至第一季末，我們擁有約 49 億美元的現金和投資，其中包括母公司 1.5 億美元的現金投資。

As of March 30, 2025, our insurance subsidiaries had approximately $1.5 billion of capital and surplus, including $907 million of excess capital, which was driven by our strong operating performance.

截至 2025 年 3 月 30 日，我們的保險子公司擁有約 15 億美元的資本和盈餘，其中包括 9.07 億美元的超額資本，這得益於我們強勁的經營業績。

Turning now to 2025 full year guidance. Based on first quarter results, we are reaffirming all of our full year guidance metrics. We continue to expect total revenue in the range of $11.2 billion to $11.3 billion in 2025.

現在談談 2025 年全年指引。根據第一季的業績，我們重申所有全年指引指標。我們繼續預計 2025 年總收入將在 112 億美元至 113 億美元之間。

While membership at quarter end exceeded our expectations, our outlook now contemplates the end of the monthly SEP for those at or below 150% of FPL.

雖然季度末的會員人數超出了我們的預期，但我們目前的展望是考慮到那些處於或低於 FPL 150% 的會員的每月 SEP 結束時間。

Collectively these updates resulted in no change to our full year revenue outlook. Turn to medical loss ratio, we continue to expect the MLR in the range of 80.7% to 81.7%. On administrative expenses, we also continue to expect an SG&A expense ratio in the range of 17.6% to 18.1%. We continue to expect earnings from operations in the range of $225 million to $275 million.

總的來說，這些更新並未對我們的全年收入前景產生任何影響。談到醫療損失率，我們繼續預期 MLR 在 80.7% 至 81.7% 之間。在管理費用方面，我們也繼續預期銷售、一般及行政費用率將在 17.6% 至 18.1% 之間。我們繼續預計營業利潤將在 2.25 億美元至 2.75 億美元之間。

As a reminder, we would expect adjusted EBITDA to be roughly $140 million higher than the ranges from operations.

提醒一下，我們預計調整後的 EBITDA 將比營運範圍高出約 1.4 億美元。

In closing, we had a strong start to the year. We continue to execute against our strategic plan, and we're well positioned to achieve net income profitability and margin expansion again this year.

總而言之，我們今年有一個好的開始。我們將繼續執行我們的策略計劃，我們已做好準備，在今年再次實現淨收入盈利和利潤率擴大。

With that, I will turn the call over to the operator for the Q&A portion of our call.

說完這些，我將把電話轉給接線生，進行電話的問答部分。

Thank you. We are now opening the floor for question-and-answer session.

謝謝。我們現在開始問答環節。

(Operator Instructions)

（操作員指示）

Your first question comes from the line of John Ransom of Raymond James.

您的第一個問題來自雷蒙德詹姆斯 (Raymond James) 的約翰蘭瑟姆 (John Ransom)。

I played that course for, isn't that great?

我參加了那個課程，不是很棒嗎？

Yeah, that's fantastic. See you later.

是的，太棒了。回頭見。

Got.

得到。

Hello John, do you, John, do you have a question?

你好，約翰，約翰，你有問題嗎？

I'm sorry, I didn't think I was in the queue. They told me I went in the queue, yeah, just, cleaning up a little bit the numbers what.

抱歉，我不認為我在排隊。他們告訴我，我去排隊了，是的，只是稍微清理了一下數字。

Yeah, the $2 million membership you ended the quarter with, how should we think about that number for the second quarter and for the rest of the year?

是的，本季末您的會員費為 200 萬美元，我們應該如何看待第二季和今年剩餘時間的這個數字？

Yeah, good morning.

是的，早安。

Membership in the first quarter had a couple dynamics. So, first of all, we saw really strong payment rates, which was great, that exceeded our expectation, and then SEP in general was quite strong as well. So, we ended the quarter with more members than what we had anticipated.

第一季的會員人數有幾個動態。因此，首先，我們看到了非常強勁的支付率，這很好，超出了我們的預期，然後 SEP 總體上也相當強勁。因此，本季結束時我們的會員數量超出了我們的預期。

Looking forward, I would expect that you know ours. We'll see membership trend up in the first half of the year. We're now expecting that with the proposal to end the continuous SEP for individuals that are at or below 150% of the federal poverty level, that we would see membership then trend down in the back half of the year.

展望未來，我希望您了解我們。我們將看到上半年會員數呈上升趨勢。我們現在預計，隨著針對收入處於或低於聯邦貧困線 150% 的個人終止持續 SEP 的提議，我們將看到會員人數在今年下半年呈下降趨勢。

And so, net I end up kind of in the same place as what we were expecting when we gave our guidance at the beginning of the year.

因此，最終的結果與我們年初給出指導時預期的一致。

So, in other words, a million eight by the end of the year, but trending up and then trending back down.

換句話說，到今年年底將達到 180 萬，但呈上升趨勢，然後又呈下降趨勢。

Yeah, I think that's, about, where we would expect to finish the year.

是的，我想這就是我們預計今年底的結果。

Okay, thank you.

好的，謝謝。

(Operator Instructions)

（操作員指示）

Your next question comes from the line of Stephen Baxter of Wells Fargo. Your line is now open.

您的下一個問題來自富國銀行的史蒂芬·巴克斯特。您的線路現已開通。

Hey, good morning. It's a question. Just wanted to ask first on, the grace period membership.

嘿，早安。這是一個疑問。我首先想問寬限期會員資格。

I think it would be really helpful to potentially get some context around, as we try to think about what percentage of your membership that represented during the quarter and what that might look like for maybe.

我認為了解一些背景資訊會非常有幫助，因為我們試著思考本季您的會員人數佔比是多少，以及可能的情況如何。

What we consider maybe a more recent period kind of normalized number just so we can think about how much larger that is and then obviously to the extent that you know that's a more contribution positive part of your book maybe you could help us just think about how that kind of works its way into the MLR seasonality for the year and then.

我們認為這可能是最近一段時間的一種標準化數字，這樣我們就可以思考它有多大，然後顯然，就您所知，這是您書中更積極的貢獻部分而言，也許您可以幫助我們思考它是如何影響今年的 MLR 季節性的。

Secondarily, just wanted to get an update on risk adjustment. I think you provided a net impact in the press release in terms of the 2024 through up. Maybe you could also provide us with the risk adjustment item in isolation and then just remind us how that's informing how you're thinking about 2025 risk adjustment.

其次，只是想了解風險調整的最新情況。我認為您在新聞稿中提供了從 2024 年起的淨影響。也許您還可以單獨向我們提供風險調整項目，然後提醒我們這是如何告知您對 2025 年風險調整的看法的。

Thank you.

謝謝。

Okay, Why don't, I'll start with the membership and look, I think that what we've seen is, on Grace.

好的，為什麼不呢，我將從會員資格開始看，我認為我們所看到的是在 Grace 上。

As you start the year you have a portion of that membership which you know is getting auto renewed and we would expect to see those people, in their grace period as of April 1, which is why we kind of shared the difference between effectuated and paid membership we've seen pages really perform well and.

在年初，您有一部分會員資格會自動續訂，我們預計這些人將在 4 月 1 日進入寬限期，這就是為什麼我們分享了生效會員和付費會員之間的區別，我們看到頁面確實表現良好。

I would expect that in the second quarter we would see the gap between paid and effectuate between effectuated and paid, to be a normalized level and frankly, it was closing in on that as we ended the first quarter.

我預計，在第二季度，我們會看到已支付金額與實際支付金額之間的差距達到正常水平，坦白說，在第一季度結束時，這一差距已經接近正常水平。

With respect to, what happens on a go forward basis I think we would expect to see normal patterns in terms of the percentage of our members that are in grace and shifting towards what happened with prior period development so.

至於未來會發生什麼，我認為我們期望看到正常的模式，即我們的成員中處於寬限期的百分比，以及向前一時期的發展轉變。

PPD was $30 million net unfavourable in the quarter. The increase to the risk adjustment was $92 million which was offset by favorable claims run out with the other factors mostly offsetting, and that was about 60 basis points of the increase in the year over year MLR.

本季 PPD 淨虧損為 3,000 萬美元。風險調整增加了 9,200 萬美元，但被有利的索賠額所抵消，其他因素也基本抵消了這一增加，這相當於 MLR 同比增加約 60 個基點。

The rest of the increase in the year over year MLR was mix related. So those are the drivers, Steve.

MLR 年增幅的其餘部分與混合有關。所以這些就是驅動因素，史蒂夫。

Your next question comes from the line of John Young of UBS. Your line is now open.

您的下一個問題來自瑞銀的約翰楊 (John Young)。您的線路現已開通。

Okay, thanks for the question here. Just on new versus retired members, is there anything of note between the utilization patterns between the two and on inpatient, I'm assuming that may have been flu driven in your comments there, but anything too far out there and comment on.

好的，感謝您的提問。僅就新成員和退休成員而言，兩者之間的利用模式和住院情況有什麼值得注意的地方嗎？我假設您的評論中可能是由流感引起的，但任何太過分的事情都值得評論。

And then on the better than I expected pharmacy, that's a little different than kind of, I think just generally and broadly the comments we've heard across space, anything of note there. Thanks.

然後，關於比我預期更好的藥房，這與某種程度上有點不同，我認為一般來說，我們在整個空間聽到的評論，都值得注意。謝謝。

Yeah, I would say that on utilization we're seeing a continuation of some of the trends that we saw at the end of last year, which is higher inpatient utilization with favorable pharmacy, overall utilization was above our expectations, and we didn't see any specific driver of conditions that really was driving inpatient.

是的，我想說，就利用率而言，我們看到了去年年底看到的一些趨勢的延續，即住院利用率更高，藥房條件有利，總體利用率高於我們的預期，而且我們沒有看到任何真正推動住院治療的具體因素。

We had some flu but nothing that would be outsized, overall, at this point in the year we're at about 15% of claims, completion, so it's pretty early for us to draw any conclusions about utilizations, a utilization, I would say that we are expecting that, the elevated utilization is going to mostly be offset by risk adjustment.

我們遇到了一些流感，但沒有什麼特別嚴重的問題，總體而言，今年這個時候我們的索賠完成率約為 15%，因此現在就得出關於利用率的任何結論還為時過早，我想說，我們預計，利用率的提高將主要被風險調整所抵消。

The other thing I would say is that we always start the year with a list of actionable initiatives that you know we. Would expect to be able to pull to you know decrease medical costs and we don't include those levers in our guidance and we're actioning on those initiatives at this point, to offset any potential headwinds from the increased utilization that we've seen.

我想說的另一件事是，我們總是在新年伊始就制定一份可行的舉措清單。希望能夠降低醫療成本，但我們的指導中不包括這些槓桿，目前我們正在採取這些舉措，以抵消我們所看到的利用率增加所帶來的任何潛在阻力。

Great, if I may ask, just one of your comparison is exiting the exchanges in 26, kind of how you think about the opportunities and risk around that, around this and what it may mean to you. Thanks.

太好了，如果我可以問的話，您的一個比較是在 26 日退出交易所，您如何看待圍繞這個的機會和風險，以及它對您意味著什麼。謝謝。

I am Mark here. We view this as both sad and as an opportunity. We hate when competition's lessened in the marketplace. We believe that's appropriate. The more people we have in, the more opportunities for people to find the product that works for them.

我是馬克。我們認為這既是悲傷也是機會。我們討厭市場競爭的減少。我們認為這是合適的。我們擁有的人越多，人們找到適合自己的產品的機會就越大。

However, in this circumstance, we have fairly significant overlap with this competitor, and we view that as an opportunity come 1,126 to help people maintain their coverage at a level of pricing that we find disciplined and competitive in the market.

然而，在這種情況下，我們與該競爭對手有相當大的重疊，我們認為這是一個機會，可以幫助人們以我們認為在市場上有紀律和競爭力的定價水平維持他們的保險範圍。

Thank you.

謝謝。

(Operator Instructions)

（操作員指示）

Our next question comes from the line of Joanna Gajuk of Bank of America. Your line is now open.

我們的下一個問題來自美國銀行的 Joanna Gajuk。您的線路現已開通。

Hey, good morning. Thanks so much for taking the question. So, a couple of, I guess those high-level questions on the regulatory environment. So first you alluded to this proposal that came out in early March, right, it would include a couple of these different items in there. So, any kind of thoughts. You know which of these provisions would be finalized?

嘿，早安。非常感謝您回答這個問題。所以，我猜想這些是關於監管環境的幾個高層問題。首先，您提到了 3 月初提出的這項提案，其中將包括幾個不同的項目。所以，任何想法都可以。您知道這些規定中的哪些將會最終實施嗎？

Sounds like you don't agree with most of them, and I guess because all in all these items together, CMS had estimated would have reduced enrolment on exchanges by 3% to 9%, so it could be, somewhat material, right?

聽起來你不同意其中的大部分內容，我想因為所有這些項目加在一起，CMS 估計交易所的註冊人數會減少 3% 到 9%，所以它可能有點重要，對嗎？

And then related topic to that. Any updated thoughts on, people in Congress than on extending the enhanced subsidies on exchanges, and can you remind us of the percentage of your exchange book that is fully subsidized?

然後是與此相關的主題。國會議員們對延長交易所補貼有什麼最新想法嗎？您能否提醒我們，您的交易所帳簿中完全獲得補貼的百分比是多少？

Thank you.

謝謝。

Thanks, Joanna. I'll talk first to the enrolment changes that were made.

謝謝，喬安娜。我先談談所進行的招生變更。

I want to remind everybody that a number of these programs were on integrity were put. In midway through 2024, so we've seen some of the effect of that already, as we've reviewed and commented on the on the terms of the of the proposed regulation, we believe it's really important that we support CMS's effort to strengthen the integrity of the ACA and foster a stable risk pool.

我想提醒大家，這些計劃中有許多都是關於誠信的。在 2024 年中期，我們已經看到了一些影響，正如我們審查和評論擬議法規的條款時一樣，我們認為支持 CMS 加強 ACA 完整性和建立穩定風險池的努力非常重要。

So, we want a market we can trust where enrolments are. And that we're taking care of real people. So, we're fine with all of that. The one issue that I mentioned during my comments is that the shortened enrolment period does not allow for enough shopping for individuals and brokers.

因此，我們希望有一個可以信賴的、有招生的市場。我們正在照顧真實的人。所以，我們對這一切都很滿意。我在評論中提到的一個問題是，縮短的註冊期不允許個人和經紀人進行足夠的購物。

We'll have to both comply with these regulations and then determine this last question or on a competitor find a new place to get coverage. And so we think they should really seriously consider extending those enrolment periods.

我們必須遵守這些規定，然後確定最後一個問題，或在競爭對手那裡找到新的覆蓋範圍。因此我們認為他們應該認真考慮延長入學期限。

Scott, any comments on the risk.

斯科特，對於風險有什麼評論嗎？

I think that with respect to, Which of these things we expect to go forward we, as I mentioned in my prepared remarks, and one of the questions we do expect that they will limit the continuous SEP enrolment in 2025. That's what we're planning for in terms of impact this year, looking at the remainder of the impacts, I think that there's a lot of overlap between what may happen with the.

我認為，關於哪些事情我們希望繼續推進，正如我在準備好的演講中提到的那樣，其中一個問題是，我們確實預計它們將限制 2025 年 SEP 的持續註冊。這就是我們今年針對影響所製定的計劃，看看其餘的影響，我認為可能發生的情況有很多重疊。

The new rule and what may happen with subsidies, so you know those are all kind of blended together, so we're not going to at this point make any comments about how 2026 may run forward.

新規則以及可能發生的補貼，所以你知道這些都是混合在一起的，所以我們現在不會對 2026 年的發展發表任何評論。

And then your question with respect to what portion of our book is fully subsidized, I would say that Oscar has always had a significant portion of our membership that receives some oral subsidized amounts of premiums.

然後，關於您所問的關於我們書中有多少部分是完全補貼的問題，我想說，奧斯卡一直有相當一部分會員獲得了一些口頭補貼的保費。

Great, thank you.

太好了，謝謝。

Your next question comes from the line of Joshua Raskin of Nephron Research. Your line is now open.

您的下一個問題來自 Nephron Research 的 Joshua Raskin。您的線路現已開通。

Hi, thanks, good morning. Wanted to just follow up on the competitor exits. I'm just curious when you see this historically are those generally good members to attract, meaning, medical management versus risk adjustment, and then how do those large exits impact your estimates of risk adjustment?

嗨，謝謝，早安。只是想跟進競爭對手的退出情況。我只是很好奇，當您從歷史上看，那些通常是吸引好會員的，也就是說，醫療管理與風險調整，那麼這些大規模的退出如何影響您對風險調整的估計？

And then my bigger picture question is just I'd be curious to get any progress on the ICRA market to sort of in general just sort of environmental progress and. Are you talking to large employers even about 2026 and maybe where are we in that cycle?

然後我更大的問題是，我只是好奇 ICRA 市場在整體環境進步方面是否能取得任何進展。您是否正在與大型雇主談論 2026 年以及我們處於該週期的哪個階段？

Great, thanks, Josh. First, and foremost, let me talk a little bit about ICRA. On the ICRA front, we believe that there is increased momentum. We're starting to see larger groups in the middle market space starting to get interested and talk to us about the opportunity.

太好了，謝謝，喬希。首先，讓我簡單談談 ICRA。在 ICRA 方面，我們相信勢頭正在增強。我們開始看到中端市場領域的更大群體開始感興趣並與我們討論這個機會。

We have introduced through our House Ways and Means Committee testimony, the idea of this tax credit issue that needs to make the level plain. Field for employers and we believe that that has some opportunity to get pushed through on this next bill.

我們已經透過眾議院籌款委員會的證詞介紹了需要明確說明的稅收抵免問題的想法。為雇主提供領域，我們相信這有機會在下一項法案中得到推動。

So, we believe once those kinds of conditions are in place, that the momentum will continue to build. We have talked to large employers. I was in a room with large employers earlier this week where there's a lot of interest expressed. I was invited to speak about my comments on CNBC.

因此，我們相信，一旦這些條件具備，這種勢頭就會繼續增強。我們已經與大型雇主進行了交談。本週早些時候，我和一些大型雇主在一個房間裡，他們表達了許多興趣。我被邀請在 CNBC 上談論我的評論。

About, the best way to solve health care problems is to eliminate the employer sponsored health insurance market, and I gave the reasoning behind all of that, which we've shared with you before, Josh, and we believe that that's an opportunity.

關於解決醫療保健問題的最佳方法是消除雇主贊助的健康保險市場，我給出了背後的原因，我們之前已經與你分享過，喬希，我們相信這是一個機會。

It'll be slower because there's always resistance in these staffs, but we think that that continues to be a very important market. And then on your first question, I lost your Point if you could sort of remind me quickly.

由於這些員工總是有抵觸情緒，所以速度會比較慢，但我們認為這仍然是一個非常重要的市場。然後關於您的第一個問題，如果您能快速提醒我一下，我就不明白您的意思了。

Our competitor exits or, when you get members from other plans that have exited markets, is that that good news and adjustment and yeah.

我們的競爭對手退出，或者當你從其他退出市場的計劃中獲得成員時，這是好消息和調整，是的。

Well, the good thing is that risk adjustment levels the playing field for everybody at the end of the year. So, it's how you go into the market price.

嗯，好消息是，風險調整在年底為每個人提供了公平的競爭環境。所以，這就是你如何進入市場價格。

And again, we don't underwrite these markets. So as long as we believe we have discipline pricing in the marketplace and the risk adjustment continues to work effectively the way it has, that we'll be fine in those markets and growing the membership. The reason that this competitor is.

再次聲明，我們不承保這些市場。因此，只要我們相信我們在市場上有紀律的定價，並且風險調整繼續有效地發揮作用，我們就會在那些市場上表現良好，並增加會員數量。這個競爭對手的原因就是。

Exiting more importantly is that they got behind on their margin and behind on their pricing. It's really hard to catch up unless you price way up, which other competitors have done in prior years.

更重要的是，他們退出是因為利潤和定價都落後了。除非大幅提高價格，否則很難趕上，而其他競爭對手在前幾年就已經這麼做了。

But in this instance, they tried to move up slowly, didn't get all the way there, and as a result, they need to exit the market. And we think that's their pricing problem, not ours. Again, with risk adjustment, we think we're fine.

但在這種情況下，他們試圖緩慢上升，但並沒有完全達到目標，因此，他們需要退出市場。我們認為這是他們的定價問題，而不是我們的問題。再次，透過風險調整，我們認為一切都很好。

And generally if people are, it'll be a mix that is consistent with the marketplace. Each market individually.

一般來說，如果人們願意的話，這將是與市場一致的組合。每個市場都單獨進行。

Your next question comes from the line of Jessica Sexton of Piper Sandler. Your line is now open.

您的下一個問題來自 Piper Sandler 的 Jessica Sexton。您的線路現已開通。

Hi. Thanks for taking the question. I just wanted to start with, is your expectation for 2025 still that risk adjustment payable is a similar percent of premiums, as it was in 2024? And if not, can you give us, a sense of any updated expectations on the risk adjustment as percent of premiums?

你好。感謝您回答這個問題。我首先想問的是，您對 2025 年的預期是否仍然是風險調整應付額佔保費的百分比與 2024 年相同？如果沒有，您能否告訴我們，對風險調整佔保費百分比的最新預期是什麼？

Yeah, thanks, Jess. Why don't I make a couple of comments about seasonality for a couple of different components of the book. So, with respect to risk adjustment, no, it's no significant adjustment at this point in time, although, if we see elevated claims, continue, that will tend to push down the risk adjustment as a percentage of revenue. So, we'll have to see how that plays out.

是的，謝謝，傑西。我為什麼不針對這本書的幾個不同部分的季節性發表一些評論呢？因此，就風險調整而言，目前還沒有進行重大調整，但是，如果我們看到索賠金額繼續增加，這將會降低風險調整佔收入的百分比。所以，我們必須看看結果如何。

On MLR seasonality. I would expect that MLR seasonality will be a little bit flatter in the second, third, and fourth quarter than what we've seen historically. So, a step up in the second quarter with the fourth quarter being the highest, and then with respect to SG&A seasonality, we still expect to see gradual increases in the SG&A expense ratio, each quarter.

關於 MLR 季節性。我預計第二、第三和第四季的 MLR 季節性將比歷史上的情況稍微平緩一些。因此，第二季度有所上升，第四季度最高，然後就銷售、一般和行政費用的季節性而言，我們仍然預計每季銷售、一般和行政費用率都會逐漸上升。

Got it. That helps. And then just, I guess thinking about next year, and the several alternative options, can you give us a sense of the margin profile of bronze plans, both MLR and then, just interested in the, SG&As the percent of premiums there, and whether you have an opportunity to kind of maintain flat margins despite the potential for downward mix shift. Thanks.

知道了。這有幫助。然後，我想考慮明年和幾種替代方案，您能否讓我們了解一下青銅計劃的利潤狀況，包括 MLR 以及 SG&A 的保費百分比，以及您是否有機會在組合向下轉變的可能性下保持平穩的利潤率。謝謝。

Yes, I would say that we're not yet going to be giving any information about 2026. I would say is we're working on our pricing, where our intent is to continue to grow margin for this company and so we'll be looking at a pricing strategy that'll have discipline pricing that'll allow us to. Continue to take share and improve margins. So that's what we're focused on for '26.

是的，我想說我們暫時不會提供任何有關 2026 年的資訊。我想說的是，我們正在研究定價，我們的目的是繼續增加公司的利潤率，因此我們將研究一種定價策略，這種策略將具有允許我們這樣做的紀律定價。繼續佔領市場份額並提高利潤率。這就是我們 26 年關注的重點。

And I would add that there's relatively high overlap between the enhanced premium tax credits and fraudulent and the integrity regulations that they put in place. So depending on how those both settle out and what the details of each of them are, is going to largely depend on what the mix is going to do relative to pricing versus morbidity.

我想補充一點，增強的保費稅收抵免和他們實施的欺​​詐及誠信法規之間存在相對較高的重疊。因此，取決於這兩者如何解決以及各自的細節是什麼，很大程度上將取決於組合在定價和發病率方面的作用。

Got it, thank you.

知道了，謝謝。

Your next question comes from the line of Michael Ha of Baird. Your line is now open.

您的下一個問題來自貝爾德公司的邁克爾·哈 (Michael Ha)。您的線路現已開通。

Alright.

好吧。

Thank you and congratulations on the quarter historic GA print, achieving 15% two years early before 27. With that said, I was wondering if you could elaborate more on the drivers of the GNA performance, how much of the beat would you attribute to fixed cost leverage versus the lower exchange fee rate versus the variable.

謝謝您，並祝賀本季創歷史性的 GA 業績，在 27 日之前兩年實現了 15% 的成長。話雖如此，我想知道您是否可以更詳細地闡述 GNA 業績的驅動因素，您認為固定成本槓桿、較低的匯率和可變匯率在多大程度上推動了業績的成長。

Cost efficiencies, I think, Jess asked it but in terms of cadence and seasonality of GNA throughout the remainder of this year, just given how strong the print is, just trying to understand how durable this level of GNA is going forward and again the source of the beat as well.

我認為，成本效率是傑西問的，但就今年剩餘時間 GNA 的節奏和季節性而言，考慮到印刷的強度，只是想了解這種水平的 GNA 在未來會有多持久，以及再次成為節拍的來源。

Thank you.

謝謝。

Yeah, I appreciate the question and in terms of the Just kind of stepping back, SG&A improved, the ratio improved year over year by about 260 basis points. So, a big step forward and our cost trend honestly is just a great story.

是的，我很感謝這個問題，就剛才回顧而言，銷售、一般及行政開支有所改善，該比率同比提高了約 260 個基點。因此，向前邁出了一大步，我們的成本趨勢確實是一個偉大的故事。

Our tech is playing a big part of driving the performance, and we've been, very focused and disciplined about expense management both on the fixed side and the variable side. And those are the primary drivers of the year of your improvement just to give you some specifics. Fixed cost leverage is about 40% of the improvement.

我們的技術在推動績效方面發揮著重要作用，我們一直非常關注和嚴格地管理固定方面和可變方面的費用。這些就是您今年進步的主要驅動力，只是為了給您一些具體資訊。固定成本槓桿約佔改善的40%。

Improvements in our variable cost structure is another, let's call that 15% and then the remainder is, improvements in broker taxes and fees. We did see some lower fees, this year, and then, the remainders are a geography so.

我們的變動成本結構的改善是另一個因素，我們稱之為 15%，其餘的則是經紀人稅費的改善。今年我們確實看到了一些較低的費用，其餘的則與地理位置有關。

The, a very significant portion of the year your improvement is durable and as I mentioned on the last question, we do expect to see from this point, that we would see some, quarterly increases in SG&A going forward.

今年相當長一段時間內，你們的改善是持久的，正如我在上一個問題中提到的，我們確實希望從現在開始看到，未來銷售、一般和行政費用 (SG&A) 會有一些季度增長。

And Michael, as we said before, when we put together our operating plan, we have a number of different levers we pull as we go through the year. So, we're already reacting to 26 and setting the stage for 26, depending on how it all pans out, and we're making those moves ahead of time so that we're prepared to be competitive and to continue our move forward in enhancing margin for the business.

邁克爾，正如我們之前所說，當我們制定營運計劃時，我們會在全年採取多種不同的措施。因此，我們已經對 26 做出了反應，並為 26 做好了準備，這取決於一切進展如何，我們正在提前採取這些行動，以便我們做好準備保持競爭力，並繼續向前邁進，提高業務利潤率。

Great, thank you. And a follow up question. So, if I take a step back and think about Oscar's evaluation over the past few months, I think its clear investors are pricing in the worst-case scenario, millions of fraudulent lives in the marketplace, but with all the evidence and proof just continuing to stack.

太好了，謝謝。還有一個後續問題。因此，如果我退一步思考奧斯卡過去幾個月的評估，我認為很明顯投資者正在為最壞的情況定價，即市場上數百萬人的生命受到欺騙，但所有證據和證明都在不斷堆積。

Number one being required attestations helping to address the ghost member issue. Number two, the nonpayment of premiums now reflected in one queue effectuate the enrolment number three, CMS even gave us the two-year FTR members at risk nationally.

首要的是要求提供證明來幫助解決幽靈會員問題。第二，現在未繳保費的情況反映在一個隊列中，從而實現了登記；第三，CMS 甚至在全國範圍內為我們有兩年期 FTR 風險的會員提供了保障。

With all these new data points, could you refresh us on your latest thoughts here and I guess your level of conviction that what we're in is no longer a $4 or $5 million fraudulent member problem. And also, how do you view the catalyst path going forward in terms of what will it take to fully dispel, disprove this debate once and for all.

有了這些新的數據點，您能否讓我們了解您的最新想法，我想您確信我們所面臨的不再是一個價值 400 萬美元或 500 萬美元的欺詐性會員問題。此外，您如何看待未來的催化劑路徑，即如何徹底消除、一勞永逸地反駁這場論點。

Thank you.

謝謝。

We're not going to size the government's estimate. We're doing our own homework as we get ready for 26. We'll have a very clear view on it, but I can tell you that we are not backing off on our long-term targets. We continue to work as an organization to make those happen.

我們不會對政府的估計做出評估。我們正在做自己的功課，為 26 日做準備。我們對此有非常明確的看法，但我可以告訴你，我們不會放棄我們的長期目標。我們作為一個組織將繼續努力實現這些目標。

We believe the market will continue to be competitive and we believe the market will continue to be strong. We may have a pricing issue as we get.

我們相信市場將繼續保持競爭，我們相信市場將繼續保持強勁。我們可能會遇到定價問題。

Into the 2026 market versus where we've been, which is below CPI at or below CPI, largely because there's a high single digit impact of both fraudulent of both integrity regulations and enhanced premium credits that will be the basis before, we apply trend going.

進入 2026 年的市場與我們目前的水平相比，即低於 CPI 或低於 CPI，主要是因為誠信法規和增強保費抵免的欺詐行為都產生了較高的個位數影響，這將成為我們應用趨勢之前的基礎。

Forward. So that could be a major change. It would have an impact. We believe that now that we sit at 8% uninsured that we could get back into double digits if that should happen. But we're watching all of that happen in front of us, and until the regs are really clear and specific, we're not going to make any estimates against 26.

向前。所以這可能是一個重大的改變。這會產生影響。我們相信，如果發生這種情況，我們現在的無保險率為 8%，而該比例可能會重新回到兩位數。但我們正在觀察眼前發生的一切，直到法規真正明確和具體為止，我們不會對 26 做出任何估計。

Our final question for today comes from the line of Dave Windley of Jeffrey's. Your line is now open.

我們今天的最後一個問題來自 Jeffrey's 的 Dave Windley。您的線路現已開通。

Hi, thanks for taking my question, Mark. You may have obviated my question with your last point, but I was going to ask about the proposal to refund CSRs and what your thoughts are around that. Is that a is that positive relative to integrity and how much disruption to kind of the pricing structure of second lowest silver, etc.

你好，謝謝你回答我的問題，馬克。您可能已經用最後一點迴避了我的問題，但我還是想問一下退還 CSR 的提議以及您對此的看法。這對誠信來說是否是正面的，以及對第二低白銀定價結構造成多大破壞等等。

If the government kind of steps in and refund CSRs, thanks.

如果政府介入並退還 CSR，謝謝。

Dave, look, I would say that you know with respect to CSR and silver loading.

戴夫，聽著，我想說你了解 CSR 和銀負荷。

I think practically speaking, that's a big undertaking for plans to try to put into place the processes and infrastructure and the same for the government in terms of their side so you know we're.

我認為從實際角度來說，這對於試圖建立流程和基礎設施的計劃來說是一項艱鉅的任務，對於政府而言也是如此，所以你知道我們。

Obviously not a fan of that going into place for 26 because we think it's going to take, a fair amount of process to get that set up and, in theory, that neutral, we should all be neutral to that switch and we'll just have to see how that plays out.

顯然，我們並不支持在 26 日實施這一舉措，因為我們認為這需要相當多的過程才能完成，而且從理論上講，我們都應該對這一轉變保持中立，我們只需要看看結果如何。

But again, we think it's a fairly big undertaking, so you know we're, we will be recommending that the government not move forward with that in 2026.

但我們再次認為這是一項相當大的工程，所以我們建議政府在 2026 年不要繼續進行這項工程。

Got it to your point we're in May, so bids aren't that far away. A lot of undertaking for a couple of months' worth of time, I guess is the added point.

我明白你的意思了，現在是五月，所以出價的時間不遠了。我想，用幾個月的時間完成很多工作就是額外的收穫。

Yeah.

是的。

Thanks for taking my question.

感謝您回答我的問題。

And that includes today's conference call.

其中包括今天的電話會議。

Thank you for your participation. You may now disconnect. Goodbye.

感謝您的參與。您現在可以斷開連線。再見。