Oscar Health Inc (OSCR) 2025 Q4 法說會逐字稿

Good morning. My name is Jenny, and I will be your conference operator today. At this time, I would like to welcome everyone to Oscar Health's Fourth Quarter and Full Year 2025 Earnings Conference Call. (Operator Instructions) I will now turn the call over to Chris Potochar, Vice President of Treasury and Investor Relations.

早安.我叫珍妮，今天我將擔任你們的會議接線生。在此，我謹代表 Oscar Health 歡迎各位參加 2025 年第四季及全年財報電話會議。（操作員指示）我現在將電話轉交給財務和投資者關係副總裁克里斯·波托查爾。

Good morning, everyone. Thank you for joining us for our fourth quarter and full year 2025 earnings call. Mark Bertolini, Oscar Health's Chief Executive Officer; and Scott Blackley, Oscar Health's Chief Financial Officer, will host this morning's call.

各位早安。感謝您參加我們2025年第四季及全年業績電話會議。Oscar Health 的執行長 Mark Bertolini 和 Oscar Health 的財務長 Scott Blackley 將主持今天上午的電話會議。

This call can also be accessed through our Investor Relations website at ir.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 ir.hioscar.com.

您也可以透過我們的投資者關係網站ir.hioscar.com收聽本次電話會議。有關我們業績的完整詳情和管理層的更多評論，請參閱我們的盈利報告，該報告可在我們的投資者關係網站ir.hioscar.com上找到。

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 quarterly report on form 10-Q for the period ended September 30, 2025, and filed with the Securities and Exchange Commission and other filings with the SEC, including our annual report on form 10-K for the period ended December 31, 2025, to be filed with the SEC. Such forward-looking statements are based on current expectations as of today.

Oscar 對未來所做的任何評論均構成 1995 年《私人證券訴訟改革法案》安全港條款意義上的前瞻性陳述。由於各種重要因素，實際結果可能與這些前瞻性聲明所指出的結果有重大差異，這些因素包括我們在截至 2025 年 9 月 30 日的季度報告（表格 10-Q）以及向美國證券交易委員會提交的其他文件中討論的因素，包括我們將向美國證券交易委員會提交的截至 2025 年 12 月 31 日的年度報告表（表格 10-K）。此類前瞻性陳述是基於截至目前為止的預期。

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.

奧斯卡預計，後續事件和發展可能會導致估算結果改變。雖然公司未來可能會選擇更新這些前瞻性聲明，但我們特此聲明不承擔任何更新義務。

A reconciliation of these measures to the most directly comparable GAAP measures can be found in the fourth quarter and full year 2025 earnings press release available on the company's Investor Relations website at ir.hioscar.com.

這些措施與最直接可比較的 GAAP 措施的調節表可在公司投資者關係網站 ir.hioscar.com 上發布的 2025 年第四季和全年收益新聞稿中找到。

We have not provided a quantitative reconciliation of estimated full year 2026 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 will turn the call over to our CEO, Mark Bertolini.

我們沒有提供本次電話會議中所述的 2026 年全年調整後 EBITDA 估計值與 GAAP 淨利潤的定量調節表，因為 Oscar 無法在不付出不合理努力的情況下有把握地計算某些調節項目。接下來，我將把電話交給我們的執行長馬克貝爾托利尼。

Good morning. Thank you, Chris, and thank you all for joining us. Today, Oscar announced fourth quarter and full year 2025 results and the 2026 outlook. We reported total revenue of $11.7 billion, a 28% increase year-over-year. Our SG&A expense ratio of 17.5% improved by approximately 160 basis points over the prior year, reflecting continued efficiency gains through growth, disciplined expense management and AI and technology advancements across the business.

早安.謝謝你，克里斯，也謝謝各位的參與。今天，Oscar公佈了2025年第四季和全年業績以及2026年展望。我們公佈的總收入為 117 億美元，年增 28%。我們的銷售、一般及行政費用率為 17.5%，比前一年改善了約 160 個基點，這反映了透過業務成長、嚴格的費用管理以及人工智慧和技術進步而持續提高的效率。

MLR increased 570 basis points year-over-year to 87.4% and our 2025 loss from operations was $396 million, primarily due to higher market morbidity resulting in a higher risk adjustment payable. Oscar is on track to return to profitability this year.

MLR 較去年同期上升 570 個基點至 87.4%，我們 2025 年的營運虧損為 3.96 億美元，主要原因是市場波動加劇，導致風險調整支出增加。Oscar預計今年轉虧為盈。

We expect a significant year-over-year improvement of nearly $750 million in earnings from operations in 2026, representing the midpoint of our guidance. Scott will discuss our financials in more detail shortly.

我們預計 2026 年營業收入將比上年大幅成長近 7.5 億美元，這與我們先前的預期相符。Scott稍後將更詳細地討論我們的財務狀況。

Before I get into our business highlights, I want to provide an update on the performance of the individual market. Overall, 2025 was a reset year for the industry. The industry-wide increase in market morbidity due to Medicaid lives entering the market and program integrity initiatives shifted market dynamics.

在介紹我們的業務亮點之前，我想先報告個別市場的表現。總體而言，2025 年是該行業的重置之年。由於醫療補助計劃受益者進入市場以及計畫完整性舉措，整個行業的市場疾病發生率上升，改變了市場動態。

Oscar embraced the change and positioned the company for strong top line growth and margin expansions in 2026. We took decisive actions with a disciplined pricing, distribution and product strategy to go after profitable growth as competitors pulled back or exited the market. Our pricing strategy always assume the expiration of enhanced premium tax credits.

Oscar 欣然接受了這一變化，並為該公司在 2026 年實現強勁的營收成長和利潤率擴張做好了準備。當競爭對手撤出或退出市場時，我們採取了果斷的行動，制定了嚴格的定價、分銷和產品策略，以追求獲利成長。我們的定價策略始終假設保費稅收抵免政策會到期。

Our final 2026 rates also reflected higher market morbidity, elevated trend and the effects of program integrity initiatives. Early 2026 open enrollment results demonstrate the resilience of the individual market. The latest CMS data indicates overall market membership of 23 million lives representing a better-than-expected decline of 5% year-over-year.

我們最終的 2026 年利率也反映了較高的市場發病率、上升的趨勢以及專案完整性舉措的影響。2026 年初的開放註冊結果顯示了個人保險市場的韌性。最新的 CMS 數據顯示，市場總會員人數為 2,300 萬人，年減 5%，比預期好。

We expect many passively enrolled members facing higher premiums will exit the market when the grace periods expire. We will, therefore, have greater clarity on final paid membership and market contraction when CMS releases final enrollment data midyear.

我們預計，許多被動參保的會員在寬限期結束後，由於保費上漲而退出市場。因此，當 CMS 年中發布最終註冊資料時，我們將對最終付費會員人數和市場萎縮情況有更清晰的了解。

Current enrollment data indicates market contraction may track toward the lower end of our original projection of 20% to 30%. The individual market stability underscores the priority consumers place on maintaining health coverage, more small business owners, working Americans and gig workers are running the market as group insurance fails to meet their affordability needs.

目前的入學數據顯示，市場萎縮幅度可能接近我們最初預測的 20% 至 30% 的下限。個人保險市場的穩定性凸顯了消費者對維持健康保險的重視，越來越多的小企業主、美國勞工階級和零工人員在個人保險市場中佔據主導地位，因為團體保險無法滿足他們的負擔能力需求。

The individual markets fundamental characteristics, combined with a larger and growing addressable market can absorb morbidity changes without dramatic trend impacts Oscar is in a strong position to continue leading the individual market and defining the future of consumer-centered health care for all Americans.

個人市場的基本特徵，加上不斷擴大的潛在市場，能夠吸收發病率的變化而不會產生劇烈的趨勢影響。 Oscar 處於有利地位，將繼續引領個人市場，並為所有美國人定義以消費者為中心的醫療保健的未來。

Now I will review our business highlights. The 2026 open enrollment period was a record for the company. Oscar delivered another year of above-market growth, and we are privileged to serve 3.4 million members as of February 1, 2026.

現在我將回顧我們業務的亮點。2026 年的開放註冊期是該公司的記錄。Oscar 又實現了高於市場平均的成長，截至 2026 年 2 月 1 日，我們很榮幸能為 340 萬會員提供服務。

We expect to start the second quarter with approximately 3 million paid members, a 58% increase year-over-year. Member retention remains solid across the book, driven by our suite of affordable products, agenetic AI features and a superior member experience.

我們預計第二季開始時付費會員人數約為 300 萬，年增 58%。憑藉我們一系列價格實惠的產品、基因人工智慧功能和卓越的會員體驗，會員留存率在整個業務範圍內保持穩定。

Oscar's market share across our footprint increased from 17% in 2025 to 30% in 2026. We continue to grow IFP and ICRA membership in prominent service areas, including new and existing markets in Arizona, Florida, New Jersey and Texas. The team created new cost-effective bronze and gold plans to support consumers losing enhanced premium tax credits and expanded broker partnerships by 60% to manage distribution across the overall market.

Oscar 在我們業務覆蓋範圍內的市佔率從 2025 年的 17% 成長到 2026 年的 30%。我們繼續在重要的服務區域發展 IFP 和 ICRA 會員，包括亞利桑那州、佛羅裡達州、新澤西州和德克薩斯州的新市場和現有市場。該團隊制定了新的、具有成本效益的銅級和金級計劃，以支持那些失去增強型保費稅收抵免的消費者，並將經紀人合作夥伴關係擴大了 60%，以管理整個市場的分銷。

Our integrated strategy, which we deployed well ahead of enhanced premium tax credit exploration, positioned us to profitably capture new membership in the active shopping season. Product innovation was a key growth driver of this open enrollment. We launched several new lifestyle offerings tailored to certain conditions at stages of life.

我們在加強保費稅收抵免探索之前就部署了綜合策略，這使我們能夠在活躍的購物季中獲利地獲得新會員。產品創新是此次開放註冊的關鍵成長驅動力。我們針對人生不同階段的特定情況，推出了一系列全新的生活風格產品。

These include Hello Menno, the first menopause plan in the ACA, when a Salud, our Spanish first experience for members with diabetes and Hive Health with Oscar, our landmark ECR plan. Our lifestyle products are attracting new consumer segments and creating a loyal customer base.

其中包括 ACA 中的第一個更年期計劃 Hello Menno，以及我們為患有糖尿病的會員提供的西班牙語首個體驗 Salud，還有我們具有里程碑意義的 ECR 計劃 Hive Health with Oscar。我們的生活風格產品正在吸引新的消費群體，並建立起忠實的客戶群。

Members enrolled in our lifestyle products have above-average retention rates and are 50% more likely to recommend Oscar to family and friends. They are also more likely to come in as direct enrollments, demonstrating the greater attachment to our brand.

參加我們生活風格產品的會員擁有高於平均水平的留存率，並且向家人和朋友推薦 Oscar 的可能性高出 50%。他們也更有可能直接報名參加，這表明他們對我們的品牌有更強的歸屬感。

Our deep understanding of the consumer and the strength of our product experience continue to create powerful entry points for consumers, positioning us for long-term IFP and ICRA growth. Oscar investments in AI are creating efficiencies across the business as we grow. We lowered administrative costs by 160 basis points year-over-year while significantly increasing membership.

我們對消費者的深刻理解和強大的產品體驗不斷為消費者創造強有力的切入點，使我們在 IFP 和 ICRA 方面實現長期成長。隨著公司的發展，Oscar 在人工智慧領域的投資正在提高整個業務的效率。我們較去年同期降低了 160 個基點的行政成本，同時會員人數大幅增加。

AI is integrated across the Oscar platform, enabling teams to automate routine tasks, efficiently scale our service operations and improve decision support. For example, our Agentic AI bot for care guides reduced response times by 67% during peak and open enrollment period.

Oscar 平台整合了人工智慧，使團隊能夠自動執行日常任務，高效擴展我們的服務運營，並改善決策支援。例如，我們的 Agentic AI 護理指導機器人在高峰期和開放註冊期間將回應時間縮短了 67%。

AI is also central to our member experience. Oswell, our industry-first Health agent now completes 86% of questions received from members with high accuracy and quality. We continue to embed Oswell across our product portfolio to help members take control of their health. The impact of AI on our efficiency and the quality of the interactions for our members is unparalleled in this pace in my 40 years in this industry.

人工智慧也是我們會員體驗的核心要素。Oswell 是業界首款健康代理，目前能夠以高​​準確率和高品質完成會員提出的 86% 的問題。我們將繼續把 Oswell 融入我們的產品組合中，以幫助會員掌控自己的健康。在我從事這個行業的 40 年裡，人工智慧對我們的效率和會員互動品質的影響，以如此之快的速度是前所未有的。

In summary, Oscar's disciplined pricing, record high membership and top line growth lay a strong foundation for this year. We are well positioned to significantly expand margins and return to profitability in 2026. Our strategic priorities position Oscar to shape the next evolution of the individual market in the following ways. First, accelerate National IFP and Ecra expansion. Second, create lifestyle products with an exceptional consumer experience and third, drive operational excellence through AI and frictionless execution.

總而言之，Oscar 嚴格的定價策略、創紀錄的會員人數和營收成長為今年奠定了堅實的基礎。我們已做好充分準備，在 2026 年大幅提高利潤率並恢復盈利。我們的策略重點使 Oscar 能夠透過以下方式塑造個人市場的下一個發展階段。首先，加快國家IFP和Ecra的擴張。第二，打造具有卓越消費者體驗的生活方式產品；第三，透過人工智慧和無縫執行實現卓越營運。

The individual market is the engine of consumer-driven health care. When consumers choose how and where to spend their money, they exploit inefficiencies and improve the quality of the interaction.

個人市場是消費者主導型醫療保健的引擎。消費者在選擇如何以及在哪裡花錢時，會利用效率低下的環節，提高互動品質。

We see in our own growth, the power of designing products around consumer needs. That's the promise of the individual market. the promise of choice, the promise of long-term innovation, innovation our country needs to turn healthcare into a market that fits real lives and creates meaningful coverage for life.

我們從自身的發展中看到了圍繞消費者需求設計產品的力量。這就是個人市場的承諾。它承諾提供選擇，承諾進行長期創新，而這種創新正是我們國家將醫療保健轉變為一個符合真實生活、為人們提供有意義的終身保障的市場所需要的。

I want to thank our Oscar team for their dedication to our customers if we're delivering a successful open enrollment. Our 12 years of experience in the individual market will drive results for 2026 and beyond.

我要感謝 Oscar 團隊對客戶的奉獻精神，正是他們的付出使得我們能夠成功地進行開放註冊活動。我們在個人市場累積的 12 年經驗將推動 2026 年及以後取得佳績。

I will now turn the call over to Scott. Scott?

現在我將把通話轉給史考特。史考特？

Thank you, Mark, and good morning, everyone. 2025 was a challenging year for ACA carriers as market morbidity stepped up across the industry. We experienced these industry-wide trends with higher-than-expected claims and lower-than-expected risk adjustment offset leading to a net loss of $443 million in 2025. Over the course of 2025, we took appropriate steps to position Oscar to deliver strong earnings in 2026 including disciplined pricing and cost management actions.

謝謝馬克，大家早安。 2025年對ACA保險公司來說是充滿挑戰的一年，因為整個產業的市場波動加劇。我們經歷了這些行業普遍趨勢，索賠金額高於預期，風險調整抵銷額低於預期，導致 2025 年淨虧損 4.43 億美元。在 2025 年，我們採取了適當的措施，使 Oscar 在 2026 年能夠實現強勁的盈利，包括採取嚴格的定價和成本管理措施。

I'll begin with a brief overview of fourth quarter results, review of our full year performance and then discuss our outlook for 2026. Starting with the fourth quarter. We ended the year with approximately 2 million members, an increase of 22% year-over-year.

我將首先簡要概述第四季度業績，回顧全年表現，然後討論我們對 2026 年的展望。從第四節開始。年底時，我們的會員人數約為 200 萬，較去年同期成長 22%。

Membership growth was driven by solid retention, above-market growth during open enrollment and continued SEP member additions. The fourth quarter medical loss ratio was 95.4%, an increase of 730 basis points year-over-year.

會員成長主要得益於穩定的會員留存率、開放註冊期間高於市場平均水準的成長以及持續的SEP會員增加。第四季醫療損失率為 95.4%，較去年同期上升 730 個基點。

During the quarter, we received an updated risk adjustment report for claims through October. The report indicated that overall market morbidity remains stable from the third quarter to the fourth quarter. However, relative to our expectations, Oscar's membership skewed healthier than the broader market, which required an increase of our risk adjustment accrual of $275 million in the fourth quarter.

本季度，我們收到了截至 10 月份的索賠風險調整報告。報告顯示，從第三季到第四季度，整體市場發病率保持穩定。然而，與我們的預期相比，Oscar 的會員狀況比更廣泛的市場更為健康，這導致我們在第四季度增加了 2.75 億美元的風險調整準備金。

The fourth quarter risk adjustment true-up was partially offset by $99 million of favorable in-year development and $36 million of favorable prior period development, primarily related to claims run out from the prior year.

第四季風險調整調整部分被 9,900 萬美元的有利年內發展和 3,600 萬美元的有利前期發展所抵消，主要與上一年結轉的索賠有關。

Overall utilization in the quarter was modestly above our expectations. Inpatient utilization continued to moderate while outpatient and professional increase, which we believe was associated with members accelerating care as the enhanced premium tax credits expired.

本季整體利用率略高於我們的預期。住院治療使用率持續趨於平穩，而門診和專業治療使用率則有所上升，我們認為這與會員在增強型保費稅收抵免到期後加快就醫有關。

Pharmacy utilization was largely in line with our expectations. Turning to the full year. Total revenue increased 28% year-over-year to $11.7 billion, driven by membership growth, partially offset by an increase in the net risk adjustment payable.

藥房使用情況基本上符合我們的預期。展望全年。總營收年增 28% 至 117 億美元，主要得益於會員人數的成長，但部分被應付淨風險調整金的增加所抵銷。

The full year medical loss ratio was 87.4%, an increase of 570 basis points year-over-year. Risk adjustment was a headwind throughout 2025, driven by higher market morbidity which we primarily attribute to the full year impact of members entering the ACA market as a result of Medicaid redeterminations as well as program integrity efforts.

全年醫療損失率為 87.4%，較上年同期成長 570 個基點。2025 年全年，風險調整都是一個不利因素，其主要原因是市場發病率上升，我們認為這主要是由於醫療補助重新認定以及專案完整性努力導致會員進入 ACA 市場，從而對全年市場造成了影響。

Risk transfer as a percentage of direct premiums was approximately 18.5% for 2025, representing a 390 basis points increase year-over-year. Switching to administrative costs. We continue to drive improvements in our SG&A expense ratio.

2025 年風險轉移佔直接保費的比例約為 18.5%，比前一年增加 390 個基點。轉為管理費用。我們持續努力改善銷售、管理及行政費用率。

The full year SG&A expense ratio improved by approximately 160 basis points year-over-year to 17.5%. The year-over-year improvement was driven by fixed cost leverage, lower exchange fee rates and disciplined cost management, including an increased impact from technology and AI initiatives.

全年銷售、一般及行政費用率較去年同期下降約 160 個基點，至 17.5%。年比改善主要得益於固定成本槓桿作用、較低的匯率和嚴格的成本管理，其中技術和人工智慧措施的影響日益增強。

The loss from operations for the full year was approximately $396 million, a change of $454 million year-over-year, driven primarily by the higher risk adjustment payable.

全年營運虧損約 3.96 億美元，年減 4.54 億美元，主要原因是應付風險調整金增加。

The adjusted EBITDA loss for the full year was approximately $280 million, a change of $479 million year-over-year.

全年調整後 EBITDA 虧損約 2.8 億美元，較去年同期減少 4.79 億美元。

Turning to 2026. We have been preparing for the expiration of the enhanced premium tax credits for some time and took deliberate actions in 2025 to position the business for profitable growth and improved financial performance. We introduced innovative and affordable plan designs aligned with member needs, optimized our distribution strategy and took a measured approach to geographic expansion.

展望2026年。我們已為增強型保費稅收抵免政策到期做好了準備一段時間，並在 2025 年採取了審慎的措施，以使業務能夠實現盈利增長和財務業績改善。我們推出了符合會員需求的創新且價格合理的計畫設計，優化了分銷策略，並採取了穩健的地域擴張方式。

Our disciplined pricing assumed and expected market contraction at the high end of our previously communicated 20% to 30% range driven by the expiration of enhanced premium tax credits and CMS program integrity initiatives.

我們嚴謹的定價策略假設並預期市場收縮幅度將達到我們先前公佈的 20% 至 30% 範圍的高端，這是由於增強型保費稅收抵免到期和 CMS 專案完整性計劃的實施所致。

We also refiled rates in states covering approximately 99% of our membership to reflect the higher market morbidity in 2025. Together, these actions position us to profitably drive share growth. For 2026, we expect total revenues to be in the range of $18.7 billion to $19 billion, an increase of 61% year-over-year at the midpoint, driven by another year of above-market growth during open enrollment, solid retention and rate increases.

我們也重新提交了涵蓋我們約 99% 會員所在州的費率，以反映 2025 年更高的市場發病率。這些舉措共同使我們能夠實現盈利性的市場份額成長。預計 2026 年總收入將在 187 億美元至 190 億美元之間，年增 61%（取中間值），這主要得益於開放註冊期間連續第二年高於市場平均水平的增長、穩健的客戶留存率和費率上漲。

While our weighted average rate increase for 2026 was approximately 28%, the increase on a per member per month basis is lower, reflecting shifts in member age and metal mix. Our outlook also reflects elevated churn this year, driven primarily by passively enrolled members facing higher premiums following the sunset of the enhanced premium tax credit and ongoing CMS program integrity initiatives.

雖然我們 2026 年的加權平均費率漲幅約為 28%，但以每位會員每月計算的漲幅較低，這反映了會員年齡和金屬組合的變化。我們的展望也反映了今年較高的流失率，這主要是由於被動參保會員在增強型保費稅收抵免政策到期後面臨更高的保費以及 CMS 正在進行的項目完整性計劃舉措。

From a member profile perspective, our average member is 38 years old, approximately one-year younger year-over-year. As expected, we saw migration from silver plans to Bronson gold plants, reflecting plan designs intended to offer affordable options following the expiration of the enhanced premium tax credits. For 2026, we expect risk adjustment as a percentage of direct premiums to be approximately 20% based on our updated membership mix and 2025 risk adjustment experience. Turning to medical costs. We expect our medical loss ratio to be in the range of 82.4% to 83.4%, representing 450 basis points of year-over-year improvement at the midpoint.

從會員概況來看，我們會員的平均年齡為 38 歲，比前一年年輕約一歲。正如預期的那樣，我們看到人們從白銀計劃轉向 Bronson 金計劃，這反映了在增強型保費稅收抵免到期後，旨在提供經濟實惠的選擇的計劃設計。根據我們更新後的會員組成和 2025 年的風險調整經驗，我們預期 2026 年風險調整佔直接保費的百分比約為 20%。接下來談談醫療費用。我們預計醫療損失率將在 82.4% 至 83.4% 之間，以中點計算，這意味著年比改善 450 個基點。

Our outlook reflects elevated market morbidity observed in 2025, an incremental increase in morbidity in 2026 and medical cost trends and utilization patterns largely consistent with our 2025 experience. We also incorporated additional third-party data to assess the risk profile of new members, which is tracking modestly better than our pricing expectations, while renewal risk scores are in line with our expectations.

我們的展望反映了 2025 年市場發病率上升、2026 年發病率進一步上升，以及醫療成本趨勢和利用模式與我們 2025 年的經驗基本一致。我們也納入了額外的第三方資料來評估新成員的風險狀況，結果略優於我們的定價預期，而續約風險評分與我們的預期相符。

With respect to seasonality, we expect MLR to be lowest in the first quarter and highest in the fourth quarter as members meet their annual deductibles. On administrative expenses, we expect continued improvement in our SG&A expense ratio. We expect the SG&A expense ratio to be in the range of 15.8% to 16.3%, representing an approximately 140 basis points year-over-year improvement at the midpoint.

就季節性而言，我們預計 MLR 在第一季最低，在第四季度最高，因為會員將達到他們的年度免賠額。在行政費用方面，我們預期銷售、一般及行政費用率將持續改善。我們預計銷售、一般及行政費用率將在 15.8% 至 16.3% 之間，以中位數計算，較上年同期改善約 140 個基點。

We continue to see the benefits of scale as fixed cost leverage and variable expense efficiencies driven by technology and AI are expected to drive further improvement in our SG&A expense ratio. We expect our SG&A expense ratio to be fairly consistent in the first three quarters with an uptick in the fourth quarter. We expect to meaningfully improve financial performance and a return to profitability in 2026.

我們持續看到規模效益，固定成本槓桿作用以及技術和人工智慧帶來的可變費用效率有望進一步改善我們的銷售、一般及行政費用率。我們預計前三個季度的銷售、一般及行政費用率將保持相對穩定，第四季度將有所上升。我們預計到 2026 年財務表現將顯著改善，並恢復獲利。

We expect earnings from operations to be in the range of $250 million to $450 million, a significant improvement of nearly $750 million year-over-year implying an operating margin of approximately 1.9% at the midpoint. Adjusted EBITDA is expected to be approximately $115 million higher than earnings from operations.

我們預計營業收入將在 2.5 億美元至 4.5 億美元之間，比去年同期大幅成長近 7.5 億美元，這意味著營業利潤率中位數為 1.9% 左右。調整後 EBITDA 預計比營業收入高出約 1.15 億美元。

Shifting to the balance sheet. we have taken opportunistic steps to strengthen our capital position and optimize our capital structure. As a reminder, during the third quarter, we increased our capital in preparation for 2026 growth, completing a $410 million convertible notes offering due 2030, generating $360 million of net proceeds.

轉向資產負債表。我們已採取機會性措施來增強資本實力並優化資本結構。提醒一下，在第三季度，我們增加了資本，為 2026 年的成長做準備，完成了 4.1 億美元的 2030 年到期可轉換債券發行，產生了 3.6 億美元的淨收益。

Subsequent to that transaction, we entered into a new $475 million three year revolving credit facility. The transaction was well supported by a strong syndicate of top-tier banks and executed on favorable terms, further strengthening our balance sheet and providing additional flexibility as we execute on our strategic plans.

在那筆交易之後，我們簽訂了一份新的 4.75 億美元的三年循環信貸協議。這項交易得到了實力雄厚的一流銀行財團的大力支持，並以優惠的條款執行，進一步增強了我們的資產負債表，並在我們執行戰略計劃時提供了更大的靈活性。

We ended the year with approximately $5.5 billion of cash and investments, including $414 million at the parent.

截至年底，我們擁有約 55 億美元的現金和投資，其中母公司持有 4.14 億美元。

As of December 31, 2025, our insurance subsidiaries had approximately $1 billion of capital in surplus, including $315 million of excess capital. To help frame our capital position in the context of our growth outlook, I want to spend a moment on regulatory capital requirements.

截至 2025 年 12 月 31 日，我們的保險子公司擁有約 10 億美元的盈餘資本，其中包括 3.15 億美元的超額資本。為了更好地理解我們的資本狀況及其與成長前景的關係，我想花一點時間談談監管資本要求。

While individual states vary, a useful rule of thumb is that for every $1 billion of premiums, we are required to hold approximately $50 million of capital, which reflects roughly 55% quota share reinsurance ceding percentage for 2026. Overall, our capital position remains very strong.

雖然各州規定不盡相同，但一個有用的經驗法則是，每10億美元的保費，我們就需要持有大約5000萬美元的資本，這反映了2026年約55%的配額再保險分出比例。整體而言，我們的資本狀況依然非常強勁。

In closing, 2025 marked a shift in the individual market dynamics. Oscar has been in the ACA since its inception. And today, we are operating from a position of scale and experience. That perspective has informed the actions we've taken to position our business for profitable growth in a rational market and improved financial performance. We are well positioned to return to meaningful profitability this year.

總之，2025 年標誌著個人市場動態的轉變。奧斯卡從《平價醫療法案》創立之初就一直是該法案的參與者。如今，我們憑藉規模和經驗優勢開展業務。這種觀點指導了我們採取的行動，使我們的業務能夠在理性的市場中實現盈利增長並改善財務業績。我們已做好充分準備，今年可望恢復獲利。

With that, I'll turn the call back over to Mark for his closing remarks.

接下來，我將把電話交還給馬克，請他作總結發言。

Oscar is stronger than ever. Our decisive actions in 2025 position us to take a significant leap forward on profitability in 2026. We primed Oscar for the market of the future. The team introduced new affordable consumer products. We increased broker distribution with new tools, data and training to efficiently move new and existing members to Oscar Plans.

奧斯卡比以往任何時候都更強大。我們在 2025 年採取的果斷行動，使我們在 2026 年的獲利能力方面實現了重大飛躍。我們讓 Oscar 為未來的市場做好了準備。該團隊推出了價格親民的新型消費產品。我們利用新工具、數據和培訓增加了經紀人分銷管道，以便有效地將新舊會員轉移到 Oscar Plans。

We drove strong retention, showcasing brand loyalty and followership. 2026 is the springboard for Oscar to accelerate financial performance toward our long-term targets. Our playbook drives repeatable value in the market with ongoing product innovation, geographic expansion and membership growth.

我們實現了強勁的用戶留存率，展現了品牌忠誠度和粉絲群。 2026年是Oscar加速實現財務業績，達成長期目標的跳板。我們的策略是透過持續的產品創新、地理擴張和會員成長，在市場上創造可複製的價值。

We are not here by accident. Our growth is the culmination of years spent navigating the market and obsessing about the consumer experience.

我們來到這裡並非偶然。我們的成長是多年來不斷探索市場、專注於提升消費者體驗的成果。

We proved consumers vote where they find value. Oscar's growth is not just about retaining our book of business. It's about staying ahead of the consumer, driving long-term individual market growth and setting a new standard for healthcare. Now I will turn the call over to the operator for the Q&A portion of our call.

我們已經證明，消費者會投票給那些能提供價值的地方。Oscar 的發展不僅在於留住現有客戶。關鍵在於始終走在消費者前面，推動個人市場的長期成長，並為醫療保健樹立新的標準。現在我將把通話轉交給接線員，進行問答環節。

(Operator Instructions).

（操作說明）

Joshua Raskin, Nephron Research.

Joshua Raskin，腎單位研究。

Hi, good morning. I guess the obvious question is how you get comfort on this new membership coming in for 2026 and why you think the MLRs will be down so much? And then I guess, related to that, maybe, Scott, if you could provide a little bit more color on your assumptions around risk adjustment, I heard the 20% accrual. But as you become a larger part of the market, I think you said 30% market share overall. Does that actually help, does that reduce your overall accruals? So I know there's a bunch in there.

您好，早安。我想最顯而易見的問題是，你如何看待 2026 年即將加入的新會員制度，以及為什麼你認為 MLR 會大幅下降？然後，我想，與此相關的是，斯科特，如果你能更詳細地說明你關於風險調整的假設，我聽說有 20% 的應計提。但隨著市佔率的擴大，我想你說過最終市佔率會達到 30%。這樣做真的有幫助嗎？這樣做能減少你的總應計費用嗎？所以我知道裡面有很多。

Yeah, Josh, thanks for the question. Can you just restate the second half of your question? I want to make sure I get that right.

是的，喬希，謝謝你的提問。你能把問題的後半部再複述一次嗎？我想確保我做對了。

Just more color on the assumptions around your risk adjustment in 2026. And my point being, if you're 30% of the market does that make your risk accruals more market rate, right? Meaning are you going to see less volatility as you become a larger part of the market?

關於您在 2026 年進行風險調整的假設，再補充一些細節。我的意思是，如果你佔市場份額的 30%，那麼你的風險累積是否就更接近市場水平了，對吧？也就是說，隨著你在市場中所佔份額的增大，市場波動性是否會降低？

Yeah, understood. All right. Well, let's start off with kind of the membership and our ability to project what we see there. So I would kind of bifurcate the membership between we've got a significant portion of our membership or renewing members we have a lot of information about those members and feel like we can project what their behaviors are going to look like. And then we also have a population that is new members for Oscar we obviously picked up share.

嗯，明白了。好的。好，我們先從會員組成以及我們預測會員組成的能力開始。因此，我會將會員分為兩類：一類是我們的會員，另一類是續會會員；我們掌握了大量關於這些會員的信息，感覺我們可以預測他們的行為會是什麼樣子。此外，我們還有一些新成員加入 Oscar 的行列，我們顯然也獲得了份額。

So we do have a lot of new members One of the things that we've increasingly done is to leverage third-party data to pull in clinical information about those members. That really is giving us a fairly rich amount of information about those members in terms of their historical utilization trends. It also helps us to target our outreach to help them manage their care journey.

所以我們確實有很多新成員。我們越來越多地利用第三方數據來獲取這些成員的臨床資訊。這確實為我們提供了這些成員歷史使用趨勢的相當豐富的資訊。這也有助於我們更有針對性地進行外展工作，幫助他們管理治療過程。

So we feel like we've got better insights into this oncoming membership and we've had really at any point in our history. So those are kind of the building blocks in terms of why we're comfortable with the MLR projections.

因此，我們感覺我們對即將到來的會員發展有了更深入的了解，這在我們歷史上是前所未有的。所以，這些就是我們對MLR預測感到放心的基本原理。

On risk adjustment in '26, I would say that you can see from my talking points that we're actually expecting our risk adjustment as a percentage of direct revenues to increase year-over-year from 25% to 26% to about 20% in 2026. It's an interesting thing that we're starting to see a little bit of a barbell between the plans who really cater to the highest morbidity populations and the plans that have everyone else, we're picking up a very large share of young, healthy members. And so that's driving risk adjustment higher.

關於 2026 年的風險調整，我想說，從我的發言要點可以看出，我們預計風險調整佔直接收入的百分比將逐年增長，從 25% 至 26% 增長到 2026 年的 20% 左右。有趣的是，我們開始看到，那些真正迎合高發病率人群的保險計劃和那些服務於其他所有人的保險計劃之間出現了一種類似槓鈴的局面，我們正在吸引大量年輕、健康的會員。因此，這推高了風險調整幅度。

We are continuing to look at ways to get more information about what is going on outside of our books because that's the hardest part of forecasting risk adjustment.

我們正在繼續尋找方法，以獲取更多關於帳面之外發生的事情的信息，因為這是預測風險調整中最困難的部分。

We've been engaged with Wakeley on helping around this new reporting that they're proposing to bring forward in the first quarter. We're expecting that will give the entire market more visibility into what's going on with membership. That should help all of us in forecasting risk adjustment and so I don't know that it's going to decrease the challenges in making that estimate as accurate as it can be, but it certainly will give us a head start.

我們一直在與韋克利公司合作，幫助他們推進他們計劃在第一季推出的這項新的報告工作。我們預計這將使整個市場更清楚地了解會員狀況。這應該有助於我們所有人預測風險調整，所以我不知道這是否會減少做出盡可能準確的估計所面臨的挑戰，但這肯定會給我們一個先機。

All right, perfect, thanks.

好的，太好了，謝謝。

Jessica Tassan, Piper Sandler.

傑西卡·塔桑，派珀·桑德勒。

Hi, thanks for taking the question. So I appreciate the color on membership. Can you elaborate maybe a little on the fourth quarter utilization pull forward you described. You guys spoke about higher retention. So should we think about the pull forward as being kind of silver members in '25 who are disinclined to utilize care in '26 due to higher deductibles? Just any color on 4Q utilization and how it relates to your 2026 utilization expectations?

您好，感謝您回答這個問題。所以我很欣賞會員制度中的色彩。您能否詳細解釋一下您之前提到的第四季產能利用率提前的情況？你們之前討論過提高客戶留存率的問題。那麼，我們是否應該把提前終止保險計劃的人看作是 2025 年的銀級會員，由於 2026 年的自付額較高，他們不願使用醫療服務呢？請用任何顏色來描述第四季的產能利用率，以及它與您2026年產能利用率預期之間的關係？

Yes, thanks for the question, Jess. Good morning. So I want to emphasize utilization was modestly higher than our expectation in the quarter. Really, when I look at the MLR performance in the quarter, I really would say that it is vastly driven by the risk adjustment true-up. In terms of the utilization pressure, we did see -- we had a modest expectation of an increase as we went into the end of the year.

是的，謝謝你的提問，傑西。早安.因此，我想強調的是，本季的利用率略高於我們的預期。說實話，當我查看本季度 MLR 的表現時，我真的認為它很大程度上是由風險調整調整所驅動的。就利用率壓力而言，我們確實看到了——隨著年底臨近，我們預計利用率會略有上升。

members losing their subsidies likely to go ahead and seek care. We saw that. We think that was a primary driver of some of the movement we saw in outpatient and professional. We also saw things like substance abuse disorders that ticked up, some mental health benefits that ticked up in labs types of things.

失去補貼的成員很可能會繼續尋求治療。我們看到了。我們認為這是我們在門診和專業領域看到的一些變化的主要驅動因素。我們也發現，藥物濫用障礙的病例增加，一些心理健康的益處在實驗室檢測中也有所改善。

So really things that would indicate to us these were members that we're just trying to make sure that they took advantage of the benefits why they have them don't give us a lot of concern about carry-forward impact of those types of activities.

所以，真正能讓我們意識到這些成員正在努力確保他們利用了他們所享有的福利的事情，並不會讓我們太擔心這些活動會產生後續影響。

Got it. And then just -- I know you all mentioned that overall market-wide membership could come in a little bit better than the 20% to 30% disenrollment you had been forecasting last year. Can you just maybe offer any color on the overall size of the market post the fluctuation? And then secondarily, just any comments on kind of the adequacy of pricing market wide.

知道了。然後——我知道你們都提到，整體市場會員人數可能會比你們去年預測的 20% 到 30% 的退會率略好一些。您能否就市場波動後的整體規模提供一些資訊？其次，請問各位對整體市場定價是否合理有任何看法？

So how should we get comfortable with the fact that all of the peers have been also priced appropriately and that risk adjustment doesn't end up being a problem in '26 might was in '25.

那麼，我們該如何接受這樣一個事實：所有同業的定價也都合理，而且風險調整在 2026 年不會像在 2025 年那樣成為一個問題呢？

Thank you.

謝謝。

Thank you, Jessica. From the standpoint of effectuation versus actual enrollment, we believe that the market -- the market currently has shrunk by 5%. However, a lot of people have changed their plan signs and it was purposeful on our part to give brokers specific transitions that they could do for their members to impact the loss of enhanced premium tax credits.

謝謝你，潔西卡。從實際效果與實際參與率的角度來看，我們認為市場—目前市場已經萎縮了 5%。然而，許多人已經更改了他們的計劃標誌，而我們特意為經紀人提供了具體的過渡方案，以便他們能夠為會員採取措施，從而影響增強型保費稅收抵免的損失。

And so as a result, in our book, we saw silver drop in half as a percentage of what it was before and bronze increase by almost 50% and gold almost quadruple. And that's the kind of shift we saw in our membership mix. That means people are carrying higher deductible plans.

因此，在我們的書中，我們看到白銀的價格佔比下降了一半，而青銅的價格佔比上升了近 50%，黃金的價格佔比上升了近四倍。這就是我們在會員組成中看到的轉變。這意味著人們購買了自付額較高的醫療保險計劃。

And this is the big open question mark for the rest of the year, two things. One, when we get closer to pages and our pads are on par with where they've been in the last couple of years anyway. The next question is how many people when they see their premium actually pay it.

今年剩下的時間裡，最大的懸念就是兩件事。第一，當我們接近書頁的時候，我們的紙張和過去幾年的紙張水平也差不多了。下一個問題是，有多少人在看到保費後會真正支付保費。

And that's the first piece that will get us to the end of the year, and that's where we go from 3.4 million lives as we currently stand in February, the 3 million lives by the time April 1 rolls around. The next big question is this is as big a political issue is any other thing around in premium enhanced premium tax credits is as people start to use their plans and realize the amount of out-of-pocket that they need to pay to use those plans, will they maintain coverage?

這是讓我們走到年底的第一塊拼圖，也是我們從二月的 340 萬條生命，到四月一日到來時減少到 300 萬條生命的目標。下一個大問題是，這和任何其他有關保費增強型保費稅收抵免的事情一樣，都是一個重大的政治問題。當人們開始使用他們的計劃並意識到他們需要自付多少費用才能使用這些計劃時，他們會繼續享有保險嗎？

Or will they drop out? And this is where the big paths of enrollment, you don't know how they're going to behave until they start using the plans. It's going to create a lot of financial hardship for most Americans who only have $400 in their bank account.

他們會退出嗎？而這正是大型招生途徑的問題所在：在他們開始使用這些計劃之前，你無法知道他們會如何表現。這將給大多數銀行帳戶裡只有400美元的美國人造成很大的經濟困難。

And this is where we have an open question. And we think by the end of the year that number drops to the lower end of our range, which was 20% to 30% reduction in the overall market size.

而這裡就存在著一個懸而未決的問題。我們認為到年底，這個數字將降至我們預期範圍的下限，即整體市場規模減少 20% 至 30%。

Andrew Mok, Barclays.

Andrew Mok，巴克萊銀行。

This is Tiffany on for Andrew. Can you share where OEP membership landed for the book and give us a sense of where paid rates are tracking in January '26 versus January 2025.

這是蒂芙尼替安德魯報道。能否分享一下 OEP 會員人數在本書中的分佈情況，並讓我們了解一下 2026 年 1 月與 2025 年 1 月的付費率走勢對比？

Our OEP ended with 3.4 million lives enrolled. We have not seen all the page yet, but our current pads are sitting close to where they were last year. and a little lower than they were in '23 and '24 on the Oscar book.

我們的開放註冊期結束時，共有 340 萬人註冊。我們還沒有看到全部頁面，但就奧斯卡獎的預測來看，我們目前的預測排名與去年相​​近，比2023年和2024年的預測排名略低。

And as a reminder, we expect that as of the end of the first quarter, we'll have 3 million paid members. That's what our expectation is for that time period.

再次提醒大家，我們預計到第一季末，我們將擁有 300 萬付費會員。這就是我們對那段時間的預期。

Okay. Got it. That's helpful. Can you provide a bit more color around expected membership cadence following the 1Q grace period? And how we should think about that throughout the year?

好的。知道了。那很有幫助。能否詳細說明一下第一季寬限期結束後預期的會員成長節奏？那麼，我們該如何在一年中始終思考這個問題呢？

Sure. So in terms of churn expectations, through the first quarter, we're obviously going to see higher churn as we see the effects of the higher payment rates or premiums that Mark just talked about. And so we'll see a dip from [$3.4 million] down to [$3 million] by our estimate by the end of the first quarter.

當然。因此，就客戶流失預期而言，第一季我們顯然會看到更高的客戶流失率，因為我們會看到馬克剛才提到的更高的支付率或保費的影響。因此，據我們估計，到第一季末，該數字將從 340 萬美元下降到 300 萬美元。

From there, we're expecting churn patterns to look more similar to what we saw pre-ARPA, so in the range of 1% to 2% a month in terms of kind of churn from the end of the first quarter through the end of the year. The other thing I'd just point out is the other factor impacting the churn rates is that we are expecting to see less SEP membership this year than what we've seen in recent years as some of the things like the continuous enrollment for people below the FPL 150 level now that, that's expired, we would expect to see less of that membership.

從那以後，我們預期客戶流失模式將更類似於ARPA實施之前的情況，即從第一季末到年底，每月客戶流失率在1%到2%之間。我還要指出一點，影響流失率的另一個因素是，我們預計今年的 SEP 會員人數將比近年來有所減少，因為一些因素，例如 FPL 150 水平以下人群的持續註冊，現在已經到期，我們預計這部分會員人數會減少。

So while in recent years, we've seen our overall membership trending up throughout the year, we would expect this year to kind of revert to more pre-ARPA trajectories where you see membership decrease throughout the year.

因此，雖然近年來我們看到會員總數全年呈上升趨勢，但我們預計今年會員總數將恢復到 ARPA 實施前的水平，即全年會員人數下降。

Jonathan Yong, UBS.

瑞銀集團的Jonathan Yong。

Hey, thanks for taking the question. Can you just talk about your mix of metal tiers. It sounds like Bronson Gold went up significantly and silver went down. And I assume you're skewing a little bit more towards bronze which typically has had more variability. How would you characterize your historical experience with bronze and how you're thinking about this time around?

嘿，謝謝你回答這個問題。可以談談你對金屬等級的搭配嗎？聽起來布朗森黃金價格大幅上漲，而白銀價格則大幅下跌。我猜你更傾向於青銅材質，因為青銅材質通常變化更大。您如何描述您過往與青銅器打交道的經歷，以及您對當前時代又有何想法？

Yeah, I would say it's going to be interesting, everything that you might think about metals, we should probably discard because we've seen a transition from people who've historically been in silver to other metal mixes.

是的，我認為這將會很有趣，所有你可能想到的關於金屬的東西，我們可能都應該拋棄，因為我們已經看到人們從歷史上使用白銀過渡到其他金屬混合物。

So I don't think you're going to be able to really proxy history. Bronze in general for us has always been a high-performing product. So the fact that we've seen more growth in bronze than in silver, and we've seen that transition is actually something that we are completely comfortable with.

所以我認為你不可能真正代理歷史。對我們來說，青銅一直是性能優異的產品。所以，我們看到銅牌的成長比銀牌的成長更多，而且我們看到了這種轉變，我們對此完全感到滿意。

If I just kind of pull up for a second and talk about the metals. Overall, our general philosophy is that our plans need to have margins that are in a relatively tight band. We would expect that all of them generate strong contribution towards total company profitability.

如果我稍微停下來談談金屬的話。總的來說，我們的整體理念是，我們的計畫需要留有相對較小的利潤空間。我們預計它們都將為公司整體獲利能力做出重大貢獻。

I do think that with the momentum -- with the movement from silver to bronze and gold, we will see those plans look and act actually more similar to each other. Obviously, bronze has higher deductibles. So we may see a bit higher churn in that population than we may see in other populations that don't have those higher deductibles. As Mark talked about, we think that may be a driver over time of more churn.

我認為，隨著勢頭的增強——從銀牌到銅牌再到金牌，我們將看到這些計劃在外觀和運作方式上實際上會越來越相似。顯然，銅級保險的自付額較高。因此，我們可能會看到，與沒有較高自付額的其他族群相比，該族群的流失率會略高一些。正如馬克所說，我們認為隨著時間的推移，這可能是導致客戶流失率上升的一個因素。

Great. And then just going back to the membership gains. If I think of that 400,000 that's going to roll off by 2Q, I assume those are the passive renewals. So that would imply a little less than half of your membership is new I guess are those new members coming in from new markets that you entered into? And I know you have data you're using third-party data to get a better sense of the members.

偉大的。然後我們再來看看會員人數的成長情況。如果我考慮到第二季將到期的 40 萬份保單，我假設這些是被動續保。所以這意味著你們的新會員不到一半，我猜這些新會員是來自你們新進的市場嗎？我知道你們有數據，你們正在使用第三方數據來更了解會員。

But I guess how much has things changed from last year to what it may look like this year where maybe that third-party data may not be as accurate.

但我想，從去年到今年，情況會發生多大變化？也許第三方數據不再那麼準確了。

I'll let Scott talk about the third-party data, but let me just sort of dimension this for your calculation is pretty close. That 400,000 is going to be passive that will roll off. We have grown a bit. And what we did early in the summer as we went out and enrolled 11,000 new brokers. We met with 17,000 brokers over the summer and gave them a list of members that they have with us.

關於第三方數據，就讓 Scott 來談談。不過，我先簡單說明一下，你的計算結果已經相當接近了。那40萬將是被動收入，會逐漸減少。我們長大了一些。我們在初夏時節招募了 11,000 名新經紀人。今年夏天，我們與 17,000 名經紀人會面，並向他們提供了他們與我們合作的會員名單。

and showed them the members that were most affected by the lack of enhanced premium tax credit and what plans you could move them to based on their needs. They went and did that. And we gave them access through our broker portal to our campaign builder software, which we used to outreach to members to reach those people and give them the information before open enrollment. And that's why we got off to a fairly significant start early on because the brokers had it all stacked up, ready to go.

並向他們展示了受保費稅收抵免不足影響最大的會員，以及您可以根據他們的需求將他們轉移到哪些計劃中。他們真的這麼做了。我們透過經紀人入口網站向他們提供了訪問我們活動創建軟體的權限，我們利用該軟體聯繫會員，並在開放註冊之前向他們提供資訊。正因如此，我們才能在早期取得相當大的進展，因為經紀人已經做好了一切準備，隨時可以行動。

Our view was the more we can help the brokers get people to the right place, the more they can be productive elsewhere, which is then what happened, is that they went to other plans who either were leaving the market or had not prepared the broker community or the membership with the right kind of product changes and move those members as well.

我們的觀點是，我們越能幫助經紀人把人們帶到合適的地方，他們就越能在其他地方發揮作用。而事實也正是如此，他們轉投了其他計劃，這些計劃要么是退出了市場，要么是沒有為經紀人群體或會員做好充分的產品變更準備，也沒有將這些會員也轉移過去。

So that's sort of the lay of the land on how our growth occurred. We weren't sure how it was going to roll out for new membership, but it obviously had a significant impact.

以上就是我們公司發展歷程的大致狀況。我們不確定這項措施對新會員會有什麼影響，但顯然它產生了重大影響。

Yeah, and Jonathan, with respect to the third-party data, I would say that for new initiations, most of those people, we've got clinical information from third parties that gives us a good basis to have an expectation of how they're going to perform. And importantly, it gives us a lot of information about who we need to start to engage to help them manage their healthcare conditions.

是的，喬納森，關於第三方數據，我想說，對於新啟動的項目，我們大多數人都有來自第三方的臨床信息，這為我們提供了一個很好的基礎，可以預期他們的表現如何。更重要的是，它為我們提供了大量信息，讓我們知道需要開始與哪些人接觸，以幫助他們管理自己的健康狀況。

That's important both from the perspective of managing our costs as well as getting the member in as early as we can, which is a positive thing for risk adjustment as well. There are a portion of our new initiations who are new to the market, who we don't have great information about, but we do have a significant amount of data over time as to what those types of people might look like in terms of their acuity.

從控製成本的角度來看，這一點很重要；而從儘早讓會員加入的角度來看，這一點也很重要，這對風險調整來說也是一件好事。我們新推出的服務有一部分是市場新用戶，我們對他們了解不多，但我們確實累積了大量數據，可以了解這類人群在敏銳度方面可能呈現的特徵。

And we've -- in looking at kind of the information that we do have about those members, we're not seeing anything in terms of the characteristics of them that costs us to think that there's something there that should be concerning for us.

我們——在查看我們掌握的關於這些成員的資訊時，我們沒有發現他們的任何特徵，讓我們認為其中存在任何值得我們擔憂的問題。

John Ransom, Raymond James.

約翰·蘭索姆，雷蒙德·詹姆斯。

Hey, good morning. So if we take 3 million as kind of the quote -- real member number, approximately what percent of those do you think work with the broker and tried to tailor the coverage versus the remaining passive renewals. I think that would be helpful.

嘿，早安。所以，如果我們以 300 萬作為實際會員人數的報價，你認為其中大約有多少百分比的會員會與經紀人合作並嘗試定制保險方案，而其餘會員則只是被動續保。我覺得那樣會有幫助。

We generally see 90%, 95% of our members come through the brokers, although in some of our custom plans, like -- hello Meno, we saw a lot of direct enrollment, significant direct enrollment. People specifically wanting that product and came directly through us through the exchanges. So -- but generally, and we're looking at 90%, 95%.

我們通常看到 90% 到 95% 的會員都是透過經紀人加入的，儘管在我們的一些客製化計劃中，例如——你好 Meno，我們看到了很多直接註冊，大量的直接註冊。有些人特別想要這款產品，並且直接透過我們的交易所購買。所以——但總的來說，我們看到的是 90%、95%。

And then my -- I mean this is kind of a basic question. So you all can downgrade your opinion of my IQ. But what I don't understand is, I get the passive enrollment, but you've got to pay the first premium before you get covered. So what kind of member gets passively renewed pays the first premium and then decides to drop off?

然後我的——我的意思是，這算是一個比較基礎的問題。所以你們都可以降低對我智商的評價了。但我不太明白的是，我理解被動參保，但是你必須先支付第一筆保費才能獲得保障。那麼，什麼樣的會員會被動續費，支付第一筆保費，然後決定取消會員資格呢？

Again, that's the big question this year versus prior years, usually when they start paying premium, they stay with us. unless there's some sort of event where they don't require our coverage anymore. However, in this case, when they start looking at the out-of-pocket costs associated with plans that they were moved to or stayed in.

同樣，今年與往年相比，最大的問題在於，通常情況下，一旦他們開始繳納保費，他們就會繼續使用我們的保險服務，除非發生某些特殊情況，導致他們不再需要我們的保險。然而，在這種情況下，當他們開始考慮與他們轉入或繼續留在原計劃相關的自付費用時，情況就不同了。

They're going to start to say, wait a minute, this is expensive, and I'm not going to be able to afford this. Now what we see, and this is an important aspect, it's far different than prior years in the marketplace is that most Americans now see health care is the single largest line item in their homes, in their family budget, more than their own mortgage.

他們會開始說，等等，這太貴了，我買不起。現在我們看到，這是一個重要的方面，與往年市場情況大不相同，那就是大多數美國人現在認為醫療保健是他們家庭預算中最大的一筆支出，甚至超過了他們的抵押貸款。

The result is that they are afraid of a lot of people who buy from us are afraid of losing the house or losing their family or having to go bankrupt if they don't get coverage.

結果是，許多從我們這裡購買保險的人都害怕，如果沒有保險，他們可能會失去房子、失去家人，甚至破產。

So then the real question, the pivot question that we have and I met with the AHA Board of Directors a couple of weeks ago, is what happens when they can't pay the deductible? And how do we handle that? And that's where we're sort of looking at this mill and saying, does it create this enrollment. Do people still hold on to it because they're afraid of losing their homes or going into bankruptcy. We're not sure.

那麼真正的問題，也是我們面臨的關鍵問題，幾週前我與美國心臟協會董事會討論過的問題，是當他們無法支付自付額時會發生什麼？那我們該如何處理這個問題呢？所以我們現在要檢視的就是這個工廠，以及它是否能帶來這樣的入學人數。人們是否仍然緊抓著不放，因為他們害怕失去房屋或破產？我們不確定。

So we're not -- we're hedging our bets on the level of disenrollment that will occur as a result.

所以，我們並沒有──我們只是在對沖由此產生的退學率。

John, just to add one more dimension there. When you look at our expectation and what we're seeing on payment rates, if you're going from having an out-of-pocket premium that you were paying in 2025 to having an out-of-pocket premium that you're paying to '26. And you have actively enrolled and even passively enrolled. We're seeing relatively strong payment rates in those categories. It's really the population where you're going from a $0 plan to something that you've got to pay out of pocket.

約翰，我再補充一點。當你審視我們的預期以及我們看到的付款率時，你會發現，如果你從 2025 年支付的自付保費，到 2026 年支付的自付保費。你既有主動報名參加的，也有被動報名參加的。我們看到這些類別的支付率相對較高。真正的問題在於，對於某些人群來說，他們原本可以享受零費用的計劃，現在卻需要自掏腰包支付費用。

So you've either lost your subsidy, or you've transitioned from one plan to another. That's where we expect to see really high nonpayment rates. And the way the whole process works, you may not make your first payment in January, but you don't ultimately churn off until the end of the quarter because you are in a grace period until then.

所以，要嘛你失去了補貼，要嘛你從一個計畫過渡到了另一個計畫。我們預計那裡的欠款率會非常高。整個流程的運作方式是，你可能不會在 1 月支付第一筆款項，但你最終不會在季度末之前停止付款，因為在此之前你處於寬限期。

I see. So passive going from 0 premium to some premium. And we know that like call centers, in some cases, we used to send these people up and never had a payment link. But our understanding was of care wasn't a big user of these legacy call centers. So you've got payment links. It's just that they go from, say, $0 to $100 a month, and they just -- that's just a bridge to part. Is that right?

我懂了。所以被動地從零保費增加到一定保費。我們知道，就像呼叫中心一樣，在某些情況下，我們過去常常把這些人轉接過去，但從未提供過付款連結。但我們之前了解到的情況是，醫療保健產業並不是這些傳統呼叫中心的主要使用者。所以你已經有了支付連結。只是他們的收入從例如每月 0 美元增加到 100 美元，而這只是通往成功的一座橋樑。是這樣嗎？

You are correct. We did not -- we are not a big user of call centers.

你說得對。我們沒有—我們不是呼叫中心的大量使用者。

Stephen Baxter, Wells Fargo.

史蒂芬‧巴克斯特，富國銀行。

Yeah, hi, thanks. I want to come back to some of the questions on mix. I appreciate you're saying that silver is lower in both gold and bronze are much higher. But is it possible to get maybe the percentages kind of before and after for each category? And basically, the crux of it is that, obviously, your membership, PMT seem like they're going to be up somewhere in the 50% range. So we're kind of comparing that to the overall revenue increase on the guidance line and it's a little bit hard for us to square quite why.

嗨，謝謝。我想再回答一些關於混音的問題。我明白你的意思，白銀的價值較低，而黃金的價值較高，青銅的價值則高得多。但能否得到每個類別在前後的百分比變化呢？基本上，問題的關鍵在於，很明顯，你們的會員人數和 PMT 似乎都會增加 50% 左右。所以我們正在將其與指導方針中的整體收入成長進行比較，但我們很難解釋其中的原因。

There's not maybe more of a PMPM yield in there. So it'd be great to have some more quantification on that? And then I have a follow-up at this time.

那裡可能沒有更高的 PMPM 收益率。如果能得到更多量化數據就太好了？然後，我此時還有一個後續問題。

Sure. So for Bronze for the prior two years, around 25% and '26 to 39%. Silver has been steady at 71% in the prior two years. This year, they're at 36%. In gold, which is in the low -single digits, 3%, 4% for the last two years is now 25%. So fairly significant changes. And the bronze and the gold plans we offered were $0 with fairly -- not very rich benefits.

當然。所以前兩年的銅牌得主分別在 25% 到 39% 之間。過去兩年，白銀價格一直穩定在71%。今年，他們的佔比為 36%。黃金價格過去兩年一直徘徊在個位數低位，3%、4%，而現在已漲至 25%。所以變化相當顯著。我們提供的銅級和金級計劃價格為 0 美元，福利也相當一般。

Stephen, the other thing I would just mention is that the characteristics of the membership are important to modeling your revenue. So the fact that we're seeing a year younger membership has an impact on PMPM revenue. So you need to factor that in. That's one of the reasons why I discussed that in the call is to help with your ability to project revenue with that information.

史蒂芬，我還想提一點，就是會員的特質對於建立收入模型非常重要。因此，會員年齡平均年輕一歲這一事實對每人每月收入產生了影響。所以你需要把這一點考慮進去。這也是我在電話會議中討論這個問題的原因之一，目的是為了幫助你們利用這些資訊來預測收入。

Got it. No, that's helpful. And then maybe just qualitatively, like is there any difference in terms of this MLR guide, how you're thinking about kind of what you're budgeting in for retain membership and sort of how you're thinking about this newer to the planned membership and how that might perform? I would love to understand is philosophically how you're thinking about that part of it?

知道了。不，這很有幫助。然後，從定性角度來看，例如，根據這份 MLR 指南，您在考慮如何為留住會員制定預算，以及您如何考慮為計劃中的新會員制定預算，以及新會員的招募和招募效果，這兩者之間是否存在任何差異？我很想了解你從哲學角度是如何看待這部分的問題？

Yeah. Well, we obviously modeled membership with a lot of our past history. So we will have experiences that are different for returning members versus new initiations. I would say that in the aggregate, given the amount of work we've been doing on this population going -- which is now over two years that we've been expecting that the subsidies are going to go away. And so starting with the whole, how do we design plans to capture people who had a price shock.

是的。顯然，我們借鏡了過去許多經驗來建構會員制度。因此，舊會員和新會員的體驗會有所不同。總的來說，考慮到我們為這個群體所做的工作量——現在已經超過兩年了，我們一直預期補貼將會取消。因此，首先要考慮的是，我們如何設計方案來吸引那些遭受價格衝擊的人。

We've really built in, I think, a deep level of expectation and understanding about how those different populations are going to perform. I talked about all the ways that we tried to triangulate and get data about those folks.

我認為，我們已經真正建立了對不同人群表現的深刻預期和理解。我談到了我們嘗試用各種方法來交叉驗證並獲取有關這些人的數據。

But I think that in general, I would say we're using our historical experience with each of those populations to project the future, feel like that the estimates that we've made both in pricing. And now we've taken everything that we've heard to date and built that into our guidance. And I feel like we're being very balanced in our estimates.

但我認為，總的來說，我們會利用我們對每個群體的歷史經驗來預測未來，感覺我們在定價方面所做的估計也是如此。現在，我們已經將迄今為止聽到的所有資訊納入我們的指導方針中。我覺得我們的估算非常平衡。

And the increase in risk adjustment allowed also takes MLR up.

風險調整幅度的增加也會提高醫療損失率。

Scott Fidel, Goldman Sachs.

Scott Fidel，高盛集團。

Hi, this is Sam Becker on for Scott Fidel. Yes, I was just curious on what are your levers -- key levers to achieving EBITDA profitability without the extension of the enhanced subsidies? And what are those key headwinds or tailwinds when thinking about MLR and SG&A from 2025 to 2026.

大家好，我是 Sam Becker，代 Scott Fidel 為您報道。是的，我只是好奇在不延長補貼期限的情況下，你們實現 EBITDA 獲利的關鍵槓桿是什麼？那麼，在考慮 2025 年至 2026 年的 MLR 和 SG&A 時，主要面臨的不利因素或有利因素是什麼？

Well, there are a number of them. First, it's growth. So it's growth drives a reduction in overall percentage of costs. AI, where we're able to create a better member experience and greater stickiness, and we're seeing that on a regular basis. We have a dozen of LLMs on the back end of the business.

嗯，有很多這樣的。首先是成長。因此，其成長帶動了總成本百分比的下降。人工智慧使我們能夠創造更好的會員體驗和更高的用戶黏性，而且我們經常看到這種情況。我們公司後台有十幾位法學碩士。

and now two agentic AIs are about to launch another here in the next few months. So we're now having a lot of impact where people can access us quicker with much more accuracy and without having to wait on phones, which would also again reduces our costs.

現在，兩個智慧人工智慧即將在未來幾個月內在這裡推出另一個項目。因此，我們現在產生了很大的影響，人們可以更快、更準確地聯繫到我們，而無需在電話上等待，這也會再次降低我們的成本。

And then on the MLR front, we are constantly working on our contracts and our utilization management, and we task the team to deliver so many hundred basis points every year and opportunities to keep our trend in line with where we think the market should be. And so all of those things together, and there are a lot of levers that we manage every day through the management process are the things that we track to make sure that we commit our targets.

在MLR方面，我們不斷改進合約和利用率管理，並要求團隊每年實現數百個基點的目標，以及保持我們的趨勢與我們認為的市場應有的水平保持一致的機會。因此，所有這些因素加在一起，以及我們每天透過管理流程管理的許多槓桿，都是我們追蹤以確保我們實現目標的因素。

And Sam, I just want to make 1 point really clear. Our guidance is on EBIT. So it's not on adjusted EBITDA. I did talk about it in the call that we would expect adjusted EBITDA to be $115 million above our earnings from operations guidance that we put out. So I just want to make sure that we're talking about the same things.

山姆，我只想把一點說清楚。我們的績效指引是基於息稅前利潤（EBIT）。所以它與調整後的 EBITDA 無關。我在電話會議中確實談到過，我們預計調整後的 EBITDA 將比我們發布的營運收益預期高出 1.15 億美元。所以我想確認一下我們說的是同一件事。

Thank you.

謝謝。

Michael Ha, Baird.

Michael Ha，貝爾德。

Good morning. This is Olivia on for Michael. Because exchange marketplace risk adjustment is net neutral, creating a reliance on other plans in our markets the lack of visibility, any one plan has into the rest of the market makes risk adjustment mechanics difficult in our view.

早安.這裡是奧莉薇亞替麥可報道。由於交易所市場風險調整是淨中性的，導致市場對其他計劃的依賴性降低，並且任何一個計劃對市場其他部分的可見性不足，因此我們認為風險調整機制難以發揮作用。

Looking to 2026 and beyond, you mentioned the potential Wakely industry report in 1Q, whether it's through this potential Wakely report or other efforts, can you share how you're getting more insight into the rest of the market as well as your thoughts on what can be done to make risk adjustment more transparent and less volatile in the future. Is there any potential reform you think could be done to improve risk adjustment? And I have a follow-up at this time.

展望 2026 年及以後，您提到了第一季可能會發布 Wakely 產業報告。無論是透過這份潛在的 Wakely 報告還是其他努力，您能否分享一下您是如何更深入地了解市場其他方面的，以及您對未來如何使風險調整更加透明、波動性更小有什麼看法？您認為有哪些潛在的改革措施可以改善風險調整機制？我此時還有後續問題。

Olivia, thanks for the question. Look, I think that estimating risk adjustment, as you say, is the most difficult thing that we have to do each quarter because you're both trying to project your own performance inside your own book and also the market. It's -- I think we're quite good at projecting our own market -- our own book and what the performance is where we do get surprised by how the market moves in ways that we can't see.

奧莉維亞，謝謝你的提問。你看，我認為正如你所說，估算風險調整是我們每個季度都必須做的最困難的事情，因為你既要預測自己帳簿上的業績，又要預測市場業績。我認為我們很擅長預測自己的市場、自己的產品以及業績，但市場走勢常常出乎我們的意料，讓我們感到驚訝。

I'm optimistic that working with Wakeley, and it sounds like most of us in the industry are working with them as an important service provider to all of us. to help get more timely information about what's going on with the market because that's the most challenging part of our ability to project that.

我對與 Wakeley 的合作持樂觀態度，而且聽起來我們業內大多數人也都在與他們合作，因為他們是我們所有人的重要服務提供者。這有助於我們更及時地了解市場動態，因為這是我們預測市場趨勢時面臨的最大挑戰。

So I think we're taking steps in that direction. I'm not sure that we'll get all the way there in this first report, but I do think that with the support of many of the industry players that we can increase visibility into this estimate over time.

所以我認為我們正在朝著這個方向邁進。我不確定我們能否在第一份報告中完全實現目標，但我認為，在眾多業內人士的支持下，隨著時間的推移，我們可以提高這項估算的透明度。

Thank you. And if I can squeeze in one more, please. When I think about healthcare innovation, two specific areas I see offer leading the way and becoming an agent of change are in ICRA that could disrupt an employer group market that is ripe for change and leading the charge in crafting condition and disease-specific plans, which appear to be the future of health insurance. Both are exciting, but both are early on.

謝謝。如果可以的話，請再加一個。當我思考醫療保健創新時，我認為有兩個領域正在引領潮流並成為變革的推動者：一是 ICRA 可能會顛覆亟待變革的雇主團體市場；二是引領制定針對特定疾病和病症的計劃，這似乎是健康保險的未來。兩者都令人興奮，但都還處於早期階段。

So as you look ahead, what do you think needs to happen to catalyze the rate of adoption. And as a first mover, what type of competitive advantages do you believe this will present us for longer term?

展望未來，您認為需要發生什麼才能加快普及速度？作為先行者，您認為這將為我們帶來哪些長期的競爭優勢？

So from a micro standpoint, Olivia, we are not only concentrating on products to capture membership in the insurance company, but we've also built out the front end of the business where we can now work with employers to convert them. There's a lot of opportunity in revenue and actually in a higher margin, unregulated and not requiring any risk capital to work with employers to move employees into defined contribution and once in defined contribution, work with brokers to get them into whatever plan works for them, whether that is an Oscar plan or not?

所以從微觀角度來看，奧利維亞，我們不僅專注於產品以吸引保險公司的會員，而且我們還建立了業務的前端，現在我們可以與雇主合作，將他們轉化為會員。在收入方面有很多機會，而且利潤率更高，不受監管，也不需要任何風險資本，可以與雇主合作，將員工轉移到固定繳款計劃中，一旦員工進入固定繳款計劃，就與經紀人合作，讓他們加入任何適合他們的計劃，無論是 Oscar 計劃還是其他計劃？

So you're going to start seeing us over time report two different kinds of revenue in the model. where we're going to have revenue coming out of the conversion of employers that have defined contribution, the whole brokerage work that's done there, and then also membership that we capture inside our own health plan.

因此，隨著時間的推移，您將會看到我們在商業模式中報告兩種不同的收入。一種收入來自那些實施固定繳款計劃的雇主的轉換，以及我們為此開展的所有經紀業務；另一種收入來自我們自己的健康計劃中獲得的會員費。

So the acre opportunity is much larger than just the membership, although our membership did double this year. And given what happened in the individual market relative to rates, there was some reluctance on employers to jump in now. We need to show that we can stabilize that marketplace and get more people in. So that's sort of the lay of the land on ICRA.

因此，土地投資的機會遠不止會員人數那麼簡單，儘管我們今年的會員人數確實翻了一番。鑑於個人保險市場利率的變化，雇主現在不太願意貿然介入。我們需要證明我們能夠穩定市場，並吸引更多人參與。以上就是ICRA的大致情況。

On the disease or the lifestyle products, we truly believe and this is the proposal that we put in front of the administration and one they've talked about is to separate the investment decision from the financing decision.

對於疾病或生活方式產品，我們真心相信，這也是我們向政府提出的建議，也是他們討論過的建議，那就是將投資決策與融資決策分開。

The investment being what I buy versus how I pay for it. And the opportunity to create HSA Roth IRA like funds, where people can take whatever funding mechanism they have, whether that's their employer, their own money, Medicare, Medicaid or other subsidies like from the ACA and put them into a bucket -- and by buying a qualified health plan manage the rest of their costs by themselves, and this is where our new Agentic AI tool is headed than having a marketplace where people can use the money that they receive for healthcare to buy what they want in their local market, a narrow network with a plan design that changes with their life, starts to create the opportunity for lifetime value of membership and change the investment thesis that insurance companies would have in managing that membership and how we would approach it, which leads to the lifestyle products if we can move with a family or an individual through their lifetime, offering them new designs that allow them to stay with their network, be effective in managing their current health status and live as fully as they can until the last day, I think that's the ultimate culmination of an individual market where all Americans can get healthcare that they want their choice -- and where we have a market so large, the morbidity changes really have no impact on the overall underwriting cycle of the business.

投資指的是我買什麼，以及我要如何支付。而我們新的智慧代理人工智慧工具（Agentic AI）的目標是創建一個類似HSA和Roth IRA的基金，讓人們可以將他們現有的任何資金來源——無論是雇主提供的、自有資金、聯邦醫療保險（Medicare）、聯邦醫療補助（Medicaid）還是其他補貼，例如來自《平價管理法案》（ACA）的補助金這比建立一個市場更有意義，人們可以利用獲得的醫療保健資金在當地市場購買他們想要的保險產品。這種市場模式類似於一個小型網絡，其計劃設計會隨著個人生活的變化而變化，從而開始創造終身會員價值的機會，並改變保險公司在管理會員方面的投資理念和方法。如果我們能夠陪伴家庭或個​​人走過他們的一生，為他們提供新的計劃設計，使他們能夠留在自己的醫療網絡中，有效地管理當前的健康狀況，並儘可能充實地生活到生命的最後一天，我認為這才是個人市場的最終目標：所有美國人都能獲得他們想要的、自主選擇的醫療保健——而我們擁有如此龐大的市場，發病率的影響而對企業的整體變化。

Raj Kumar, Stephens.

Raj Kumar，史蒂芬斯。

Hi, I'm Maybe just following up on the kind of ICA commentary. Just curious on the membership associated with the [Hvi] arrangement and kind of what's the initial uptake from that employee base -- and then historically, have you seen kind of the ICRA population exhibit a more kind of stickier membership base? Or should we expect a similar level of churn relative to the kind of broader individual plan?

您好，我可能只是想跟進一下ICA的評論。我只是好奇與 [Hvi] 安排相關的會員資格，以及該員工群體最初的接受度如何——從歷史上看，您是否看到 ICRA 人群表現出更穩定的會員基礎？或者，我們應該預期，相對於更廣泛的個人計畫而言，其客戶流失率也會有類似的水平？

I think -- first of all, we're not giving out actual ICRA numbers by segment yet. It's not meaningful enough to move the dial, although we see all of these efforts being successful so far. The more important part is, again, back to this thesis of I have my money, I buy it the way I want. We think ICRA's stickier because as long as I have the funds to pay for it, I can keep what I bought. I don't have to change it.

我認為——首先，我們還沒有按行業細分市場公佈實際的 ICRA 數據。雖然到目前為止我們看到所有這些努力都取得了成功，但這還不足以產生實質的影響。更重要的是，這又回到了我之前的論點：我有錢，我想怎麼買就怎麼買。我們認為 ICRA 的黏性更大，因為只要我有資金支付，我就可以保留我購買的東西。我不需要更改它。

If my financial -- if my funding circumstances change, I just use the different funding to keep the same thing I had. So we view ICRA as a development moving beyond the ACA model. which is helping people when they can't afford health insurance to a model where I now buy my own insurance, my own network, the product design that fits me at this time, it allows me to stay with my product and my network for as long as I want. That's where the member experience and all these tools we're building comes in where people can actually use it the way they need to and have the information they need to use it most effectively.

如果我的財務狀況發生變化，我只需利用不同的資金來源來維持我原有的狀況。因此，我們認為ICRA是超越ACA模式的一種發展，ACA模式旨在幫助那些負擔不起醫療保險的人，而ICRA模式則允許我購買自己的保險、自己的醫療網絡，選擇適合我當前情況的產品設計，並允許我根據需要長期使用該產品和醫療網絡。這就是會員體驗以及我們正在建立的所有工具的意義所在，人們可以真正按照他們需要的方式使用它，並獲得他們需要的資訊，從而最有效地使用它。

Got it. And then as a quick follow-up, just kind of curious on the new member engagement rates for 2026. And how is that comparing to what you're seeing or experiencing at this same point last year?

知道了。然後，作為後續問題，我很好奇 2026 年的新會員參與率。那麼，與去年同期你所看到或經歷的情況相比，現在的情況如何？

Yes, I don't think that It's too early to tell -- after the first quarter, we'll have a better idea.

是的，我認為現在下結論還為時過早——第一季結束後，我們就會更清楚了。

Craig Jones, Bank of America.

克雷格瓊斯，美國銀行。

Right, thank you. So I was wondering what you've assumed in your guidance, does the change in the percentage of zero utilizers between 2025 and 2026. I think that will need to come down the exploration enhanced tax credits. I was just going to give us an exact percentage, maybe just how do you think it will compare to your [2019 percentage] prior to when those were enacted?

好的，謝謝。所以我想知道您在指導意見中做了哪些假設，即 2025 年到 2026 年零用戶百分比的變化。我認為這需要減少勘探相關的稅收抵免。我本來想給出一個確切的百分比，您覺得它與這些措施實施之前的[2019 年百分比]相比會如何？

Yeah, correct. Thanks for the question. In general, we don't comment on the portion of our book that's no utilizers. It's a normal part of given that we have a very healthy membership, we would anticipate that not all of those members need care in any given year. So we do have a portion of the book that doesn't utilize.

是的，沒錯。謝謝你的提問。一般來說，我們不會對書中無人使用的部分發表評論。這是正常現象。鑑於我們擁有非常健康的會員群體，我們預計並非所有會員在任何一年都需要照護。所以這本書確實有一部分沒有被利用。

When I look at the -- how our book has evolved, there our book is younger than it was a year ago. So it isn't necessarily the case that you should assume that we'll see lower levels of non utilization. We take all of those factors into account when we set our guidance for MLR.

當我回顧我們這本書的發展歷程時，我發現它比一年前更年輕了。所以，你可能應該假設我們會看到更低的非利用率。我們在製定MLR指導方針時，會考慮所有這些因素。

And as I talked about earlier, we've done a terrific amount of work to build up our estimates around those projections and we feel like we've -- we're as comfortable as we can be with them at this point in the year?

正如我之前提到的，我們已經做了大量工作來完善這些預測，我們覺得──就今年的這個階段而言，我們對這些預測已經夠有信心了？

Okay. Got it. And then maybe for those 400,000 numbers that you expect to roll off by the end of the quarter, what do you think their 2025 MLR was? And how would that compare to, say, historically what your members that rolled off would be.

好的。知道了。那麼，對於預計到本季末將減少的 40 萬個數字，你認為他們的 2025 年 MLR 是多少？那麼，這與歷史上流失的成員數量相比又會如何呢？

Thank you.

謝謝。

Yeah. I'm not going to dimension the specifics of those members. When I look at the difference between 2025 MLR and 2026 MLR. It's really a story about the changes in market morbidity on a year-over-year basis. That's really the biggest driver.

是的。我不會具體說明這些成員的情況。當我查看 2025 年 MLR 和 2026 年 MLR 之間的差異時。這其實是一個關於市場發病率逐年變化的故事。這才是真正的最大驅動因素。

We've taken into our pricing for the upcoming year, all the changes that happened in market morbidity last year, our expected increases as people are leaving the ACA in '26. We've built all of those things in. We've included a trend that is higher than what we've seen in the historically but relatively consistent with last year. So we feel like we've taken all of those building blocks that's going to impact utilization next year into our pricing, which gives us confidence about our ability to return to profitability next year.

我們已經將未來年的定價考慮在內，包括去年市場波動的所有變化，以及隨著人們在 2026 年退出 ACA 計劃而預計的增長。我們已經把所有這些功能內建進去了。我們納入的趨勢高於歷史上的水平，但與去年基本一致。因此，我們感覺我們已經將所有會影響明年利用率的因素都納入了我們的定價中，這讓我們對明年恢復獲利能力充滿信心。

There are no further questions at this time. Ladies and gentlemen, that concludes today's call.

目前沒有其他問題了。女士們、先生們，今天的電話會議到此結束。

Thank you all for joining. You may now disconnect.

感謝各位的參與。您現在可以斷開連線了。